Nervy Girl!

by Michelle Milne
"Sooner or later, my boyfriend will get tired of fighting a losing battle with me and Ana."

"After a weekend with my family, today is my first day back with Ana...I missed her!"

"I am so worthless, I have failed Ana."

"Well...for better or worse...she's back. My dear old friend Ana."

At first glance, it may seem like the girls and women in these online groups are just chatting away about a close friend. Unfortunately, Ana is no friend - she is a cruel slave master, along with her cohort, "Billy." Ana is short for anorexia, Billy for bulimia, and these e-friends are bonding over their commitment to disorders that have the potential to kill them.

They are participants in a growing number of pro-anorexia web sites and email groups, supporting each other in their quest for "thinness," a resolve they defend as a lifestyle choice. Although some admit their need is an illness, many discount that idea.

The messages they give each other play off of other cultural messages. In the U.S., self-control and discipline, not to mention thinness, are signs of success. Magazines, movies, and television all extol the virtues of continuous weight loss. Commercials exalt lo-cal, fat-burning qualities of everything from cereal to medications. Telephone poles sport stapled posters: "Get paid to lose weight!" One friend tells another, "You're so skinny!" her voice brimming with envy.

Pro-anorexic e-group sites take those messages one step further, claiming pride in reaching goals and mastering self-discipline. Ironically, says Dr. Britta Dinsmore, Portland psychologist and eating disorder specialist, what starts out as control over what goes into and out of their bodies eventually leads to being controlled by the disorder itself.

Studies report that anywhere from five to 20 percent of those living with anorexia will die. According to Dinsmore, it has a higher rate of morbidity than any other psychiatric condition - more than suicides, depression, or bi-polar condition. Eating Disorders Awareness and Prevention, Inc. (EDAP) reports that five to 10 million adolescent girls and women, and one million boys and men, struggle with eating disorders and borderline conditions. That number is three times the number of people living with AIDS, says EDAP1. Even populations previously less affected are experiencing higher rates of the disorder.

"Society is becoming more rigid," says Dinsmore. "There are more expectations about men's and boys' bodies, increasing pressure for them to be thin. It's also affecting different cultures. The African American culture has generally been more accepting of different body types. But that's changing, so we're seeing a rise in Eating Disorders (EDs) within minority populations."

Pro-anorexia proponents take note of society's messages. "I was so humored by the cover story of the recent People magazine claiming 'Hollywood's healthy bodies are back; starvation diets be damned'," one ED sufferer scoffs on a web site. "What a f***ing joke. It talked about like 10 actresses or whatever, none really over a size eight. And for some reason, it failed to mention the rest of Hollywood that is stick thin and serves as my thinspiration."

"Thinspiration" is what makes these women push on, stick to hyper-rigid diets, exercise when they're ill or injured, miss important life moments because they are afraid they'll have to eat during them. Though obsessed with the media's messages, they rarely question the road down which they lead.

Many of the participants are young, as young as 13, but no age group is immune. "I'm wondering what the age range is here.... I feel rather old," asks one. The answers come back:

"I am 26 and have a 2.5-year-old."

"Everyone thinks I'm so strong. Single mother, went to college, took care of very sick daughter, so strong...so smart...blah f*cking blah..."

"I have been married for five years in July."

"I'm a prostitute."

"I'm a nurse and male."

"I am 36, married two-and-a-half years, and I have a nine-year-old stepson."

"I'm 38, married, with two kids."

"I am an army ROTC cadet."

These females and males find each other, and a community of sorts, in the listservs and sites. "I look at your posts and they fill me with hope that I have finally found my island, my hope, my friends," a newcomer confides.

If these women wanted to, they could read emails non-stop all day. Hundreds or thousands of messages pour in, depending on how many email groups and chats an individual is signed up for. Dinsmore reflects, "It shows how small their world is" that they are always checking the mail and sites. Like the disorder itself, "It can start innocently enough, but then it takes over a person's life."

What do these people talk about at such great lengths? Everything. Everything, that is, related to eating and losing weight. Even when they discuss family, school, and work it tends to center around food-restriction or purging. They offer suggestions and encouragement in sticking with diets, counting calories, exercising. They give hints on hiding their condition from others. They pass along links to informational web sites, such as one on fasting from a spiritual viewpoint (making the leap from a periodic spiritual cleansing ritual to "lifestyle choice" in the blink of an eye). They refer each other to pictures and books that serve as thinspiration, including a porn site containing nude photos of anorexic girls. "Ah, perfection," says one. One popular picture features a woman's ultra-thin legs, with one arrow pointing to the thighs saying, "When this part is as skinny as this part," and another arrow pointing to the calves, concludes, "perfection."

They latch onto images in the media, comments from friends and family. They justify the lengths they are willing to go to in order to "do it right."

Some of these women are dealing with past sexual abuse. They cut themselves, they turn to smoking and diet pills, and lie on the floor with laxative-induced cramps at midnight to lose themselves and their past. They believe no one cares. They want someone to care. But when someone does care, they get angry. "Don't tell me what to do. This is all I have," they say.

"My parents don't notice I'm not eating. Sometimes I wish they would," one girl admits. "I'm glad mine don't," says another. "OMG," a third chimes. "If my parents would just chill out and leave me alone like yours do! You are so lucky, girl." A similar conversation takes place about husbands. One complains that her husband is forcing her to eat. Another says her husband berates her when she does. One admits she used to have an anorexic boyfriend. "It was so much easier to do together," she proclaims.

Some claim a distinction from other anorexic and bulimic people. "OK. Goes like this," writes one woman. "We are pro Ana - different than anorexics in a way... well... some of us are." Later she continues, "I do believe we are anorexics...but kind of a more enlightened breed."

They believe they're not "true" anorexics because they don't have "underlying issues." However, Dinsmore points out that underlying issues do not have to be dramatic events like rape or abuse. "It doesn't have to be some deep, dark, horrible thing people have endured," says Dinsmore. "Most people don't do life-threatening things to themselves just because."

In addition, says Dr. Dinsmore, being pro-anorexic is not really a new idea. Technology has just made it more visible. Prior to the Internet, girls found other ways to egg each other on, finding solace in "not being the only one," while also being "not like the rest of them." Some would find each other in their own communities; others would meet, ironically, at residential treatment centers.

But this World Wide Weight loss could be more dangerous, says Dinsmore. There is no oversight or neutralization by positive role models. Here, patients are not committed to getting better.

People who do not want to get well are invested in maintaining the eating disorder, says Dinsmore. This illness is theirs to own and control. In a world where they feel alone most of the time, they have found a community to support and encourage them as they are, which allows them to avoid confronting the problems and risks. But that community focuses on one thing - getting thin.

One of the main difficulties with treating those with eating disorders such as anorexia and bulimia, Dinsmore says, is that sufferers lose perspective. A woman losing body functions because she has so little body fat still considers herself overweight. Women naturally develop weight on their hips and thighs, but those suffering from an eating disorder believe there should be no fat anywhere.

Dinsmore believes these people are not happy, rather they are "accepting what they see as the lesser of all other evils in their life." The fact that they have named their illness "is so striking," says Dinsmore. "The disorder does become like a relationship. It takes the place of unsatisfying or unhealthy relationships the women may have found themselves in previously." Clinical psychologist Dr. Ann Kearney-Cooke, director of the Cincinnati Psychotherapy Institute, explains that they develop a hunger for relationships to take the place of the hunger for starvation.

Sometimes Dinsmore has her patients write a letter to their eating disorder in an effort to let go of something that has become a comfort, a way to function in the world. "There is a grieving process," she says. "The circle of what they think they can do well has shrunk so much. It's scary to think of putting meaning in other parts of their life."

Many patients say they do not want to get better if it means gaining weight. But adult sufferers often tire of feeling out of control. They're willing to at least explore the idea of getting better. Adolescents, on the other hand, are often forced into treatment and are angry about it. "All my friends are dieting," they demand. "Why can't I be left alone to diet too?"

Anorexia has the benefit of immediate positive reinforcement from the world. "You look great!" they're told. And they tell themselves, "I feel good, I'm in control, I have mastery over this." The e-community reinforces these messages. But the short-term folds over itself until the initial impulse is invisible, covered over by an out-of-control mess that seems to grow by itself. "This is one thing that is familiar, that they get to control," says Dinsmore. "But it ends up feeling more out of control. It's a cruel paradox. How long it takes varies, but eventually it feels like tyranny."

While anorexia can provide sufferers with a fleeting feeling of accomplishment, the health costs are long term. The illness affects heart function and can lead to heart failure. It lowers blood pressure and pulse. It places huge demands on the organs and weakens kidney and liver functions. Osteoporosis risk is heightened. Bulimia can lead to electrolyte imbalances and heart problems. It can also lead to ruptured esophagus, erupted blood veins in the eyes, dental problems (sometimes requiring that all teeth be removed), stomach ulcers and other acid-related problems. Many of these things are brushed off by younger women. "To a 16-year-old what happens at 30 is light years away," says Dinsmore.

In the e-groups, the women talk about a light-headed, wonderful feeling of being empty, of reaching goals, and the physical evidence of their victory, their perfection - for the moment. Eventually it becomes a race to prove that they're good enough, all the while believing that they're not.

Distorted perception can transfer not only to their bodies, but to their minds as well. Many exhibit a high level of intelligence and/or creative talent. Girls write to the group that they are valedictorians, mentors to younger girls, writers, artists, mothers. "These girls are unique in so many other ways," Dinsmore bemoans. "I just wish they could see that."

They share poems, artwork, and essays. "You are so insightful!" , "You are such a good writer!" they tell each other. "I wish I could be more like you. I'm nothing. I'm a failure." They extend emotional nourishment to each other but reject what's offered. They do, at least, counsel each other to resist Ipecac (an extremely dangerous purgatory drug) and too many laxatives. They don't want to see each other die. So they keep at their addiction, but keep each other just barely above ground. Or do they?

Behind the scenes, what happens when one stops writing? One writer asks, "Does anyone know anything about Kat? Deb? Anyone from before? Any news? Please?" They know a silent voice could mean danger; it could also mean death.

One website maintains a virtual altar to all who have died. Interestingly, the site owner does not make connect her behavior to the possibility of joining those women, of not reaching her potential, of disappearing entirely.

Some acknowledge the possibility, but continue nonetheless: "Having nearly died several times from our dear friend Ana...sometimes I get an attack of conscience being on this list.... I mean, I am trading tips with others on how to best commit a slow suicide."

Other women, unfortunately, wish for that trip to non-existence. Their messages are heartbreakingly direct. "I want to be small," says one woman. "I want to be very small."

"Alright," another signs off. "I gotta go fade away."