Pro-anorexia websites have been forced to clean up their image, but experts say the fact that they still exist normalises the disease and makes it harder for individuals to leave pro-ana behind.
"Castaway" (an internet pseudonym) sits at her study desk with a glass of dry white wine and a bowl of ice cubes. This is her dinner.
"The wine is to dull the sensation of hunger and the ice cubes trick my brain into thinking I am eating something," the 30-year-old explains. The dry white has fewer calories than its red and sweet white counterparts and is Castaway's favourite because "every calorie counts".
Her white fingertips, which she constantly rubs to stave off the cold, and her frail frame are the only two signs that Castaway is a former pro-anorectic who, despite seeking help, still has days when she relapses.
Pro-anorexia or pro-ana is a subculture that views eating disorders not as a disease but a lifestyle. Its supporters, who communicate through online forums, refuse to seek help for their condition.
These forums consist of people at all stages of an eating disorder cycle "anas" (anorectics), "mias" (bulimics), "EDNOS" (eating disorder not specified) and "COEs" (compulsive overeaters). They believe eating disorders are a choice rather than a psychiatric illness with potentially deadly consequences.
The only group banned from these forums is "anabees" or "wannabe anorectics" who seek advice on how to become eating disordered. According to the community "if you're not sick, you are just looking for the next fad diet".
Pro-ana forum users have been known to share dangerous tips on how to maintain an emaciated frame, including punching yourself in the stomach to make yourself too nauseous to eat, consuming cotton wool balls with water to feel full and putting coins in your pockets during weigh-ins so no-one realises you are losing weight.
In cases of over-exceeding caloric limits or a "binge emergency", pro-ana adherents will teach you how to purge using a toothbrush or suggest taking syrup of ipecac, a substance used in cases of poisoning, to induce vomiting.
Cleaned up, but is it enough?
Earlier this year a mandatory clean-up, initiated both by web hosts and administrators of pro-ana forums, forced these communities to alter their forum content or be blacklisted. Sites rebranded themselves as "pro-support" and removed all content that could "trigger" a relapse in a recovering anoretic.
The administrators of these sites defend their existence saying they provide support to girls who would otherwise be completely isolated and marginalised.
But experts say the communities normalise eating disorder behaviours and prolong the recovery period for those who attempt to leave pro-ana behind.
A support network?
One pro-anorexia forum, now rebranded as pro-support, has more than 1000 members. The site's administrator strongly defends her forum saying it does not offer medical diagnoses.
"Support forums are a network for the mental ups and downs that come along with eating disorders," she says.
The administrator compiles lists of self-help books to aid members seeking recovery and launching promotional campaigns to attract new posts to the site.
She claims the forum "is an amazing support [not pro] community for, primarily, adults in all stages of [an eating disorder]," she says.
A team of moderators named "angels" police the site for abusive content.
The forum has three rules:
- do not join unless you have an eating disorder;
- don't ask how to develop an eating disorder, and;
- don't ask for tips.
An avid 23-year-old forum user says the change of content on the forum is self-initiated.
"Our members have always been uncomfortable with the term 'pro-ana'. We are tired of defending ourselves against those who did not, could not, understand," she says. The member claims pro-support sites offer solace for sufferers who are unwilling to seek recovery in a conventional manner.
"Why cause persons already withdrawn from society to feel more misunderstood and in turn, isolated further?" she says.
Anorexia nervosa is most common in females aged between 15 and 24. Between 10 and 20 percent of cases end in death or suicide.
Danni Watts is education manager for the Butterfly Foundation, which runs mentorship programs for sufferers of eating disorders in NSW and Victoria.
Watts says anything that deems itself pro-anorexic is detrimental and dangerous to a sufferer and their recovery, regardless of whether "triggering" material has been removed.
"It provides a world for their eating disorders to coexist. Sufferers need to be exposed to a world without their eating disorder," she says.
She adds that the number of cases of eating disorders may be underreported.
"If a sufferer is undiagnosed or has not formally sought treatment for an eating disorder then their information cannot be researched or included," she says.
University of Sydney clinical psychology professor Stephen Touyz says these makeshift support sites are extremely dangerous and must be shut down immediately.
"They give advice that can end up killing the sufferer. A website dealing with such a complicated disorder must be done with evidence based on medical and scientific scrutiny," he says.
Professor Touyz compares anorexia to cancer.
"If it is detected early the patient has hopes of recovery. If not, they will struggle with it throughout their adulthood," he says.
Still a struggle
Castaway left the forum in 2009 to seek recovery outside. But despite being 173cm tall, she still weighs only 48kg. Chewing on her ice cubes, she explains she's having a "red day".
"It's touch and go," she says."I may wake up and eat three meals a day. Then I look in the mirror, something disgusts me, and before you know it I'm chewing ice cubes."
To learn more about recovering from anorexia visit Eating Disorders Association of New Zealand.