Trigger warning: this article includes descriptions and experiences of eating disorders and anorexia.
For about a year in high school, I carried a small notebook with me, hidden underneath my books at the bottom of my backpack. I kept it with me like a bible, looking for comfort amid its pages during challenging moments. These moments often occurred during lunch break, alone in a toilet cubicle somewhere in the back of the building, my empty stomach growling. Instead of religious texts, the glittering purple cover was filled with images of skinny women's bodies. Thigh gaps, protruding collarbones, poking hips and visible ribs, all meticulously categorised and glued in accordingly.
Shortly before that grim period -- I must have been thirteen -- I discovered a pro-ana website for the first time. "Ana" is slang for anorexia nervosa, and on pro-ana sites and forums, eating disorders are glamorised as a lifestyle choice, tips are given, disturbing images are shared. It's a place to find peers, to feel less alone in your illness. I don’t remember how I ended up on that particular page, but the immediate grip it had on me is hard to forget. It took ten years before I was able to rid myself of the toxic glorification of thinness pro-ana websites facilitate; to realise that being skinny doesn't equal being more successful, driven, or worthy as a human being. Even now, in stressful times, I have to repeat that mantra to myself.
Instagram launched in my last year of high school, and during my recovery, I often wondered what would have happened to me if the platform had been available during those early stages. If that scrapbook had been replaced by an endless source of triggering new images.
In March of 2019, both the BBC and The Guardian published research into the pro-ana community on Instagram. Their message was unequivocal: eating disorder content on the platform was getting out of control. For its part, Instagram is waging an ongoing war against pro-ana posting, but questions remain about the effectiveness of its measures. In 2012, after a public outcry from eating disorder professionals and clients, the platform began banning hashtags that implemented self harm. Terms such as #proana and #thighgap no longer showed any posts, while others like #anorexia and #skinny are shielded with a warning and link to resources to get help. But it didn’t take long before pro-ana found its way around these initial measures. Alternative spellings soon skyrocketed.
Today, hashtags, posts, images and search terms promoting eating disorders are still numerous, and profiles that explicitly reference pro-ana in their Instagram handles are easy to find. While body positivity and body neutrality content might be on the rise, a shadow community of pro-eating disorder users lingers.
Instagram is left adding new terms to the list of banned and sensitive hashtags every day. Additionally, as a representative of Instagram tells me via email, in-feed recommendations of accounts that have posted eating disorder content have been banned. Tara Hopkins, Head of Public Policy of Instagram EMEA, states: “We will never allow content that promotes eating disorders and will remove it as soon as we are made aware.”
The platform's policies may have made the movement more obscure, but is it any smaller? When I had a go at it myself recently, I found hundreds of accounts with pro-ana keywords in their usernames. Recognisable by bios containing phrases such as “trigger warning”, “do not request, in recovery”, or “please block, don’t report”, and ed. jargon like SW (start weight), CW (current weight), GW (goal weight) and UGW (ultimate goal weight). I tried reaching out to tens of them, but received little response. With a ‘regular’ profile, follow requests are almost never accepted. It goes to show how closed off this community is.
Laura*, 19, has a private profile that follows about a hundred similar accounts. When asked what it offers her, she writes: “Support, motivation and people that hold me accountable.” As it turns out, the nature of the platform itself also changes the way users interact with pro-eating disorder content. Researchers of the Dublin City University in 2017 found that eating disorder content on Instagram has become “more competitive and gamified”, compared to that on pro-ana forums. Think of users asking followers for likes or comments in return for periods of non eating, lengthy exercise sessions, or naming types of forbidden foods. Something Eva*, 23, who I was in therapy group with, also experienced: “People, for example, ask their followers to give them a new weight goal, or to name food group they cannot eat that week.”
“We often notice that the gap between what is discussed in therapy and what clients do online, is way too big. Their social media usage should become a regular topic of conversation."
But if banning harmful hashtags is futile, or -- worse -- unintentionally stimulates new types of eating disorder engagement, what can be done instead?
One thing that the experts I spoke to agree on, is that simply blocking more and more content might be dangerous. “The more under the surface pro-ana gets, the trickier it becomes," says Denise Schneider, a psychologist at Human Concern (an eating disorder treatment centre with six locations in The Netherlands). "It allows this network to grow even stronger. You don’t want to demonise these behaviours, because these people often already feel alone as it is. Also, if you suspend accounts, it can be hard to find each other again because of their coded usernames, making people possibly dangerously isolated in their illness.” Nadine Fischer, editor-in-chief of Proud2Bme (a Dutch eating disorder awareness platform that was originally launched as a counter movement to pro-ana) agrees: “We shouldn’t forget that these networks are often their only way of finding support, even if it is seemingly the wrong kind.”
Instead, Proud2Bme strongly believes that it is time more eating disorder treatment facilities start exploring the relationship between clients and their social media as part of their therapy setup. “We often notice that the gap between what is discussed in therapy, and what clients do online, is way too big,” Nadine continues. “Their social media usage should become a regular topic of conversation. Now there is little-to-no monitoring happening.” Human Concern is already changing their approach. “Right now our therapists ask clients about their pro-ana use, but it still hasn't received the amount of attention it needs," Denise says. We’re busy working on a campaign that will launch this year, intended to inform clients and their loved ones about the possible impact of Instagram. We're also rolling out a plan to better prepare therapists for these conversations."
And what can Instagram do? Dr. Ysabel Gerrard, lecturer at the University of Sheffield and author of a study looking into Instagram’s content moderation of the eating disorder community, suggests that Instagram should start by employing trained moderators, specialised in identifying pro-eating disorder content. But most experts I spoke with agree that solutions have to be found outside of the app -- in opening up the conversations between Instagram and eating disorder specialists, between therapists and their clients, and between clients and their next of kin.
Of course, developing an eating disorder is down to a lot more factors than being subjected to an unhealthy beauty ideal, or engaging with others that suffer from these illnesses online. But the images we consume have the power to feed into this disease, allowing it to grow. As Instagram has become an integral part of our lives, it seems only logical that it should be an integral part of therapy and eating disorder awareness programs too.
*Names have been changed at the request of the individuals