First Monday

#anawarrior identities and the stigmatization process: An ethnography in Italian networked publics by Agnese Vellar

Received opinion holds that pro-ana are “sites that promote anorexia”. In this paper, I will describe the stigmatization process operating in digital environments and the evolution of pro-ana identities in the light of the theories that view eating disorders (EDs) as culture-bound syndromes. I will then illustrate the findings of an ethnographic study of the ana-mia (from the contraction of anorexia and bulimia) culture that has emerged on Italian social media (blogs and visual SNSs such as Instagram). Analyzing the forms of self-representation drew back the curtains on the “popular discourse” of the ana-mias, whose digital bodies express the need for self-discipline typical of post-feminist identity in neoliberal societies. Ana-mias represent themselves as #anawarriors: their life is an ongoing battle against their illness and to defend themselves from outsiders, but is some cases also to gain visibility and reach the status of microcelebrities.


1. Introduction
2. The contradictory nature of eating disorders (EDs)
3. Ana-mia cultures: A history of censorship and online self-representation
4. Methodology: An ethnographic study of Italian ana-mia cultures
5. Results: The pro-ana stereotype and online self-representation as an #anawarrior
6. Discussion: A typology of ana-mia identities on Instagram
7. Conclusion



1. Introduction

“Pro-ana refers to the promotion of behaviors related to the eating disorder anorexia nervosa” [1]. Wikipedia’s definition of pro-ana Web sites as environments that “promote” an illness is widespread both in common usage and at the institutional level. Nevertheless, what has been labeled as pro-ana is in reality a culture of people who suffer from eating disorders (EDs) but in many cases have no intention either of promoting their illness or of increasing its visibility. This culture’s evolution over the years has been driven by three processes: (i) the spread of new socio-technical environments (websites, blogs, social networking sites); (ii) the stigmatization of pro-ana identity; and (iii) censorship by online services.

Online platforms block content that is considered problematic for Web users. This censorship thus applies to self-harm content, which deals with such practices as “cutting” and other forms of self-injury, and with anorexia and bulimia (boyd, et al., 2011). Since 2001, Yahoo! has removed pro-ana sites from its servers, while the hashtag #proana has not been searchable on Instagram since 2012. The rational for the platforms’ censorship stems to some extent from scientific studies of various kinds that have called attention to the dangers of self-harm content. Davies and Lipsey (2003) and Spurrier (2008) describe pro-ana Web sites as forums that celebrate anorexia as a lifestyle choice and suggest that technologies be used to monitor and restrict minors’ Internet access. Bardone-Cone and Cass (2007) found that exposure to prototypic Web sites simulating pro-anorexia environments led to negative emotional effects (lower self-esteem) and cognitive consequences (greater likelihood of engaging in weight control behaviors). In a similar study conducted with an actual Web site, however, Delforterie, et al. (2014) came to the opposite conclusion, viz., that viewing pro-ana sites is not detrimental to body satisfaction. Ghaznavi and Taylor (2015) carried out a content analysis of thinspiration images — images representing extreme thinness — finding that they “are likely to increase self-objectification [and] promote unhealthy standards of beauty” [2]. Lewis, et al. (2011) analyzed self-injury videos shared on YouTube, claiming that they sensationalize cutting, hitting and burning, and thus exacerbate the risk that such practices will spread.

All of these studies, based on artificial contexts or content analyses, point to the possible effects of exposure to self-harm (self-injury and pro-ana) content. However, these investigations relied on methods that do not make it possible to observe the medium for long term trends. In addition, their hypotheses focus on the effects on the public, but not on the motives that drive users to post such content. Lastly, there is no data showing that self-harm practices increase as a result of online accessibility to pro-self-harm content. Indeed, it would appear that the mean prevalence rates of self-injury have stabilized since 2007 (Muehlenkamp, et al., 2012).

Ethnographic and content-analysis studies of actual pro-ana Web sites have not unearthed any desire to promote a disorder, finding only a need to establish social relationships with like-minded people (Overbeke, 2008). A number of scholars have thus called for investigation of self-harm cultures in order to gain an understanding of underlying social dynamics and thus formulate appropriate policies for addressing the issue (boyd, et al., 2011; Yom-Tov, et al., 2012).

In this paper, I will interpret the studies of pro-ana identity in light of theories that view eating disorders (EDs) as culture-bound syndromes. In referring to the online forms of self-representation of people with anorexia-bulimia, I will use the term “ana-mia” (from the contraction of anorexia and bulimia), as it does not have negative connotations and is thus useful in designating ED sufferers independently of how aware they are of having a disorder. I will then describe the findings of an ethnographic study of ana-mia cultures that have emerged on Italian social media. Specifically, I will retrace the evolution of ana-mia cultures to illuminate the relationship between the stigmatization process and self-representation tactics in two different moments of history: in 2010–2011, with the rise of blogs, and in 2017–2018 when visual social networks such as Instagram reached a mass audience.



2. The contradictory nature of eating disorders (EDs)

The American Psychiatric Association defines eating disorders like anorexia nervosa and bulimia nervosa as mental illnesses that have effects on eating behaviors and body image. EDs are a complex condition for which many causes have been suggested and a variety of explanatory models have been constructed. Here, an explanatory model is the narrative framework used by professionals and patients to make sense of disease, establish categories for interpreting it (such as the dividing lines between health and illness) and identify forms of treatment (Fox, et al., 2005).

Clinically speaking, anorexia nervosa is defined as a pathology involving a loss of body weight which is typically normalized through ‘re-feeding’. This clinical interpretation reduces the complexity of EDs to the purely physical dimension, without considering their major implications for identity. Seeking to overcome this limitation, Vandereycken and van Deth (1994) suggested that EDs should be interpreted as “culture-bound syndromes”, or in other words, as syndromes that are specific to the cultural context in which they arise. From this perspective, Giddens (1991) defines anorexia as a pathology of “reflexive self-control” typical of the late modernity. The identity crisis characterizing contemporary society fuels feelings of ontological uncertainty that are kept in check through extreme “bodily regimes”. When attempts at control clash with pangs of hunger and the physiological need for food, anorexic aspirations yield to their antithesis, the bulimic urge: an insatiable need for affection, which translates into uncontrollable eating. The two symptoms — fasting and binging — are the opposite poles of the tension between independence and dependence, between the euphoria of being in control and the recognition that the emotional void can never be filled.

According to feminist scholars Bordo (1993) and MacSween (1993), the late modern identity crisis strikes women hardest. Women use their bodies to gain self-determination and as a form of protest against patriarchal ideology. Nevertheless, though “anorexic thinking” is a source of agency at the beginning, it then becomes an independent force that renders a woman powerless against the illness, thus revealing the contradictory nature of this disorder.

To analyze EDs’ online appearances, we must shift attention away from the purely biological and individual interpretation of these disorders, towards an approach that takes the sociocultural aspects and implications for identity into consideration.

First, it must be borne in mind that for people with an ED, the illness is an extremely important part of themselves. Ana-mias often refuse to contemplate treatment because they fear losing their own identities. If family members or clinicians oblige sufferers to enter recovery, treatment may prove ineffective.

Second, it is important to consider that a process of stigmatization has formed around EDs because of the clinical view that ana-mias are mentally ill. As mental illness is an undesirable attribute, society discredits those who are marked by “symbols of stigma” (Goffman, 1963). In the case of EDs, the symbols that undermine identity are physical traits like excessive variations in weight, practices such as fasting and binge eating or such compensatory behaviors as self-induced vomiting or the use of laxatives. In the online environment, ana-mias control information that is disclosed to avoid being discredited by strangers or being forced to undergo treatment. This makes it difficult for them to establish strong relationships with off-line peers. Ana-mias thus form online communities of practice where they build relationships and receive support from people who bear the same stigma (Gavin, et al., 2008; Juarascio, et al., 2010; Cantó-Milà and Seebach, 2011). Unlike such off-line support settings as self-help groups, these online communities make it possible to interact anonymously in an environment that is always open and accessible, to have greater control over shared information and to receive weak-tie support, as they perceive this advice to be more objective and less emotional than that from strong-tie network members (Potts, 2005; Bell, 2007; Yeshua-Katz, 2015).

Online ana-mia interaction takes place in two different types of environments:

Neat as this distinction may seem, many of the online environments occupy a middle ground, where pro-ana content shares space with recovery-oriented information (Borzekowski, et al., 2010). The contradictory character of ana-mia cultures stems from the inherently contradictory nature of EDs and the difficulty that sufferers have in adhering to a straightforward course of treatment. Not only do different explanatory models coexist in every environment, but the same individual will be interested in recovery at certain times, and at others will succumb again to the illness’ “temptation”.

The consequences of ED sufferers’ interactions in digital environments may be positive or negative, independently on whether the site is pro-ana or pro-recovery, or even has no specific connection with EDs. According to Peebles, et al. (2012), support received from pro-ana sites can be potentially harmful, but can also provide opportunities for interventions. Pallotti, et al. (2017) argue that the opportunities for socialization in ana-mia networks with a high degree of connectedness could help correct perceptual and attitudinal biases about body image. Likewise, Eikey, et al. (2017) found that the use of weight loss apps by ED sufferers can exacerbate or reduce disordered eating behaviors. More generally, young people’s use of social media brings risks — to privacy, for instance — as well as opportunities, e.g., in terms of reflexivity (Livingstone, 2008; boyd, 2014). In the case of EDs, expressing pro-ana identity in an online narrative could externalize the “eating disorder voice” and thus help gain psychological distance between the heathy self and the ill self, thereby moving towards recovery (Dias, 2003). Indeed, when one’s life story is interrupted by illness, narrative can provide the hindsight to make meaning of the past and think of the future (Harter and Bochner, 2009).



3. Ana-mia cultures: A history of censorship and online self-representation

To understand the ana-mia phenomenon, we must move past a deterministic approach and investigate the co-construction of identity: on the one hand, institutions and network users construct a stereotype of pro-anas as deviant individuals, while pro-anas create a contradictory and multi-faceted portrayal of their own identities. Online platforms play a major part in this process, as they reinforce stigmatization by censoring ana-mia content. In addition, the platforms’ socio-technical characteristics influence how users define the social structure and boundaries of the environments where they interact.

The first online ED discussion forums were set up around 1999. A forum like Hungrig-Online, for instance, is an example of a site launched by an association to provide information about EDs (Stommel, 2008). Alongside such “top-down” portals, we also have user-generated environments that their creators themselves dub “pro-ana”: by using a term with underground connotations, they express a clear intention to oppose resistance to the “authoritative voice” of the clinical gaze and, for teenagers, of adults (Dias, 2003; Day, 2010; Crowe and Watts, 2016).

In pro-ana environments, “communities of competence” have emerged that offer an alternative, non-clinical epistemology. These communities seeks to make sense of suffering and provide support to people who feel they cannot live without anorexia, until such time as they are ready to take steps towards recovery. The pro-ana movement does not deny that anorexia is dangerous, but rejects the medical model that regards it as an illness to be treated in specific ways (Fox, et al., 2005; Ward, 2007; Ettorre, 2010).

Reacting to the development of a non-clinical explanatory model for EDs, institutions have launched censorship campaigns. Associations such as the advocacy group ANAD (Anorexia Nervosa and Associated Disorders) and the Royal College of Psychiatrists have demanded that Internet service providers (ISPs) and governments classify pro-ana forums as harmful sites and develop ways of regulating them and of warning and educating potential users (boyd, et al., 2011). Since 2001, Web platforms such as Yahoo!, MSN and AOL have moved to ban such sites and remove pro-ana content (Borzekowski, et al., 2010; Casilli, et al., 2013).

The surge of censorship that started in 2001 was followed from 2005 onwards by a second wave of pro-ana sites that promoted acceptance of all body types while displaying distrust of medical treatments (Ettorre, 2010; Gresham, 2017). On English-language second-generation sites, the pro-ana label was deconstructed in a bid to preserve the right to exist, and EDs were acknowledged to be an illness:

This pro-mia pro-ana Web site is the birth of the evolution of proana, and the start of the second wave pro-anorexia movement [...] a truly pro-active eating disorder support group.

Pro-Ana Nation displays my personal views about societal standards regarding body image, and my complex relationship with an eating disorder, which simply means I have not recovered from my mental illness.

In the second half of the 2000s, there was thus a reduction in the number of overtly pro-ana underground Web sites. In 2007, Borzekowski, et al. (2010) analyzed 180 pro-ana sites, finding that fewer than 20 percent described anorexia as a lifestyle choice and almost 33 percent included recovery-oriented information. In any case, mapping and studying these environments is particularly difficult, as there is a constant state of flux. Casilli, et al. (2013) observed the French ana-mia community for two years between 2010 and 2012, finding a turnover of 50 percent. In addition, the community had reshaped the structure of its social network in less interconnected clusters that were harder to intercept.

The foregoing studies demonstrate that prohibitionist strategies in open networks like the Internet have not only never worked (Castells, 1996), but also hit sites that call themselves pro-ana but show a certain ambivalence towards the label. Ana-mias are thus doubly stigmatized: because EDs are branded as a mental illness, and because their practices are criminalized. For an identity born out of a need for independence, this censorship is especially problematic: it is perceived as a further attempt at control; another otherness to be resisted (Schott and Langan, 2015).

Ana-mias thus reinforce mechanisms for defense from the surrounding world by erecting physical and symbolic access barriers to shield the members of the culture — the ingroup — from the outgroup. The studies that have been carried out in ana-mia communities describe a complex social structure with an internal hierarchy that must defend itself from a variety of foes (Giles, 2006; Boero and Pascoe, 2012; Yeshua-Katz, 2015). These studies dismantle the stereotyped view of pro-ana sites as communities populated by anorexic teenagers, showing that there is in fact a prevalence of normal-weight young woman who have gone through multiple extreme weight control behaviors (Peebles, et al., 2012). The hierarchical structure of ana-mia groups can be reconstructed as follows from the findings of these investigations:

The structure we have just described characterizes online communities on sites and forums. Since 2010, however, there has been a sharp drop in Google searches for “pro-ana” (Figure 1).


Google Trends graph
Figure 1: Google Trends graph (as of 7 March 2018).
Note: Larger version of figure available here.


This drop reflects the migration of ana-mia cultures from Web sites to social networking sites, or SNSs (Cobb, 2017). Over time, SNSs such as Facebook, Pinterest, Tumblr and Instagram have also developed internal policies for dealing with self-harm content. Instagram, for example, uses two strategies for limiting such content: user reporting and automatic blocking. The “Report” function enables users to notify the platform of content they consider offensive or inappropriate. Instagram can then decide to remove the content and in some cases even delete the account. Automatic blocking applies to hashtags that are considered dangerous. When a user does a search with the hashtags #proana or #thinspiration, the message “No hashtag found” is displayed. Hashtags that are considered moderately dangerous result in a public service announcement (PSA) (Figure 2). This is the case of #suicide or #anamia, where the message that appears is: “Can we help?” The message offers three options: (i) tips on how to ask acquaintances for help; (ii) direct contact with support services; and (iii) advice provided by Instagram (e.g., “Look at the sky” or “Wear mismatched socks”).


Instagram Public Service Announcement
Figure 2: Instagram Public Service Announcement (accessed on 30 December 2017).


Ana-mia’s adoption of SNSs has reshaped the culture’s social structure. On SNSs, the communities of practice have morphed into a networked collectivism distributed across multiple platforms (Baym, 2007). Online interaction in these environments leads to the emergence of networked publics where shared content can reach a much broader public and be viewed outside the setting for which it was created (boyd, 2014).

The distributed structure of networked publics makes it more difficult for institutions to deploy control strategies (Pater, et al., 2016) and for ana-mias to mark boundaries between ingroup and outgroup. Content which before was intended for environments such as Web sites is now shared on SNSs, where there is no clear line between private and public space. While Facebook and WhatsApp still have private discussion groups, they have been replaced on Instagram and Twitter by thematic conversations that arise dynamically around the hashtags that users employ in their posts. Thus are born highly dynamic and readily permeable distributed environments. Network users field new social engineering practices to ensure that content can be viewed only by its intended public, and to draw the confines of their imaginary communities.

To avoid being censored or reported, ana-mias try to limit visibility by modifying banned hashtags. For example, #thinspiration becomes #thinspoooo, the hashtag #proana which clearly refers to EDs is replaced by words that make no explicit reference such as #secret_society123 (Pater, et al., 2016; Cobb, 2017). These lexical variations are associated with content that is more isolated from the greater community (Chancellor, et al., 2016) and are more frequent on Instagram than on Twitter, which does not implement hashtag restrictions (Stewart, et al., 2017). Lexical variations tend to set apart the more extreme environments, and lead to a polarization between pro-anas who use hashtags like #anamotivation, #anadiet or #wantobethin, and pro-recovery posters who use hashtags like #edrecovery, #anawarrior or #fuckana. An exception to this polarization stems from the tactics employed by pro-recovery posters to infiltrate pro-ana conversations. In some cases, pro-recovery users employ pro-ana hashtags to try to intercept those who have not yet entered recovery and provide them with support (Yom-Tov, et al., 2012; De Choudhury, 2015).

While the more extreme cultures hide at the edges of the network, the manifestations of ana-mia identity that remain on the surface have crossbred with mainstream cultures. In her ethnographic study of environments such as LiveJournal, We Heart It, Tumbrl, Instagram, Pinterest and Reddit, Cobb (2017) describes how pro-ana culture has evolved to become a “thinspo” (from “thin” and “inspiration”) and “fitspo” (from “fit” and “inspiration”) culture that encourages a focus on diet and fitness to lose weight in a healthy way, promoting a post-feminist ideal of beauty where the cult of thinness does not have pathological implications but, as a result, normalizes pro-ana identity.



4. Methodology: An ethnographic study of Italian ana-mia cultures

The most recent investigations of ana-mia cultures have traced how they have evolved in the face of censorship and convergence on mainstream communication. The quantitative studies indicate that the more extreme groups have gradually become isolated (Casilli, et al. 2013; Chancellor, et al., 2016; Stewart, et al., 2017), while Cobb’s (2017) ethnography described the emergence of a thinspo and fitspo culture. The present study will describe the evolution of the forms of self-representation of ana-mia identity in relationship to stigmatization processes and socio-technological changes in online platforms.

To this end, I carried out an ethnographic study combining covert non-participant observation with content analysis. First, I conducted an explorative multi-sited virtual ethnography (Hine, 2000) which enabled me to formulate the following research questions:

RQ1: What representation do the outgroups create of pro-anas?

RQ2: How do ana-mias relate to the pro-ana label?

RQ3: What needs do ana-mia self-representations express?

RQ4: What is censorship’s impact on ana-mia self-representations?

To answer these questions, I thus combined long-term, non-participant observations with an in-depth analysis of two different contexts during two stages of the development of networked publics in Italy: the rise of blogs (2010–2011) and the mainstreaming of visual SNSs such as Instagram (2017).

I started my exploratory, multi-sited, virtual ethnography of Italian ana-mia cultures in January 2010. One of the reasons I was able to zoom in on these cultures was that I had been a lurker on pro-ana sites for personal reasons well before I developed a scientific interest. Years later in 2010, when I decided to carry out an empirical study of these cultures, I initially used autoethnography (Kiesinger, 1998; Tillmann, 2009) to position myself relative to the object of study (Vellar, 2012). Then, starting in 2011, I immersed myself in ana-mia cultures through covert non-participant observation, dealing exclusively with public material. I chose not to request access to private content in order to maintain the confidentiality of sensitive information such as details concerning health, especially in a population that includes minors.

I identified the different kinds of content that can be accessed by someone surfing the Web by doing a search with the keyword “pro-ana”. In both stages (2011 and 2017), the representation that predominated in the list of the first 50 links was that given by outgroups, who either had a neutral attitude toward the topic (in scientific studies or encyclopedia articles) or expressed stigmatizing viewpoints (in news coverage and personal blogs) (Figure 3).


Types of content on the SERP for the keyword pro-ana
Figure 3: Types of content on the SERP for the keyword pro-ana.
Note: Larger version of figure available here.


In 2011, the first 50 links on the SERP (Search Engine Results Page) included three ana-mia blogs on two different free blog hosting services (Blogger and Splinder). I then used a snowball approach, starting from these blogs’ blogrolls (lists of links to other blogs) to construct a sample of 50 blogs. Afterwards, I collected the images posted on the first page of the 50 blogs, giving me an empirical base of 336 images.

In the following years, I continued to monitor ana-mia cultures, and noted that in Italy, as elsewhere internationally, the number of Google searches for pro-ana content had dropped (Figure 4). I thus hypothesized that Italy has also seen a migration from Web sites and blogs to SNSs.


Google Trend Italia graph
Figure 4: Google Trend Italia graph (as of 7 March 2018).
Note: Larger version of figure available here.


Accordingly, I decided in 2017 to scrutinize what was happening on SNSs. My intention was to construct a sample that would enable me to make comparisons with the data from the previous period. Between January 2017 and May 2017, I searched on Google and then on internal search engines on individual SNSs such as Twitter, Facebook and Instagram. Following this second multi-site exploratory virtual ethnography, I continued with non-participant observation on Instagram between June 2017 and January 2018. I chose Instagram, first because it is growing rapidly both internationally and in Italy [3], and second because visual social media had not been investigated as extensively as textual SNSs but were equally important to an understanding of online communication forms and power relationships (Nakamura, 2008; Highfield and Leaver, 2016).

On Instagram, by contrast with Web sites, blogs and forums, the boundaries of the reference social group and hence of the field under study were not clearly defined. In addition, the hashtag #proana was banned, so it was not possible to access the field by means of the stigmatized word, as is the case with Google.

Consequently, I had to search other terms that are close to ana-mias, but doubtless led me to identify a culture that differs from the one I would have found had the keyword pro-ana not been banned. As Cobb pointed out, this is a structural limitation of empirical studies of digital environments, where the data filtered by online platforms cannot be regarded as pure. Nevertheless, ethnographic study “does draw on data the everyday Internet user would expect to find” [4]. To construct the sample, I used five hashtags identified at the exploratory stage: #anoressia; #anoressiaitalia; #anoressica; #bulimiaitalia; and #bulimica. Using the Instagram Hashtag Explorer tool, I searched the five hashtags, and for each of the five searches I selected ten profiles corresponding to the last ten images uploaded. From these profiles, I collected the nine most recent images, for a total of 424 images [5].

This study’s findings are based on an analysis of material produced by outgroups and ingroups collected during non-participant observation, and on a comparative analysis of two samples of textual and visual data from 50 blogs collected in 2011 and 50 Instagram profiles collected in 2017–2018. The population thus identified is almost exclusively female, with the exception of one male Instagram profile, and consists chiefly of teenagers and young adults. Though not all profiles state the user’ s age explicitly, there are indications such as the photographs or references to school, graduation or university exams. I analyzed data using Qualitative Data Analysis (QDA) software packages such as NVivo 8 and PhotoMesa, which were replaced at a later stage with the Dedoose cloud tool. All data presented for outgroup and ingroup representations are in anonymous form with no reference to the original source, since they were mostly posted by private individuals whose privacy must be guaranteed. Institutional documents such as bills introduced in Parliament are an exception.



5. Results: The pro-ana stereotype and online self-representation as an #anawarrior

RQ1: What representation do the outgroups create of pro-anas?

In Italy, the pro-ana culture is depicted as a criminal culture that contributes to the spread of illness. In 2008, the center-right member of Parliament Beatrice Lorenzin [6], followed in 2014 by the center-left legislator Michela Marzano [7] introduced measures making instigation of anorexia and bulimia a criminal offense. With the pro-ana and pro-mia sites as their main targets, these bills “leveled charges against the over 300,000 sites that in Italy provide practical advice for the obsessive and compulsive pursuit of weight loss.”

Though the bills were never passed, Web users nevertheless accuse the ana-mia sites of being “contrary” to the law, morality and public well-being, as can be seen from online discussions on forums and blogs:

User 1 in a general forum: “It’s illegal to sponsor ana/mia culture by advertising a proana forum or glorifying an anorexic or bulimic lifestyle.”

User 2 in a general forum: “What can we do? if we run into sites like that, how to react? some sort of report to the authorities, do you think that would be ok? or is it too much? but can something for the good of our teenagers’, our daughters’ health, can that be considered too much?”

Comment in an ana-mia blog: “To begin with, as the brother of a girl who suffers from anorexia, I find your behavior not only contrary to morality and public wellbeing, but humanly and morally unseemly, repugnant and contemptuously self-destructive! [...]] I want you to know I will take legal action if you do not delete this page forthwith! Best regards.”

SNS users also wage anti-pro-ana campaigns, as witnessed by the Facebook group called “ANTI pro-ana: because it’s scandalous that a disease is touted as a lifescale!!!.”

The idea behind these protests is that pro-ana environments exist to “spread”, “advertise”, “teach” or “celebrate” an illness:

There are sites that are now dedicated to the “Ana cult” which terrorize with a manifesto where they spout their “ideological” line.

they dispense advice and tips about how to become anorexic and bulimic.

I call them sites that sing the praises of self-destruction, that give advice about how to fast, about how to vomit, etc.

The more sensationalistic aspects of these sites were emphasized, like the portrayal of anorexia as a cult and the representation of extreme diets:

“food diary” is a sort of short daily report where they write what they eat during the day, exposing themselves to the others’ judgement and accepting “precious” “suicidal” advice.

Managing not to eat, not swallowing anything for days on end, doing without a fundamental necessity for the human body. This is what they’re talking about and teaching to girls who are really young, mostly underage. Proclaiming that this is a “lifestyle” or just a diet is the wrong message.

If we read this content in the light of Becker’s (1963) theory of deviance, we can interpret pro-ana environments as a “deviant subculture”. The pro-anas are “outsiders”: by promoting an unhealthy behavior and defining a mental illness as a lifestyle, they violate society’s norms for eating, health and dealing with mental illnesses. And the “moral entrepreneurs” are up in arms against them: network users and institutions that lead the “anti-pro-ana” protests.

RQ2: How do ana-mias relate to the pro-ana label?

A stigmatizing stereotype of pro-ana identity has emerged in the public discourse. Changing vantage point and analyzing the forms of self-representation in ana-mia blogs and Instagram profiles, we see an ambivalent relationship with the pro-ana label.

Some bloggers call themselves “pro-ana” and use the term to describe a “lifestyle”:

it’s an absolutely pro ana blog ... if ur nt interested in this lifestyle please don’t come in; everybody else is welcome !!! =)

Ana is Not a Disorder but a Hard Life Style

We see another part of the pro-ana stereotype in these settings: the cult of the Goddess Ana and her Ten Commandments:

  1. If you aren’t thin you aren’t attractive
  2. Being thin is more important than being healthy
  3. Thou shall not eat without feeling guilty
  4. [...]

This representation is not elaborated on and integrated in the individual identity, but is repeated without variation. As Boero and Pascoe (2012) point out, the references to the Goddess Ana serve to develop a sense of belonging to the ana-mia culture. In addition, portraying anorexia as a goddess can be interpreted as an externalization of “anorexic thinking”, which is central not only to pro-anas, but to anyone who suffers from EDs. Anorexia is a magical or supernatural controlling force, separate from but at the same time inside the woman, which “possesses” the anorexic individual (Giddens, 1991; MacSween, 1993).

By contrast, there is no depiction of the Goddess Ana in the sample of Instagram profiles, and even the label pro-ana is little used because of censorship. Nevertheless, the pro-ana lifestyle is implicit in descriptions that present losing weight as a goal and anorexia as something to be sought after, and that again refer to an external force that “possesses”:




This last description is not that of an anorexic, but rather of a wannarexic, or a person who interprets anorexia as a way of dieting and tries to infiltrate ana-mia cultures (Yeshua-Katz, 2015).

Other ana-mias reject the pro-ana label and describe the profile as a place for self-representation of suffering (“venting”, “diary”, “my life” and “virtual alter ego”). In some cases, the blogs clearly state that they have no intention of promoting anorexia:


This blog’s nt 4 giving advice if u want to become anorexic or bulimic (cuz I don’t want anybody to go thru the HELL we put up with evry day) but its 4 me to vent CUZ IM INSIDE AND CANT GET OUT!

Instagram bios also tend to take their distance from the pro-ana label and offer a self-representation as a “fighter”:

Anorexia. No pro Ana
I’m not pro Ana. I’m pro recovery but I’m not.
Anorexia fighter

Fighting is a recurrent concept, both in the sense of fighting oneself to achieve perfection (“I’m always fighting myself”), and of fighting the illness. In the latter case, the large number of hashtags such as #anawarrior, #anafighter, #fightana and #EDfighter is significant.

Lastly, there are many pro-recovery profiles on Instagram; in some cases, they indicate that the poster has professional support from psychologists, neuropsychiatrists, centers for eating disorders or dietitians:




RQ3: What needs do ana-mia self-representations express?

Through visual representations, Internet users craft their identity, which may be in conflict with the dominant aesthetic (Nakamura, 2008). Accordingly, I analyzed the visual content collected from blogs and Instagram in an attempt to come to grips with the needs expressed by ana-mias. Five themes emerged from the analysis: (i) thinness; (ii) existential anxiety; (iii) self-harm; (iv) self-determination; and (v) food.

The first theme is thinness, associated with models and celebrities, with the ana-mia’s body which is always perceived as imperfect, as well as with the skeleton and the bones, which are also recurrent in textual descriptions (“see the bones protruding”, “bones sticking out all over”) (Figure 5).


Representations of thinness
Figure 5: Representations of thinness.
Note: Larger version of figure available here.


The second type of image can be called representations of “existential anxiety”, as suggested by Giddens’ (1991) theories of late modern identity. These images depict female figures associated with shadows, faceless bodies or phrases bespeaking an identity crisis (“Who am I?”). In other cases, the shadow or the skeleton are an unsettling otherness that accompanies the female figure, giving shape and form to the specter of anorexia or, more generally, depression (Figure 6).


Representations of existential anxiety
Figure 6: Representations of existential anxiety.
Note: Larger version of figure available here.


The third type of image is of self-harm practices such as cutting or suicide, or such typical ED compensatory behaviors as self-induced vomiting (Figure 7). EDs and self-mutilation are often associated (Farber, et al., 2007), and are also highly correlated on online environments like Instagram (Tanner, 2015).


Representations of self-harm practices
Figure 7: Representations of self-harm practices.
Note: Larger version of figure available here.


The fourth type of images represent hopes, including a desire for freedom, balance and self-determination, as expressed by a phrase posted on Instagram: “My body, my rules”, over the caption “enough with letting other people control us like video games” (Figure 8).


Representations of self-determination
Figure 8: Representations of self-determination.
Note: Larger version of figure available here.


An analysis of textual content also shows that hopes go beyond just wanting to be thin. The blogs present wish lists that refer to physical appearance, and in particular to weight (“45, 44, 43, 40 kilos”) and the body (“skinny legs”), but also to the desire to get better and accept oneself:

Overcome mia

Like myself

wake up every morning with a smile

Likewise, the goals expressed on Instagram focus both on losing weight and on getting well, which is seen as a battle:


Being reborn

fighting my battle

never give up! Back to living! Fighting against myself ... falling down but getting back up every time!

The fifth category of images consists of photos of food. Here again, we see a desire for control. Food is kept at a distance, weighed, counted and, on Instagram, arranged in compositions and plates that are intended to convey an idea of order and perfection (Figure 9).


Representations of food
Figure 9: Representations of food.
Note: Larger version of figure available here.


Analyzing the forms of self-representation drew back the curtains on the “popular discourse” of ana-mias, whose digital bodies are the stage for the existential anguish and the crisis of late modern female identity (Giddens, 1991). Ana-mia environments show ambivalence towards the pro-ana stereotype. In some cases, there is a self-representation as pro-ana, whereas in others the users shy away from the label, representing themselves as #anawarriors: people whose daily life is a battle that pits depression against self-determination, where anorexia shuttles between being a guiding force that reassures, and an enemy to be fought. But the temptation to slip back into the illness is always strong. In this process of constructing an identity as an #anawarrior rather than as a pro-ana, what remains constant is the striving for perfection typical of the anorexic (Bordo, 1993). This striving is expressed in control over the body (with the need to see and feel the bones), over one’s weight (with the desire to be thinner), over food (with the obsessive concern with counting and order). On Instagram, this striving is directed to the pro-recovery digital body via the food diaries, accounts where photographs of food are used to bring order to the representation of one’s eating, and thus to bring order and linearity to one’s route to wellness (Figure 10).


Food diary on Instagram
Figure 10: Food diary on Instagram.
Note: Larger version of figure available here.


RQ4: What is censorship’s impact on ana-mia self-representations?

The ana-mia’s self-representations point to a desire for self-determination which is expressed in the need for control over the physical body and the digital body. However, the ana-mia’s digital body belongs to vatious platforms and is thus subject to censorship.

It is significant that out of the 50 blogs identified in 2011, not a single one was still active six years later in 2017: the Splinder platform was shut down and blogs posted on Blogger had also been removed, perhaps by the bloggers, or by the platform itself.

On Instagram as well, accounts are closed and reopened very frequently, partly as a result of being reported. Ana-mias’ daily battle against EDs is flanked by a battle to defend themselves from haters that report their accounts. They react to these attacks by going private with their accounts or creating new ones, and also by re-posting content that had been removed. Phrases in blogs and Instagram bios speak of this battle:

If you hate ME, you’re not the only. But please ... stay off my blog!

Please don’t report, just block

Many profiles post the latter plea, as blocking [8] is preferable to reporting, which can cause the profile to be taken down and thus deny the right to exist online.



6. Discussion: A typology of ana-mia identities on Instagram

The empirical study revealed a representation of ana-mias that is more diversified than that contemplated by the outgroups’ stereotype. For the outgroups, the word pro-ana is associated with groups that promote anorexia. But in the blogs, this keyword brings us to a network of ana-mias that reject the pro-ana label. On Instagram, the dynamics are more complex: as the hashtag #proana is banned, a direct representation of pro-ana cannot be accessed. The decision to analyze the cultures emerging around the hashtags #anoressia, #anoressiaitalia, #anoressica, #bulimiaitalia and #bulimica thus led me to explore a surface culture that expresses needs and fears that are typical of ED sufferers and of the bloggers of previous generations, who refer to themselves expressly as #anawarriors.

On Instagram, the umbrella term #anawarrior covers many different profiles which vary in their relationship with the illness (proana/prorecovery) and the visibility accorded to the representation (public/private). In networked publics, the distinction between private and public is blurred (boyd, 2014) and gives rise to two behaviors (Lange, 2007):

We thus have two axes, proana/prorecovery and publicly private/privately public, which define four different types of ana-mia on Instagram. I have named each type with a representative hashtag (Figure 11).


A typology of ana-mia identities
Figure 11: A typology of ana-mia identities.


The first two types are “publicly private” inasmuch as they make their profile public in order to interact with like-minded people but do not try to achieve a high degree of visibility, which would put them at risk of being reported:

  1. #selfharm: These ana-mias state that they suffer from psychological issues (depression, self-harming tendencies, EDs). They post images of thin bodies (thinspiration) or bodies showing cut marks (self-cutting), sentences and quotations that reflect the feeling that their lives are useless. They use hashtags such as #anoressiaitalia to intercept people like them, but do so sparingly so as not to be too visible.

  2. #EDfighter: State that they are pro-recovery and are taking steps to get well. The profile is presented as a food diary: the posted photos are almost exclusively of food, in some cases healthy and low in calories, in others fattening, to express the courage to face the foods that frighten them most (#fearfood). They share before-and-after photos of their bodies to document their progress towards a normal weight.

The “privately public” profiles are more oriented towards gaining visibility:

  1. #ventpage: As the hashtag implies, ana-mias in this category use these pages to vent their feelings. They post motivational content about depression with quotations from famous authors or images of extreme thinness. They display the number of their followers with pride and declare their willingness to receive private messages from people who need to vent, and to provide support.

  2. #fitfood: Narrate the recovery from EDs. They describe how everyday life passes at school or work and fitness sessions, referring to a diet that may not necessarily be restrictive, but is controlled and aestheticized. In some cases, the posts include promotional content for dietary products (supplements, organic foods, etc.) or the posters’ professional activity (as a trainer, for instance).

The #ventpage and #fitfood profiles can be considered microcelebrities, as they strive for fame with a niche public and construct a “branded self” that conveys an image of authenticity (Senft, 2013; Marwick, 2013). This authenticity is enacted through two strategies: bidirectional exchanges and sharing private information. Thus, #ventpage bios and posts express a willingness to receive venting messages. By contrast, #fitfood posters reveal the more private aspects of their daily battle with EDs; they thus provide people who are having difficulty in entering recovery with a model and with the hope of getting well. The #fitfood identity differs from the thinspo and fitspo culture described by Cobb (2017) in that it does not normalize pro-anas’ typical practices; indeed, it expresses a desire to change from a state of illness to one of health, where the goal is a normal weight, not being thinner. Nevertheless, the anorexic’s characteristic striving for invulnerability and self-mastery does not evolve in substance, but only in form. Though the obsession with thinness weakens, the need for control over one’s self remains: the care lavished on the profile’s appearance and the composition of the dishes, the fanatically regular workouts, the close track kept of the number of followers are all expressions of a kind of self-monitoring and personal branding typical not only of ana-mias, but also of other cultures such as body-builders (Bordo, 1993) or the quantified self movement (Marwick, 2013; Maturo, et al., 2016). Body builders’ attention to form parallels to those of ana-mias: the former in order to increase muscle mass, the latter to reduce fat mass. Self-quantifiers and ana-mias, on the other hand, both track their physical activity and caloric intake. On Instagram, all of these cultures also engage in another kind of quantifying and monitoring: measuring their visibility and fame on the social network.

Ana-mia cultures have thus evolved as a result of changes in the socio-technical system, coming closer to the other cultures characterizing neoliberal society. In the first decade of the twenty-first century, they were confined within closed communities with an internal hierarchy and sharply defined borders. The platforms’ censorship and the rise of SNSs pushed the more extreme cultures into isolation, while the surface ana-mia identities have become part of a larger networked collectivism that expresses the need for self-discipline typical of postfeminist identity in neoliberal societies. The identities with the closest ties to ana-mia cultures (#selfharm e #anawarrior) coexist and at times cross-breed, for example by using hashtags (like #fittness or #eatwell) and quantification tools (apps such as Fitbit and Lifesum) that are shared with more commercial mass media driven cultures (#thinspo e #fitspo) and with the #quantifiedself movement and its use of digital tracking and monitoring services (Figure 12).


Evolution of the ana-mia social structure
Figure 12: Evolution of the ana-mia environments’ social structure [9].
Note: Larger version of figure available here.


The SNSs, and Instagram in particular, are thus a promising socio-technical setting for investigating the evolution of the ana-mia cultures, and more generally, the expressions of post-feminist identity in neoliberal society. For example, it would be interesting to investigate how self-representation and the construction of a digital body into which the need for self-mastery can be channeled encourage the reflexive process and the ascent out of illness.



7. Conclusion

Received opinion holds that pro-ana sites are “sites that promote anorexia”. The pro-ana self-representations that emerge from this empirical study are projections towards an “ego-ideal” (Giddens, 1991) which is a question not only of appearance but also of self-determination, of having power over one’s physical and digital body, in a context — that of being an adolescent or of being a woman — where no other aspect of life can be controlled, as all power is in other hands: those of adults, physicians or society.

In this investigation of the Italian ana-mia scene, I have described the evolution of ana-mia cultures and the stigmatization process operating in digital environments. Stigma is not an attribute of an individual or a group, but is a complex social process where the individual actors participate in their roles as “normal” and “stigmatized” (Goffman, 1963). Recovery in the sense of returning to normal weight, the bills introduced in Parliament and the anti-pro-ana campaigns, and the platforms’ censorship are all attempts to ensure that the “normal” do not have to see the signs of a stigma that embodies the contradictions of the society we live in. Taking down a blog or blocking content with a specific hashtag means denying — or rather, doubly denying — an identity that has already been stigmatized. In addition, treating an identity as deviant is a self-fulfilling prophecy, as it shapes the stigmatized individuals in the image people have of them (Becker, 1963).

This study indicated that the platforms have an important role in the stigmatization process. The procedures that the Google PageRank algorithm uses to order search results and Instagram’s decisions about whether or not to display the results of searches using hashtags that are considered to be problematic are factors that influence the outgroups’ perception of specific cultures, the relational and communication dynamics between ana-mias and, naturally, the practices and findings of scientific investigation.

To describe digital cultures, it is increasingly important to take the platforms as an object of study (Rogers, 2013). Platforms cannot be regarded simply as tools for accessing large amounts of data more quickly and sometimes more cheaply than in the past. The data available on the platforms are in fact partial, and filtered to reflect economic considerations or strategic choices that are often obscure. I would thus like to emphasize the importance of using an ethnographic approach to digital cultures that does not lose sight of the context. Here, the context consists of the relational and semantic environment that enables the researcher to interpret shared content in relation to medium-long term trends such as, for example, ana-mias’ processes of self-representation. And the context also consists of technologies — algorithms and APIs — that on the one hand can facilitate access to information, but also serve the platforms’ own interests and strategies. End of article


About the author

Agnese Vellar is Adjunct Professor in the Department of Cultures, Politics and Society at Università degli Studi di Torino (Italy).
E-mail: agnese [dot] vellar [at] unito [dot] it




2. Ghaznavi and Taylor, 2015, p. 59.

3. In 2017, the most widely used SNSs in Italy were Facebook, YouTube, Twitter and Instagram. YouTube and Instagram grew significantly with in 2017 compared to 2016; see

4. Cobb, 2017, p. 192.

5. I used the Chrome InstaG Downloader plugin for data acquisition.



8. Users who do not want to see certain content can block it. Blocking does not remove the content from the platform.

9. The representation is conceptual and does not depict quantitative data.



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Editorial history

Received 17 March 2018; accepted 3 May 2018.

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This paper is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

#anawarrior identities and the stigmatization process: An ethnography in Italian networked publics
by Agnese Vellar.
First Monday, Volume 23, Number 6 - 4 June 2018