Is banning content that is thought to “promote” eating disorders such as anorexia nervosa (pro-ana) a good idea? I want to put aside the question of whether the goal is even possible (I would argue that it is not) and focus instead on what might happen if pro-ana content is banned or threatened to be banned from mainstream social networks, blogging platforms, and web hosts.

If you only read mainstream news media, you might think that pro-eating disorder websites are evil communities seeking to lure unsuspecting young adolescents into a world of extreme dieting, lying, and who knows what else, all under the guise of being a “lifestyle.”

Well, as I’ve blogged before, the picture is not so simple:

Ultimately, it seems that the support on offer on pro-ana websites is—for all the scare stories about “purging tips” and users egging one another on with their latest BMIs—little more than sympathetic companionship in a safe, anonymous and largely sympathetic environment […] these virtual social networks engender a high degree of loyalty and exclusivity that resembles that of tight-knit offline friendship groups, counter-cultural knots of teens sheltering in the corner of the schoolyard from the more conventional “popular” students. […] Our belief is that it is difficult to claim that pro-ana sites encourage non-eating disordered people to become eating disordered, and so their direct effect on “vulnerable” individuals may have been overstated. The most potentially problematic aspect of the sites, however, is that they offer their users something of a social mirage: the sense of support, connection, and social interactions that they lack in their offline environment.

In another, recent and much publicized study, Daphna Yeshua-Katz and Nicole Martins (2012) reported similar results:

Participants were motivated to blog because they found social support, a way to cope with a stigmatized illness, and means of self-expression. Participants described blogging as a cathartic experience and perceived the social support they received from other members of the pro-ana community as a benefit. The fear that the eating disorder will be revealed if the blog is exposed and the concern that the blog encourages disordered eating were the perceived negative consequences of maintaining such a blog. Thus, blogging about anorexia serves to both alleviate and trigger anxiety about living with this stigmatized illness.

I would never claim that pro-eating disorder websites are wholly beneficial or that they are all the same–but I would never claim that about any treatment modalities either. (I’ve blogged before about potential negative effects of inpatient eating disorders treatment.)

But getting back to the question at hand: is banning pro-ana a good idea? What happens when social networking sites or blogging platforms announce a decision to ban pro-eating disorder content?

Well, the answer, as it turns, is “nothing good” from the perspective of health care providers and anybody else trying to reach out to those communities.

In a recent paper, A. Casilli, F. Pailler, and P. Tubaro (2013) show that the effect of “regulatory pressure” and “social stigma” on the number of blogs with pro-eating disorder content is basically nil. The number of websites captured using a web-mining tool (Navicrawler) in March 2010, before Pinterest and Tumblr announced their decision to ban all pro-eating disorder content, and March 2012, after the announcements, is virtually the same: 559 in 2010 versus 593 in 2012.

So, according to this analysis, attempts to decrease blogs with pro-eating disorder content have been unsuccessful.

But that’s not the whole story.

Despite the fact that the size of the network (the number of blogs) stayed roughly the same, there was almost a 50% turnover–with only 296 blogs surviving from 2010 to 2012. There were many long-lasting blogs at the center of the network with many new and ephemeral ones starting and closing around the main hubs of activity.

Here is where the bad news comes in.

While the number of blogs stayed the same, the connections between the blogs changed in such a way as that surviving blogs “have higher brokerage capacity, often acting as ‘gatekeepers’ able to allow, but also to prevent or restrict, information bridge them. In terms of information circulation, that favours redundancy: subgroups of ana-mia bloggers will exchange messages, links and images among themselves and exclude other information sources.”

What does all of this mean?

Consequently, any health information or awareness campaign is now less likely to reach out to [pro-eating disorder] bloggers. If in 2010, such a campaign would target the websites in the middle of the graph so that they relay the message to the margins, in 2012 the middle is virtually deserted, and the chances of spreading public health relevant information are lower. In sum, censorship means bad news for health care providers and policy makers alike. These results cast serious doubts on the effectiveness of repression. Bloggers anticipate even potential restrictions by reshaping the structure of their social network in dense, less and less interconnected clusters. It will become increasingly hard for physicians, families and charities to reach out to [pro-eating disorder] online communities if they become ever more secluded and inward-oriented.

As far as I see it, in practical terms it means that information about treatment opportunities (such as participating in a study), awareness campaigns, or information about new health lines or recovery websites, are less likely to reach pro-eating disorder bloggers. This is bad news.

Right now, many individuals who follow my Science of Eating Disorders Tumblr either run blogs that are devoted to thinspiration or are active members of pro-eating disorder communities. Membership in pro-eating disorder communities and pro-recovery or neutral communities is not something that is mutually exclusive–a point that often seems to get missed in discourse on this topic.

If these communities are pushed into the depth of the internet, into isolated and tightly knit communities, off mainstream social media and blogging websites, then reaching those communities will be harder. This isolates these individuals even more AND it isolated (or creates a big gap) between the individuals trying to reach them.

While having pro-eating disorder content on Instagram might be annoying, it makes it more likely that friends or family of the individual who is posting that content discover it and approach the individual. Perhaps friends will realize there’s something wrong. If I come across a blog with a lot of pro-ana content and that individual lives in my area, I can offer them real-life, in-person support AND I can provide them with information about local support groups and treatment opportunities. At the very least, I can chat with them on Skype and provide them with support.

Banning and censoring will not work. What it will do, however, is sweep the content under the “rug.” It likely won’t make a dent in decreasing the number of communities, it will just result in more concentrated and more isolated communities elsewhere online–places that awareness groups, families, friends, and physicians are much less likely to discover and thus much less likely to reach.

(You can read more about the study here from Antonio Casilli.)

References

Casilli, A., Pailler, F., & Tubaro, P. (2013). Online networks of eating-disorder websites: why censoring pro-ana might be a bad idea. Perspectives in Public Health, 133 (2), 94-5 PMID: 23467530