Like most other mental illnesses, anorexia nervosa has helpful social networks of supportive communities online – where individuals on the verge of relapsing or facing temptations can find positive feedback and encouragement on their journey toward recovery.

Then why, Cornell researchers wondered, do exponentially more individuals with anorexia seek a curious kind of comfort amid their stigmatized condition, haunting the so-called pro-anorexia websites, where too much self-destruction is never enough, where self-starving souls are never worthy – in the minds of their peers – of the mythical, idealized “Ana?”

Web surfing for thinspiration

DSM-5 (the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders) describes anorexia with the criteria of emaciation, relentless pursuit of thinness, unwillingness to maintain a healthy weight due to intense fear of gaining weight and distortion of body image.

In her 2000 book, “Fasting Girls: The History of Anorexia Nervosa,” Cornell professor of human development emeritus Joan J. Brumberg called it a “multidetermined disorder” due to the interplay of socio-cultural, mental and physical factors, which makes it difficult to treat.

With or without treatment – and feeling stigmatized and misunderstood by those who don’t share their “lifestyle choice” – an estimated 50 percent of America’s 24 million anorexics frequent sites like Pro-anaNation.com for what some call “thinspiration.”

“They hope to find solidarity in a group that shares similar pro-anorexia values, instead of being considered deviants,” Chang and Bazarova write. “They seek social validation, approval and support. But the type of support they find there normalizes pro-anorexic values and ideals, which contributes to a stigma escalation cycle.”

And how do they respond when others with anorexia (an estimated 24 million Americans are diagnosable) say: “Ana would never be satisfied with (losing) 5 pounds?” How do members of these online communities (a majority of those with anorexia are female) reply when told: ”You should starve just like Ana?”

“They are sometimes ostracized for not being extreme enough – sometimes they’re called ‘wanna-rexics’ – and these negative responses feed their need to maintain or even increase anorectic tendencies like starvation and extreme exercise,” says Pamara Chang, a Ph.D. student in Cornell’s Department of Communication in the College of Agriculture and Life Sciences.

A specialist in stigmatized conditions, like anorexia, and their place in social media, Chang says: “It’s a unique type of social support that is surprisingly popular. More than half of individuals with anorexia have visited or are members of pro-anorexia websites.”

Many with anorexia deny they have a mental illness, explains Natalie Bazarova, a Cornell assistant professor of communication who studies disclosure of personal information in social media. “They tell one another they’ve made a conscious ‘lifestyle choice.’”

Chang and Bazarova collected and analyzed a year’s worth of posts, responses and replies at Pro-anaNation.com, one of the most public and accessible pro-anorexia communities. They have prepared a report titled “Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites,” scheduled for publication in the journal, Health Communication. They also presented findings at conferences, such as the International Communication Association Annual Conference.

“As fast as Facebook and other platforms shut them down, pro-ana sites pop up under other names and different URL’s,” says Chang, citing terms like “thinspiration” and “thinspo.” “The ubiquity and popularity of pro-ana platforms,” she says, “speak to the need they fill for a lot of people.”

“We were focusing on communicative dynamics on these websites,” Bazarova says, “because we wanted to see the type of feedback people get when they divulge their problems, and how this feedback affects them.”

What they found is a continuous stream of negativity, which does not alleviate stigma communication, but instead reinforces it because people continue to ruminate on their pro-anorexic identity and condition. This type of exchange creates a dangerous cycle of stigma escalation, according to Chang and Bazarova.

 But anyone who cares about people with anorexia nervosa – medical and mental health professionals, family or friends – should spend some time on these pro-ana platforms, Chang suggests. “It’s important for us to understand the needs these individuals have and the support they seek so that we can come up with a more nuanced, rather than prescriptive, approach to intervention and recovery.”

At Cornell Bazarova’s teaching focuses on interpersonal and social media communication. She is co-director of the Social Media Lab at Cornell.