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Communicating thin: A grounded model of Online Negative Enabling Support Groups in the pro-anorexia movement

new media & society 13(1) 40–57 © The Author(s) 2010 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1461444810363910 nms.sagepub.com

Stephen M. Haas

University of Cincinnati, USA

Meghan E. Irr

University of Pittsburgh, PA, USA

Nancy A. Jennings University of Cincinnati, USA

Lisa M. Wagner

University of Cincinnati, USA

Abstract The pro-anorexia movement provides support for those with anorexia and adopts an ‘anti-recovery’ view of the disease.The internet has allowed pro-anorexia followers (proanas) to exchange messages in anonymous virtual communities where they encourage one another to be thin.Through the analysis of pro-ana websites using grounded theory, four themes encompassing eight communicative strategies were identified: 1) coconstructing an ana personal identity; 2) self-loathing ana; 3) advising ana; and, 4) group ana encouragement. An emergent grounded model explicates underlying theoretical principles that indicate a new type of social support group, the Online Negative Enabling Support Group (ONESG), in which members encourage negative or harmful behaviors, accept ‘self’ or ‘other’ negative messages without correction from others and coconstruct an affectionate ‘enabling in-group’ that evolves online ‘weak-tie’ support into ‘strong ties’ used to combat stigma in their offline world.

Corresponding author: Stephen M. Haas, Department of Communication, University of Cincinnati, 137 McMicken Hall, Cincinnati, OH 45221, USA. Email: [email protected]

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Key words anti-recovery, ONESG, online support groups, pro-anorexia, social support Social support is generally considered as a coping resource, ‘a social “fund” from which people may draw when handling stressors’ (Thoits, 1995: 64). Effective support is most likely to come from others who are in socially similar situations and/or predicaments, face(d) the same stressors and who have done so or are doing so in a calmer manner than the individual in distress (Thoits, 1986). However, finding support from similar others with concealable and culturally devalued identities is difficult, and individuals become marginalized (Frable, 1993). Bell (2007) suggests that the internet has greatly reduced the costs of expressing unpopular, marginalized or pathological desires and seeking others with these shared preferences, thus ‘extreme communities’ such as the pro-anorexia movement have emerged. The pro-anorexia movement is one that provides encouragement for those with anorexia and adopts an ‘anti-recovery’ view of the condition (Fox et al., 2005). Through medicalization and stigmatization of their condition, marginalized participants of the pro-anorexia movement (pro-anas) seek others who share their beliefs to find effective support for their lifestyle choice. As such, pro-ana websites, weblogs and personal webpages are actively maintained.

Anorexia medicalized Rich (2006) suggests that a number of dominant discourses have emerged to describe anorexia, including a ‘medicalized’ construct of anorexia. Conrad (1992: 209) describes ‘medicalization’ as ‘a process in which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders’ and assumes a medical framework to understand a problem, or using a medical intervention to ‘treat’ it. In the case of anorexia, Rich (2006) found that many young women suffering from the disorder reported that their peers, teachers and family members have made sense of their anorexia through medicalized discourse. Furthermore, Rich (2006) contends that the emphasis during treatment is largely on weight loss/gain rather than on the social and emotional facets of what it means and feels like to be a young woman suffering from an eating disorder. Placing such heavy emphasis on physical indicators may leave some women who appear to maintain a ‘normal weight’ still struggling with anorexia, the way they experience their bodies and issues of self-worth (Rich, 2006). The intense focus that medicalization places on weight gain and loss, as well as other physical issues, may be contributing to the stigma often associated with anorexia.

Anorexia stigmatized Goffman (1963: 3) defined stigma as a form of social rejection wherein the stigmatized individual is ‘reduced in our minds from a whole and usual person to a tainted, discounted one’. Stigmatized people are seen as abnormal, spoiled or mentally imbalanced and this may lead to discrimination and negative behaviors being demonstrated towards

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new media & society 13(1)

them. One of the impacts that stigma has is that people’s individual qualities and abilities are eclipsed by the discrediting characteristic (Rusch et al., 2005). Corrigan and Watson (2002) suggest that mental illness stigma is doubly misfortunate; it results in a general public that misunderstands both the course and impact of mental illness and discriminates against these individuals as well. As with other conditions, anorexia carries its own stigma. In the UK, one-third of survey respondents suggested that sufferers were to blame for their condition and that they had difficulty talking to and empathizing with people with eating disorders (Crisp, 2005). Similar results were obtained in the USA (Stewart et al., 2006). Women with anorexia have been routinely portrayed as irrational and in denial of their behavior (Dias, 2003). As such, individuals with anorexia are described as unhappy perfectionists who want complete control over their every behavior, desire approval from authority figures, have difficulty managing stress and have low self-esteem (Shade, 2003). While the general population has these perceptions, those with anorexia often hold a different view. Mond et al. (2006) found that individuals with a high level of eating disorder symptoms indicated greater perceived desirability and lower perceived need for social distance than asymptomatic individuals. Indeed, anorexia nervosa is often held in high esteem by those identified with anorexia, and social support is sought to promote anorexic behaviors by those who identify as ‘pro-anas’ (Schmidt and Treasure, 2006).

Anorexia and social support The social support sought by pro-anas, the self-esteem desired and the identity construction that comes with belonging to a group reflect the premise of Tajfel and Turner’s (1979) social identity theory. Social identity is ‘that part of the individual’s self-concept which derives from their knowledge of their membership of a social group (or groups) together with the values and emotional significance of that membership’ (Morton and Duck, 2000: 441). Individuals categorize their social worlds into groups, placing themselves into some of those groups (Edwards and Harwood, 2003). Briscoe (2005: 29) asserts that attributions support within-group practices to subordinate the other and that ‘the other is even more integrated into our identities’. As such, social identity theory contributes to an understanding of one’s self in comparison to others, thus strengthening the value of support group membership. Social support can have an impact on mental health (Cramer, 2000). Anorexic patients’ self-esteem was found to be positively associated with the perception of being socially supported (Tiller et al., 1997). Moreover, Abbey et al. (1985) found that most people do not feel closest to someone who consistently engages in high levels of social conflict along with social support. For those in the pro-ana movement, family members often engage in social conflict over eating habits, and since high levels of social conflict result in low levels of perceived social support, pro-anas may turn away from family members to avoid social conflict and to find others who offer social support. Previously, social support networks required that individuals congregated in a physical space, but the internet has opened the door to worldwide communication that is no longer restricted to geographical or temporal constraints.

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Anorexia online support The internet provides a new place to build community, and such is the case for the proanorexia movement. Chesley et al. (2003) identified three different types of websites associated with anorexia: 1) pro-anorexia sites; 2) pro-recovery sites (those supporting treatment of the disorder); and, 3) professional organizations. Of these three types of sites, pro-anorexia sites were most prevalent. In general, design components of pro-ana websites include: 1) instructions for initiating and maintaining anorexia; 2) technique and nutrition sections for rapid weight loss; 3) clinical definitions of anorexia; 4) motivational images and ‘creeds’ to encourage weight loss (‘thinspiration’); and, 5) competitions for weight loss (2003). Pro-anorexia sites also contain bulletin boards, diaries or blogs and links to other pro-ana sites (Dias, 2003). In analyzing the discussion threads on one pro-recovery pro-ana website, Mulveen and Hepworth (2006) found four themes. First, tips and techniques contain daily diarylike entries that chronicle attempts to lose weight, including dietary restriction and fasting tips. The second theme, ‘ana’ vs anorexia nervosa, differentiates between two types of anorexia: anorexia as a lifestyle choice (‘ana’) compared to anorexia nervosa as a mental illness. ‘Ana’ rejects anorexia as a mental illness, thus empowering members to maintain their ‘lifestyle’. The third theme, social support, refers to emotional group support. The fourth theme is a ‘need for anorexia’, in which anorexia is perceived as a way of purifying one’s life, both physically and mentally. Norris et al. (2006: 444) found that the most common material found on pro-ana sites focused on ‘“thinspiration” (inspirational photo galleries, quotes and writing which serve to motivate and sustain anorectic behaviors)’. This seems to support the linguistic trends discovered by Lyons et al. (2006) in comparing pro-anorexic sites to pro-recovery sites. According to their study, proanorexic sites contained more positive emotional words and markedly lower anxiety words than pro-recovery sites as well as a preoccupation with eating and fewer references to school- and death-related issues. The opportunity that the internet provides for self-presentation allows for new possibilities for experimentation and reflection on both actual and possible selves (Manago et al., 2008). Gavin et al. (2008) examined one website for identity issues within the proana online community. They found two dominant themes in the online presentation of the pro-anorexic self: 1) maintaining a sense of the pro-ana self as abnormal; and, 2) keeping the ana (anorexic) and eating disordered identity hidden from family and friends offline. As such, members of the pro-ana online community struggle between two alternating identities, one of ‘an anorexic supported by other anorexics online vs presenting as a person without an eating disorder in their offline world’ (2008: 332). The support gained in the online community must be kept secret from offline friends, family and medical professionals. Research suggests that online support groups are composed of ‘weak-tie’ networks, those that operate outside of ‘close’ relationships with family and friends (Turner et al., 2001). Wright and Bell (2003) suggest that ‘weak-tie’ theory explains some of the functions of computer-supported networks that are particularly relevant to the pro-ana movement. The ability to disclose information to others with less relational risk is particularly appealing for those with a strong negative social stigma such as anorexia. The weak ties

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of the online environment reduce the exposure to judgement and social conflict imposed by members of strong-tie networks – those usually closest in physical proximity (e.g. family). Moreover, the satisfaction, importance and social support gained from such disclosures may change perceptions of the ‘weak’ tie to that of a ‘strong’ tie. Turner et al. (2001) found that when online group members perceived support within the online community to be higher than that perceived in their offline life, they spent more time with their online community, suggesting that online group members have found support missing from their face-to-face partners. While psychologists and medical professionals have examined types, designs and psychological meanings expressed on pro-anorexia websites, little attention has been paid to how the online communication strategies and messages exchanged function in the co-construction of support in the pro-anorexia movement. The current study focusses specifically on exploring the communicative strategies and characteristics of pro-ana online postings on weblogs, online forums and personal webpages. Bortree (2005: 38) suggests that ‘bloggers are able to build and maintain an image that will afford them more access to friendship groups’. These friendship groups enacted by blogging and cultivated through internet sites act as a supportive social group. The current study seeks to explore these supportive messages by addressing the following research question: What communication strategies and messages do pro-anas exchange on internet sites in an attempt to co-construct support in the pro-anorexia movement?

Method Using a qualitative grounded theory approach (Glaser and Strauss, 1967; Strauss and Corbin, 1990), this study explored naturally occurring online pro-ana messages. Stern (2000) argues that the medium of internet forums, weblogs and home pages offers a powerful arena for self-disclosure and self-expression messages. Consequently, messages were collected from weblogs, online forum interactions and online personal home pages of pro-ana movement participants.

Data collection Pro-ana online messages were collected through a snowball, convenience sampling technique. Websites such as myspace.com, xanga.com and livejournal.com, which serve as virtual mediums through which individuals can journal or ‘blog’, served as primary sites for data collection. In addition, messages were collected from websites designed specifically for the promotion of pro-anorexia, including nothinspiration.com, proanamia.com, annasplace.com, houseofthin.com and pro-ana-nation.com. Thus, general social networking sites and pro-ana-specific websites served as collection sites for this study. Data collection took place over a six-month period from October 2006 to May 2007. Tracking websites and hyperlinks was difficult, since websites such as myspace, xanga and livejournal remove pro-anorexia content from their servers whenever it is discovered. Consequently, the researchers began with the website of a known pro-ana individual and linked from that page in order to find others in the pro-ana movement. The ‘friends section’ of the websites also provided links to other members with similar pro-ana interests.

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Since personal pro-ana webpages are deactivated and reactivated under different names on a continual basis, daily general keyword searches were conducted on sites such as myspace and xanga. Also, large search engines, such as Google and Yahoo, were utilized to formulate a rudimentary list of pro-ana websites and forums which led to pro-ana communities. Due to the guarded nature of the websites and those who post them, many sites require membership to access their material. Ethically, because the researchers did not wish to misrepresent themselves as a member of the anorexic community, only proana blogs and websites that allowed public access were used as data in this study. Furthermore, for anonymity purposes, the names of the participants have been changed to ANA and assigned a random message number (e.g. ANA151). The final sample consisted of 1200 message units (N = 1200).

Site participants Those who contribute to pro-anorexia websites often seek to hide personally identifying information to keep their anorexic behaviors from family, friends and society at large. Thus, the internet becomes a virtual ‘space for anonymous identity play and exploration’ (Gross, 2004: 643). Thiel (2005) posits that the internet permits disembodiment from a variety of demographic characteristics such as race, gender and class. As a result, it is challenging for researchers to establish sociological markers for the online pro-ana community. However, Whitty and Galvin (2001: 625) argue that online ‘text-based communication is capable of providing complex and subtle social and cultural information’, from which a few demographics can be inferred. For example, sex, age and race are demographic characteristics that are frequently revealed or inferred through text or icons that are chosen to represent individuals online. On the pro-ana sites, participants frequently chose picture icons to represent themselves. However, the icons are often of other people and rarely of one’s self, including images of supermodels, ultra-thin celebrities or women who are in a state of starvation as a result of anorexia. All of the picture icons were of Caucasian women. Other picture icons included weight scales and motivational proanorexia sayings representing their voices. Moreover, many of the participants have ‘A Letter to Ana’ on their home pages further revealing their female gender. For example, one participant wrote in her letter to Ana: ‘Please Ana, don’t give up on me. I’m so weak, I know, but only you with your strength inside me will I become a woman worthy of love and respect.’ By reading the texts, participants on the sites were assessed to be primarily 13–26-year-old Caucasian women.

Data analysis The data were analyzed through a process consistent with the constant comparison approach (Glaser and Strauss, 1967; Strauss and Corbin, 1990). Open coding was used to identify categories, subcategories and properties within the data. Categories serve as conceptual representations of commonalities identified by the researcher as being important in the data. Importance was determined based on how often categories surfaced (commonality), the representation of an issue across message units (extensiveness) and

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the valence with which a message was expressed (intensity) (see Steuber and Solomon, 2008). Properties are conceptual characteristics or attributes of a category (Glaser and Strauss, 1967). Categories and their properties were inductively derived from the data. Next, axial coding was undertaken to group subcategories into categories and develop superordinate themes worked out from the data and in relation to the researcher’s knowledge of pertinent prior research. At this point, through constant comparison, superordinate thematic categories were generated to serve as conceptual explanatory markers. Subcategories were coalesced into larger categories until no new categories emerged and saturation had occurred (Glaser and Strauss, 1967). A validity strength of constant comparison analysis is retention of the original data/ messages while categories are formed. Original data responses are retained and exemplars are selected for presentation in the report serving as evidence of the conceptual categories. Exemplars, therefore, are subject to the reader’s assessment of content validity and thematic representativeness (Strauss and Corbin, 1990). Validity of the conceptual categories is largely determined by the reader through confirmation of the data as representative evidence for the themes. Concern for data reduction error is less of an issue because the original data are retained throughout the analysis and only collapsed in the final steps of labeling categories and the dominant themes (Fielding and Fielding, 1986).

Findings and discussion Four dominant themes emerged from the analysis and are presented in Table 1: a) coconstructing an ana personal identity; b) self-loathing ana; c) advising ana; and, d) group ana encouragement. In addition, two communicative strategies emerged under each theme. The types of disclosures that represent the properties of each strategy are also provided in the table. Themes and strategies were examined for content validity by two fellow researchers with expertise in the content area. All were judged to possess explanatory value. The four themes and eight communication strategies combined shed light on communication characteristics of a new type of support group, the Online Negative Enabling Support Group (ONESG). A summary of the communicative characteristics of ONESGs will be addressed following presentation of the findings. All of the themes and communication strategies that emerged represent forms of online self-disclosure. In interpersonal communication theory, self-disclosure involves revealing personal information about one’s self to another individual and is a key component in the development and maintenance of relationships (Collins and Miller, 1994). Buhrmester and Prager (1995) delineate five functions of self-disclosure messages: 1) gaining social control; 2) achieving self-clarification; 3) exercising self-expression; 4) receiving social validation; and, 5) enhancing relationship development. People often engage in self-disclosure with the goal of ‘eliciting feedback from others and validating one’s self-concept’ (Stern, 2000: 68–9). The secretive nature of the pro-anorexia movement and the intimacy that participants feel towards the disease itself and one another breed an online environment that is ripe for self-disclosure. The types of self-disclosure observed in this study are in line with Walther’s hyperpersonal theory (1996), which proposes that online disclosures create the potential for idealized perceptions of others

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Table 1. Pro-ana ONESG dominant themes, communicative strategies and types of disclosures Dominant theme

Communicative strategy

Type of online disclosure

Co-constructing an ana A. Staying true to ana personal identity B. Creating an audience for ana Self-loathing ana

Advising ana

Group ana encouragement

A. Disclosures of loyalty to ana eating habits and exercise B. Disclosures of personal daily activities and intimate feelings A. Physical self-loathing A. Disclosures of loathing about one’s B. Esteem self-loathing physical body B. Disclosures of loathing about one’s inner being A. Dieting advice A. Disclosures on tips and techniques for B. Impression weight loss management advice B. Disclosures on managing ‘non-anas’ in social situations A. Shared dilemma A. Disclosures of cohesion through group cohesion expressing ana ambivalence B. Attitude group cohesion B. Disclosures encouraging positive attitudes and affection in the group

based on reduced cues, optimal self-presentation and information management through mindful message construction in asynchronous exchanges and the potential for an ‘intensification loop’ where extreme views are validated and escalated among members of an online group. Walther’s research suggests that individuals may perceive online exchanges as more intimate and socially desirable than face-to-face interactions, especially among people who have difficulty finding similar others offline. Hyperpersonal theory helps to explain the exchange of extremely intimate self-disclosures found in the current study. The specific functions of these self-disclosures are captured in the four themes.

Co-constructing an ‘ana’ personal identity The first primary theme captured self-disclosure strategies used by site participants to help one another co-construct a positive ‘ana’ personal identity. One communication strategy that facilitates the co-construction of an ana identity is ‘staying true to ana’. In order to ‘stay true to ana’, members frequently self-disclose in great detail how much they have eaten, exercised or binged to indicate loyalty to ana. ANA1 writes, ‘Anyway, they made a fried breakfast this morning and I was basically forced to eat one sausage and an egg white along with baked beans and a slice of bacon … Oh dear!’ Other entries pertaining to food consumption are more succinct. For instance, ANA24 writes, ‘L I ate cheese’. The forums and blogs function as a sort of ‘online confessional’, a virtual place where members can go to free themselves from the guilt of not ‘staying true to ana’ when they have eaten too much or engaged in too little physical activity. ANA2 writes, ‘Hey everyone, so I binged last night and forced myself not to purge cause there were other people in my house and my teeth are really sore lately [from purging]’. Expression of commitment to ana was a key characteristic of establishing a pro-ana identity.

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A second communication strategy in creating an ana identity is using the pro-ana websites and blogs to create an ‘audience for ana’. This strategy can be interpreted using the mass communication literature on ‘intended audiences’ and/or ‘instantiated viewers’ which proposes that, for mass messages whose recipients are unseen and unknown, a ‘mental model of our reader/listener/viewer’ is constructed (Stern, 2000: 89). It seems likely that the creators of pro-ana messages in this study similarly craft an audience in their mind in whom they confide, thus co-creating a shared online social identity. Often disclosure messages to the audience contain information about everyday activities. ANA72 muses, ‘Mondays are soooo boring. My English class seemed like it went on forever today.’ Interestingly enough, even these trivial messages normally elicit responses from readers, which likely produce feelings of validation and continued contributions. Many entries also include material that is deeply personal. ANA13 writes, ‘I wrote this long letter to my dad that I’ll never show him about how angry I am with him and how I’m letting him go. I think it’s amazing.’ Along the same lines, ANA54 blogs, ‘My mother broke down in front of me crying, asking me not to die. My nervs [sic] I are down. I cry til I collaps[e].’ By sharing painful experiences and disclosing intimate feelings, a pro-ana identity is strengthened, and the support group gains momentum through message exchange with an anonymous audience. Through the establishment of an ‘audience for ana’, pro-ana bloggers engage in co-constructing personal identities that are consistent with group ana membership expectations of a perceived audience.

Self-loathing ana One specific type of self-disclosure message, self-loathing, was another prevalent theme in the pro-ana websites. Two types of self-loathing messages functioned as communicative strategies for enacting this theme: 1) loathing of one’s physical body; and, 2) loathing of one’s inner being. Woolrich et al. (2006) found that negative self-belief is a common characteristic of those with anorexia and found such themes as powerlessness, failure, defectiveness, unattractiveness, worthlessness and emptiness. Messages depicting feelings of self-loathing run rampant throughout the pro-anorexia sites. For example, ANA31 writes of her physical failure, ‘Binged. Again. I’m revolting … ::le sigh::.’ Participants who engage in the pro-anorexia movement express self-hatred because they are unhappy with their bodies and are attempting to morph into what they consider to be the thin ideal. ANA116 writes, ‘I fucking hate my body, I fucking hate it. I fucking hate 106.5 pounds. I fucking hate that weight.’ Similarly, ANA25 blogs, ‘I just know they all look at me and think “God you’re fat”. I hate it so much, I hate myself so much, it’s my fault I’m fat, they are only being honest.’ Even for newcomers, self-loathing is a compelling force in the movement. ANA87 writes, ‘I’m new to this whole community thing, but I feel awful about myself, mostly because I failed to achieve my goal this week. I can’t do anything and I’m going to stay fat and horrible forever.’ While there is heavy emphasis placed on hatred of the body, equally as prevalent was a self-loathing and hatred of one’s inner being. Participants frequently write about feelings of inner worthlessness and weakness. ANA46 writes, ‘Why can’t I love myself? Why can’t I talk to anyone about this?! The more I lose weight, the more I hate myself.’ ANA90 blogs, ‘I’m so disgusting. Useless.’ These entries transcend a loathing of the

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body to encompass an abomination of one’s inner self. ANA59 writes, ‘I just purged dinner. I am so fucking weak.’ ANA76 expresses deep unhappiness, ‘I don’t want to be alive and I am. I don’t want to be depressed and I am. I don’t want to be fat and I am.’ Unlike other social support situations where these feelings would likely be discredited (e.g. ‘you aren’t fat’ or ‘you are beautiful the way you are’), these negative rants are embraced by others in the movement and help confirm group membership. In essence, this behavior reinforces a positive social identity for the pro-ana members. This form of social support communication appears to be unique to ONESGs. Supportive messages are commonly perceived as having positive valence (Vangelisti, 2009). When self-deprecating messages are expressed, support providers are expected to contradict negativity. In this study, pro-anas’ common exchange of negative, self-deprecating messages appears unique, such that there is no attempt among members to correct or contradict these selfcriticisms. Instead, messages of self-loathing and weakness are accepted as valid, even expected, and need no contradiction by others. Thus, there develops a shared identity and common bond in acknowledging one another’s failures and continued personal struggle to ‘better’ themselves through thinness. These self-loathing messages are frequently met with advice, commiseration or ‘thinspiration’ from others as to how to shed pounds, as the next theme details.

Advising ana Participants on these pro-anorexia websites also rely on the communication of advice as a strategy to aid them in their quest for perfection. Advice seeking and giving, a form of social support (Albrecht et al., 1994), is another prevalent theme that emerged during the study. Two forms of advice were most prevalent: 1) dieting advice; and, 2) impression management advice for dealing with ‘non-anas’ in social situations. First, queries regarding weight loss strategies and ‘tricks’ abound. ANA27 writes, ‘Do you think I will lose the most if I don’t eat at all this week (water, and maybe some tea), exercising 4–5 times? Or should I have breakfast too?’ Similarly, ANA105 blogs, ‘Can someone please tell me how many calories I have to stay under to be ana? I think I’m eating too normally … help me!’ The answers to such inquiries are derived directly from the firsthand experiences of fellow members. ANA337 writes, ‘Everyone should eat celery girls. It burns more calories to chew and digest than it does to eat it. How awesome is that?’ ANA837 shares information about a website that she has discovered, ‘On the upside, I found a website that tells you how many calories and such to eat per day to lose however much weight per week’. With the second impression management communication strategy, many advice solicitations deal with how to handle social situations in which members are forced to eat by loved ones (i.e. non-anas). ANA611 blogs, ‘Someone please help!! … My parents are forcing me to have pizza tomorrow and it’s make your own … anyone have an idea how I can get out of this or how many calories are in Asda plain pizza bases?’ ANA212, in a similar situation, writes, ‘Now here’s my question, so my parents found out that I was eating like two apples a day and are now all over me about what I’m eating, so I’ve started taking laxatives, will this work?’ In these instances, fellow members frequently advise others to purge after eating, feign the appearance of eating, take diuretics or use laxatives. ANA632 writes, ‘Make sure that you arrange the food on your plate really far

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apart. They’ll think that you’re eating it. Also you can chew your food and spit it into napkins when no one is looking at u.’ Through the giving and receiving of advice, proanorexia members support and encourage group membership through persistence to defeat the efforts of their family to get them to eat. Online support communities may be seen as ideal by pro-anas seeking and offering advice in dealing with close family members. Turner et al. (2001) suggest that online communities provide access to ‘weak-tie’ others that are free from the pressures and dynamics of close family relationships. Through online communication, pro-anas are able to exchange advice (24 hours a day) to cope with strong-tie family member pressures to alter their eating behaviors. In this way, the anonymity and perceived objectivity of online weak-tie support may create a role reversal, whereby ‘close’ family members are seen as distant outsiders and the virtual community is perceived as salient, understanding and full of helpful personal supporters. As such, advice is often associated with strategies of within-group encouragement, which is explored in the following section.

Group ana encouragement Adherence to the pro-anorexia lifestyle demands strict self-discipline. Thus, pro-ana participants use the communication strategy of posting group-oriented encouraging messages for both themselves and fellow pro-anorexia members that promote loyalty and inclusion in the group. ANA115 writes, ‘Ok I promise to you guys over the next month I am going on a seriously restricted diet and I calculated I would be in a negative of around 3300 [calories] a day. I promise pics. I’m going to make it!’ Putting their intentions into writing solidifies their commitment and increases accountability. For instance, ANA077 writes, ‘Now that I’ve promised you guys I’m starting my five-day fast I have to do it. I will do it. I love you all.’ One important type of group encouragement is expressed in the shared dilemma of ambivalence tied to a dialectic of self-loathing and self-encouragement. Dialectics exist when two opposing contradictions form unresolvable tensions within a person or relationship (Sabourin and Stamp, 1995). Goffman (1963) first suggested that stigmatized individuals often experience ambivalence – possessing both positive and negative feelings – towards the stigmatized issue. Ambivalence between self-loathing and selfencouragement expressed to the group was quite evident among the pro-ana bloggers in this study. ANA545 writes, ‘I am worthless. I am nothing. A useless piece of shit. But I can do this. I will be thin and beautiful.’ Another instance of this dialectic comes through in ANA101’s writing, ‘I am fat and hideous. Ana makes me beautiful and I will succeed.’ Embracing the ambivalence of self-loathing and self-encouragement is an important strategy because it illustrates the inner turmoil that resides within proanorexia participants. They cling relentlessly to the idea that achieving a certain level of thinness will somehow remedy their feelings of worthlessness and undesirability; however, the means by which they attain this sense of value and belonging is stigmatized and deemed undesirable. This ongoing struggle with ambivalence towards anorexia serves as a common bond for group cohesion. One final communication strategy was encouraging positive attitudes through group cohesion. These messages are intended to motivate the group as a whole, engaging in

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what Goffman (1963) called ‘within group purification’, where ‘the efforts of stigmatized persons not only “normify” their own conduct’ (1963: 108), but encourage others to embody the stigmatized behavior. Common messages center on encouraging strength and positive attitudes within the group. ANA555 writes, ‘Girls, be determined and make this week a good one! Best of luck, stay strong and think thin!’ ANA363 offers similar words of encouragement, ‘Think thin. Nothing tastes as good as thin feels exercise exercise exercise J.’ Messages intended to help fellow members maintain control in the face of adversity occur regularly. ANA444 writes, ‘We are proana because we love ana. Don’t let anyone tell you you’re sick or crazy. Embrace her [anorexia].’ ANA245 writes, ‘Our dedication to ana is our number one priority. Nothing else matters because unless we have ana, we are nothing.’ Members often criticize individuals ‘on the outside’ and blame their disapproval of pro-anorexia on jealousy and resentment. ANA050 writes, ‘My mom is always telling me to eat, but that’s because she’s gotten so huge. She’s jealous because I have ana and she doesn’t. We can do this ladies!’ Often, group encouragement and support are offered in the simplest sense. ANA888 blogs, ‘I don’t have much in terms to say about myself, doing well as expected I s’pose. Anyways I’m just here to give support J How are all my lovely friends? Bless you all.’ ANA987 journals, ‘I am here if anyone needs me for anything let me know.’ Expressions of affection for the group as a whole are also common. ANA909 writes, ‘Hope all you beauties are doing well today J I really do love u all!!’ ANA123 states, ‘I love you all. You are precious.’ Such affectionate postings serve to foster group intimacy and trust against an outside environment of disapproval and perceived misunderstanding.

Summary and implications The slogan ‘pro-anorexia is not a disease, it’s a choice!’ is a prevalent mantra of the proanorexia movement. This study found that, together, the four themes and eight communication strategies indicate the emergence of a unique type of support group, the Online Negative Enabling Support Group, for those within the online pro-anorexia movement. Traditionally, self-help support groups (including online support groups) are formed to provide individuals with positive forms of social support that focus on increasing knowledge, positive coping skills, positive self-concept, facilitating critical analysis of self and setting goals and often teach relationship and communication skills that enhance participants’ functioning in daily life (Gance-Cleveland and Mays, 2008). The current study’s findings indicate the emergence of a new type of ONESG that has several unique communicative characteristics highlighted in the theoretical grounded model presented in Figure 1. First, anonymity afforded on the internet is utilized to exchange extreme views. Second, group members use their internet interactions to co-construct potentially dangerous negative behaviors in a positive way that enables new positive identities to be created. Third, the ONESG allows members to express negative thoughts about oneself or others (i.e. out-groups) without challenge or correction from group members. As such, participants in the ONESG normalize ‘self’ or ‘other’ negative expressions and do not attempt to reframe them with positive assessments, as is done in traditional support groups. Fourth, tips and techniques for enacting negative behaviors are given as a source of informational support. Fifth, affectionate in-group messages of encouragement are

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Grounded Model of the Communicative Characteristics of Online Negative Enabling Support Groups

Exchange of Mediated Anonymous Disclosures

Uncontested Self or Other Negative Expressions

Co-Construction of Negative Behaviors as Positive Behaviors

Expression of Cohesion through Group Encouragement and Affection

Expression of Tips & Techniques to Enact Negative Behaviors

Reconstruct Mediated Weak Tie Support into Strong Tie Support

Figure 1

exchanged to create group bonding. And, finally, members reconstruct their online ‘weak-tie’ interactions into ‘strong-tie’ networks of similar others. Taken together, the communication characteristics explicated in the model provide insight into a new type of ONESG that did not exist prior to the advent of the internet. Pro-ana participants are able to quickly find and communicate with one another online. They are able to locate and build an online community that is more heterogeneous than their own personal offline network, similar to members of other online community support groups (Drentea and Moren-Cross, 2005), but for the purposes of enabling negative health behaviors. Furthermore, these sites become a place where proana members can gain strength in their own identity or ‘presented self’ (Goffman, 1959). Social networking sites and blogs can allow individuals to create an inflated sense of self-importance through the perception that ‘an audience’ wishes to track their daily activities. Ellison et al. (2007) found that individuals with low self-esteem and low life satisfaction within their offline community gained in perceived social capital as a result of intense use of Facebook and indicate that other internet applications can do the same. Together, these findings suggest that pro-ana websites not only strengthen the connectivity of anorexic individuals who cannot find like-minded individuals in their offline community, but also inflate their self-worth through their online performance.

Limitations and future research As with every study, this research has its limitations. Because pro-anorexia material has been banned from major internet sites such as xanga and myspace, and pro-anas typically find blogs through other blogs and links provided in a home page or through an instant

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message profile (Nardi et al., 2004), it was difficult to follow any one individual or group of individuals throughout the data collection period. Second, follow-up personal interviews and/or accounts could not be obtained to further probe the emergent strategies due to the anonymous online nature of the messages. Future research should attempt to establish contact with bloggers to understand their point of view. In addition, many proanorexia websites are not open to the public and approval from a webmaster is required. As stated previously for ethical reasons, only open public access websites were utilized for this study. Future studies should examine content on members-only pro-ana sites to compare and contrast those available to the general public. Finally, future research should study the role of other forms of new media within ONESGs (e.g. instant messaging, texting, Twitter, Skype, and so on). As other forms of new media emerge and gain in popularity, it will be important to understand their role and impact on ONESGs. Also, it may be possible to apply our model of the communication characteristics of ONESGs to other types of online anti-recovery or addiction groups (e.g. substance or alcohol abuse, sexual addictions, and so on). The anonymity of internet participation, the ability to meet like-minded individuals, to share tips and techniques and exchange undesirable, harmful or extreme attitudes opens the door for other potential ONESGs to form. We have illustrated how pro-anas communicate as a group and support one another in exchanging self-deprecating language and offering tips on maintaining their anorexia. Future studies should explore other potential types of ONESGs, such as hate groups that form and strengthen through the exchange of shared hatred for another group on internet websites (Cooper, 2009). The development of ONESGs also may apply to cyberbullying. Teenagers (the group most likely to cyberbully) are able to gather and propel their hateful, harassing behaviors and negative attitudes through online social networking sites such as Facebook and myspace. A 2007 Pew Research Center survey found that 32 per cent of teenagers who use the internet have experienced cyberbullying in some way (Lenhart, 2007). The internet offers a place for extreme ideas to flourish and spread and, thus, becomes a potential tool for fostering ONESGs who wish to promote harmful ideologies and behaviors.

Conclusion Pro-anas are turning to the internet to create and cultivate an ONESG that undermines loved ones’ efforts to steer pro-anas away from a debilitating and sometimes fatal disease. Although computer-mediated support group ties have been found to be ‘weak-tie’ networks, our grounded model suggests evidence that ‘weak-tie’ networks may become ‘strong’ as stigmatized individuals seek others to form a support network. In the case of the pro-anorexia movement, anas turn away from strong ties, since their close ties are trying to get them to stop their unhealthy behaviors. Moreover, the anonymous nature and pervasiveness of online content easily enable pro-anas to circumvent the concerns of their loved ones, and intensify their extreme views (Walther, 1996). The online world has become a catalyst through which the pro-anorexia movement has gained its momentum and created a new type of social ONESG. Understanding the communication strategies and characteristics used in these groups may serve as a useful tool to further address obstacles to advancing therapy for anorexics. The world of pro-anorexia is a complicated

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Stephen M. Haas is Associate Professor in the Department of Communication at the University of Cincinnati and his research focusses on health communication and social support in chronic illnesses. Meghan E. Irr (MA in Communication, University of Cincinnati) is currently a nursing student at the University of Pittsburgh Medical Center. Address: University of Pittsburgh Medical Center Shadyside School of Nursing, 3500 Victoria Street, Victoria Building, Pittsburgh, PA, USA. [email: [email protected]] Nancy A. Jennings is Assistant Professor in the Department of Communication at the University of Cincinnati and her research examines the impact of new and traditional media on the lives of children and youth. Address: Department of Communication, University of Cincinnati, 137 McMicken Hall, Cincinnati, OH 45221, USA. [email: [email protected]] Lisa M. Wagner is Visiting Assistant Professor in the Department of Communication at the University of Cincinnati and her research interests include girl studies, identity and the internet. Address: Department of Communication, University of Cincinnati, 137 McMicken Hall, ML 0184, Cincinnati, OH 45221, USA. [email: [email protected]]