Pro-ana

Background
Pro-ana refers to a group or subculture that promotes or supports anorexia as a lifestyle choice rather than an eating disorder. Most pro-ana material is disseminated over the Internet, with web sites, discussion groups, and web rings dedicated to the movement.

The pro-ana viewpoint is controversial because it contradicts the prevailing psychological and medical consensus that treats anorexia nervosa as a mental illness rather than a "lifestyle choice". However, not all pro-ana groups follow this view. They state that pro-ana websites do not promote anorexia, and that anorexia is a real medical disorder. However, these groups may also promote recovery (by the use of support systems) while still supporting their peers to refuse medical or psychological treatment for the disorder.

Overview
Since pro-ana is a loosely descriptive term rather than an organized social movement, the attitudes taken by self-proclaimed pro-ana individuals are not always comparable, and do not always reflect the definitions given on larger pro-ED (Eating Disorder) sites. The views range from denying anorexia as disease, to admitting that anorexia is a disease but stating that non-recovery from the disorder is a choice that should be respected by doctors and family. Still other pro-ED sites promote the decision to recover and offer support for those not ready to make that decision.

However, though many do claim to support those who are not ready for recovery, this form of support may include inviting members on fasting challenges, or encouraging others to harm themselves by emulating eating disordered behaviors.

Thinspiration
In pro-ana online communities, pro-ana activity often takes the form of "thinspiration" (often known as "thinspo") pictures: images of slim women, often celebrities, meant to serve as inspiration for continuing to lose weight. Thinspiration pictures can vary in nature from images of naturally slim women to emaciated women with visible bones. Conversely, "reverse thinspiration" images are photographs of overweight or obese people, meant to disgust and therefore motivate further weight loss. Journal entries on pro-ana journals often contain thinspiration pictures, and many pro-ana forums have threads dedicated to sharing thinspiration.

Thinspiration can also take the form of quotes, songs or mantras.

Criticism and controversy
Despite the pro-ana community's insistence that pro-ana sites give anorexics a place to turn to discuss their illness in a non-judgmental environment, doctors view the pro ana concept as "promot[ing] a myth that eating disorders are choices, rather than a physical and mental illness...Patients are supported in their illnesses and encouraged to stay ill by [pro-ana websites]". A 2006 Stanford study quoted in an issue of Newsweek published on the 18th of December 2006 found that "users of [pro-eating disorder] sites were sick longer...96 percent of [patients] reported learning new tips for weight loss or purging, and 69 percent said they used them." The Academy for Eating Disorders position statement on pro-anorexia web sites states that "websites that glorify anorexia as a lifestyle choice play directly to the psychology of its victims", expressing concern that sites dedicated to the promotion of anorexia as a desirable "lifestyle choice" "provide support and encouragement to engage in health threatening behaviors, and neglect the serious consequences of starvation." beat (Formally The Eating Disorder Association) states that the real danger of pro-ana sites comes when "a visitor affected by an eating disorder has at last found someone who really understands the way they feel about themselves... [The pro-ana community] can help me avoid eating, avoid going to the doctor, or if I have to go, show me how to load up with water so my weight seems ok, or load my pockets with stones to have the same effect."

Pro-ana has also naturally spawned several grassroots opposition communities, such as the Anti-Ana community, and many satirical communities, such as Pro-Cancer or Pro-Scurvy.

The communities have also gained a response among "anti-pro-ana" LiveJournal users who have started communities such as Ed_ucate, a play on the common shorthand for eating disorder, ED. The purpose of these communities is to inform pro-anas about eating disordered criteria and the health effects of disordered behaviors so that they can make informed decisions and not spread misinformation. They also encourage accurate self-diagnosis using the DSM-IV-TR criteria. One of the effects of this response has been an increase in awareness about ED-NOS because many pro-anas are told that they do not meet the criteria for anorexia. Some communities also encourage members of pro-ana to go into recovery. However on August 7, 2007, at least two people speaking in an official capacity for LiveJournal declared that pro-ana communities on the site "do far more good than harm" and that "it's not illegal to aspire to be thin" in response to a user complaint that pro-ana communities violated LiveJournal's Terms of Service.

Pro-anorexia/ED has become somewhat of an underground crash diet amongst many teenage women who have not been able to properly stick to diets that have been healthy, or do not like the results they have had, thus they seem to believe that emulating eating disordered behaviors will promote more weight loss. This is usually one of the common causes of upset amongst "anti-pro-ana" as, usually, this group of individuals have been diagnosed with the illness medically, and are long term sufferers of the illness. Thus when viewing the pro-anorexia movement, those with anorexia nervosa feel it is a belittlement of a fatal condition; hence the usually angry response that is produced.