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  • Understanding the Pro-Anorexia Experience through the Affordances of Computer-Mediated Communication

    Abstract

    With the increasing prevalence of the pro-anorexic movement online, we present a study in which we analyze disclosures across different online contexts, specifically LiveJournal and Twitter. Pro-anorexia is a movement, ubiquitous in several online contexts, in which individuals support and advise those who wish to maintain anorexia. We sought to better understand how the affordances of computer-mediated communication shape disclosures in different online venues. Therefore, we qualitatively analyzed a total of 2,000 messages from LiveJournal and Twitter. Three major themes emerged from the analysis reflecting characteristics of catharsis and actualization, ranges of extreme sentiment, and maintenance of dialectic tensions. Our findings extend existing theoretical considerations on computer-mediated communication and the self-disclosure of stigmatized health information, especially on the topic of pro-anorexia. It also has practical and design implications to better understand individuals who manage and cope with this mental illness through a computer-mediated context.

    Introduction

    Anorexia nervosa is a mental illness, categorized as an eating disorder. Anorexia is characterized by the active restriction of energy intake, ultimately resulting in significantly low body weight, an extreme fear of gaining weight, and a persistent unwillingness to maintain a healthy weight (DSM-V, 2013). Approximately 24 million people in the U.S. suffer from Anorexia (National Association of Anorexia Nervosa and Associated Disorders, 2012). This illness is especially alarming because of its high mortality rate (National Institute of Mental Health, 2012). The proliferation of anorexia is a challenge for mental health professionals because anorexia is a multi-determined disorder derived from the interaction between sociocultural, mental, and physical factors (Brumberg, 2000). Anorexia is characterized as a secretive illness (Shelley, 1997). There are also feelings of shame, embarrassment, and stigma associated with anorexia (Shisslak, Crago, Estes, 1995), which can further lead individuals with anorexia to feel lonely, isolated, and confused (Gremillion, 2003). Given the stigma and negative associations with anorexia, individuals with anorexia often seek contexts where they feel free from judgment, feel supported, and even feel encouraged (Dias, 2003). Individuals with anorexia may turn to the online milieu because of its technological affordances, such as rapid exchanges of information, anonymity, low cost of maintaining communication, and the ability to access it at any time (Grunwald Busse, 2003). Chesley et al.’s (2003) study found that pro-anorexic sites are the most prevalent type of website that is associated with anorexia.

    Pro-anorexic websites are online venues in which individuals with anorexia normalize anorectic behaviors and thoughts to maintain anorexia by communicating with individuals who have similar perspectives (Gavin et al., 2008). Individuals on pro-anorexic websites identify themselves as ‘pro-ana’ and believe that anorexia is a lifestyle choice rather than an illness (Lipczynka, 2007). Most of the extant research on pro-anorexic websites have focused on dominant themes within one pro-anorexic website (e.g., Gavin et al., 2008; Mulveen and Hepworth, 2006), have made comparisons between recovering anorexic websites and pro-anorexic ones (e.g., Lyons et al., 2006), examined content on pro-anorexic sites across the same type of websites like discussion boards (e.g., Eichhorn, 2008) or social networking sites like Facebook and Myspace (e.g., Juarascio et al., 2010), and investigated personal experiences of pro-anorexic bloggers (e.g., Yeshua-Katz and Martins, 2012). However, no study to the authors’ knowledge, has explored pro-ana disclosures across different online contexts, specifically across webblogs and social networking sites. Investigating pro-anorexic disclosures across contexts can increase the awareness of the mental health issue of anorexia and can help us gain a better sense of how individuals associated with pro-ana’s (e.g., clinicians, therapists, family members) can help influence healthy attitudes, beliefs, and behaviors rather than engage in destructive ones.

    Pro-ana disclosures also increase awareness of how individuals with anorexia are coping and where. For example, the online venues in which pro-ana’s choose to make certain disclosures and the types of disclosures they make may be a coping mechanism for their illness. Therefore, this study focuses on different types of disclosures made by pro-ana’s in two contexts, one weblog, LiveJournal, and one social networking site, Twitter. We explored disclosures in both contexts to investigate the themes, characteristics, and nature of pro-ana disclosures made across the online contexts.

    Background

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    Pro-Anorexic Sites and Social Media

    Pro-anorexic online venues provide individuals with anorexia a context in which they can share experiences and offer encouragement to other pro-ana’s (Harshbarger, Ahlers-Schmidt, Mayans, Mayans, Hawkins, 2009). Wilson, Peebles, Hardy, and Litt’s (2006) study found that almost half of those diagnosed with anorexia visit or are members of pro-anorexic websites. The philosophy driving the pro-anorexic movement is the idea that it helps maintain a chosen lifestyle (Csipke and Horne, 2007). Attractive features of pro-anorexic sites to pro-ana’s include: the normalization of pro-anorexic behaviors and thoughts (Gavin et al., 2008), the benefits of receiving social support, tips and tricks to lose and hide weightloss through quotes, images, and text (Norris et al., 2006; Sharpe et al., 2011), a sense of camaraderie (Falk, 2001), and the provision of a safe space to self-disclose intimate information that may be stigmatized in other contexts (Dias, 2003). With the stigma associated with anorexia (Shisslak, Crago, Estes, 1995) and the stressful and negative emotions derived from feeling stigmatized, these individuals find others who can help them cope. For example, individuals of a particular stigma category have a tendency to congregate where