Pro-ana

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Promotion of anorexia is the promotion of behaviors related to the eating disorder anorexia nervosa. It is often referred to simply as pro-ana or ana. [1] The lesser-used term pro-mia refers likewise to bulimia nervosa [2] and is sometimes used interchangeably with pro-ana. Pro-ana groups differ widely in their stances. Most claim that they exist mainly as a non-judgmental environment for anorexics; a place to turn to, to discuss their illness, and to support those who choose to enter recovery. Others deny anorexia nervosa is a mental illness and claim instead that it is a lifestyle choice that should be respected by doctors and family. [1]

Contents

Pro-ana sites often feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. The scientific community recognises anorexia nervosa as a serious illness. Some research suggests anorexia nervosa has the highest rate of mortality of any psychological disorder. [3]

Culture

Medical professionals treating eating disorders have long noted that patients in recovery programs often "symptom pool", banding closely together for emotional support and validation. [4] In this context, people with anorexia may collectively normalize their condition, defending it not as an illness but as an accomplishment of self-control and an essential part of their identity, with some members of these online communities going as far as claiming that starving oneself is a lifestyle choice rather than an illness. [5] These 'lifestyle' claims may be a symptom of anosognosia. Other community members band together for support in managing their illnesses, such as sharing harm reduction tips and having others to talk to about their experiences that are going through the same thing. Many individuals in pro-ana communities use the phrase "pro for myself, not anyone else" to indicate that they are only interested in furthering their own disorders, not encouraging anyone else to imitate their behavior.[ citation needed ]

Online presence

Such advocacy has flourished on the Internet, mainly through tight-knit support groups centred on web forums and social network services such as Tumblr, Xanga, [6] LiveJournal, Facebook and Myspace. [7] [8] These groups are typically small, vulnerable, partly hidden and characterized by frequent migrations. [9] They also have a high female readership and are frequently the only means of support available to socially isolated anorexics. [10]

Members of such support groups may:

Many have popular blogs and forums on which members seek companionship by posting about their daily lives [18] or boasting about personal accomplishments of weight loss. The communities centred on such sites can be warmly welcoming (especially in recovery-friendly groups) or sometimes cliquish and openly suspicious of newcomers. [19] [20] In particular, hostility is often leveled at:

Thinspiration

Pro-ana sites often (84%, in a 2010 survey [11] ) feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. [22] Pro-ana bloggers, forum members and social networking groups likewise post thinspiration to motivate one another toward further weight loss. [8] Conversely, reverse thinspiration features images of fatty food or overweight people intended to induce disgust. There exists significant controversy between supporters and opponents of thinspiration; some assert that thinspiration only "glorifies" eating disorders [23] while some thinspiration bloggers argue that the purpose of thinspiration is to support a healthy level of weight loss. [24]

Thinspirational clips circulate widely on video sharing sites, [25] pro-ana blogs often post thinspirational entries, and many pro-ana forums have threads dedicated to sharing thinspiration. Thinspiration can also take the form of inspirational mantras, quotes or selections of lyrics from poetry or popular music [26] (94% of sites in a 2003 survey [27] ).

Thinspiration often has a spiritual-ascetic flavour, referring to fasting through metaphors of bodily purity, food through allusions to sin and corruption, and thinness through imagery of angels and angelic flight. Exhortations like "Ana's Creed" and "The Thin Commandments" are also common. [12] [28]

Appeal

Social researchers studying pro-ana have varied explanations for its popularity, with some characterizing it as a rejection of modern consumerism [29] and others suggesting that pro-ana functions as a coping mechanism for those already emotionally stressed by eating disorders. [30] However, most agree on two elements of pro-ana sites:

Fashion

Red bracelets are popularly worn in pro-ana, both as a discreet way for anorexics to socially identify and as a tangible reminder to avoid eating. Pro-mia bracelets, likewise, are blue or purple. [32] [33] Most such bracelets are simple beaded items traded briskly on online auction sites. [34] [35]

Impact

Proliferation

Pro-ana has proliferated rapidly on the Internet, with some observers noting a first wave of pro-ana sites on free web hosting services in the late 1990s, [4] [36] and a second wave attributed to the recent rise of blogging and social networking services. [37]

A survey by Internet security firm Optenet found a 470% increase in pro-ana and pro-mia sites from 2006 to 2007. [38] A similar increase was also noted in a 2006 Maastricht University study investigating alternatives to censorship of pro-ana material. In the study, the Dutch blog host punt.nl began in October 2006 presenting visitors to pro-ana blogs on its service with a click-through warning [39] containing a disparaging message and links to pro-recovery sites. Although the warnings were a deterrence (33.6% of the 530,000 unique visitors logged did not proceed past the warning), the number of such blogs actually increased tenfold, with their monthly traffic figures doubling on average by the end of the study. [40] [41]

Viewership

In a 2009 survey by the Katholieke Universiteit Leuven of 711 Flemish high school students aged 13–17, 12.6% of girls and 5.9% of boys reported having visited pro-ana websites at least once. [42] In another 2009 survey, by parental control software vendor CyberSentinel of 1500 female Internet users aged 6–15, one in three reported having searched online for dieting tips, while one in five reported having corresponded with others on social networking sites or in chat rooms for tips on dieting. [43]

Visitors to pro-ana web sites also include a significant number of those already diagnosed with eating disorders: a 2006 survey of eating disorder patients at Stanford Medical School found that 35.5% had visited pro-ana web sites; of those, 96.0% learned new weight loss or purging methods from such sites (while 46.4% of viewers of pro-recovery sites learned new techniques). [44]

Effect

Pro-ana sites can negatively impact the eating behavior of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased caloric intake by an average of 2,470 calories (301 min -7851 max) per week after viewing pro-ED (eating disorder) websites. [45] Only 56% of participants actually perceived the reduction in their intake. [45] Three weeks after the experiment, 24% of participants reported continuing weight control strategies from pro-ana websites, though they did not continue to visit those sites. [45] Controls viewing health and travel websites did not decrease caloric intake at a significant level. [45] Other studies have found that women with varying levels of eating disorder symptomatology were more likely to engage in image comparison and exercise after viewing pro-ana websites versus control websites. [46] [47]

Pro-ana sites can negatively impact cognition and affect. Women who viewed a pro-ana site, but not control sites focused on fashion or home décor, experienced an increase in negative affect and decreases in self-esteem, appearance self-efficacy, and perceived attractiveness. [46] [47] They also reported feeling heavier and being more likely to think about their weight. [46] [47] The effects of perfectionism, BMI, internalization of the thin ideal, and pre-existing ED symptomatology as moderators of negative affect were comparable to chance, suggesting that pro-ana websites can affect a broad spectrum of individuals, not simply those with ED characteristics. [46]

A 2007 survey by the University of South Florida of 1575 girls and young women found that those who had a history of viewing pro-ana websites did not differ from those who viewed only pro-recovery websites on any of the survey's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and dietary restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who did not. [48]

Similarly, girls in the 2009 Leuven survey who viewed pro-ana websites were more likely to have a negative body image and be dissatisfied with their body shape. [42]

A 2012 report by Deloitte Access Economics, commissioned by Australian non-profit The Butterfly Foundation, estimated that eating disorders resulted in productivity losses totaling just over $AUD15 billion, with 1828 (515 males and 1313 females) dying that year from eating disorder-related complications. [49]

Social support vs. exacerbation of illness

Unlike pro-ana sites, pro-recovery sites are designed to encourage development and maintenance of healthy behaviors and cognitions. A study of pro-ana and pro-recovery website use among adolescents with eating disorders found that adolescents used both types of websites to further eating disordered behaviors. [50] Those who viewed pro-ana sites were comparable to those who viewed pro-recovery sites with respect to appearance dissatisfaction, restriction, and bulimic behaviors. [50] Over half of parents were unaware of any ED website usage. [50]

People who use pro-ana sites report lower social support than controls and seek to fill this deficit by use of pro-ana sites. [51] While pro-ana site users in this study perceived greater support from online communities than offline relationships, they also reported being encouraged to continue eating disorder behaviors. [51] Users of pro-ana sites (n=60) cited a sense of belonging (77%), social support (75%), and support for the choice to continue current eating disorder behaviors (54%) as reasons for joining a pro-ana site. [51] Reasons for continuing to use a pro-ana site included general support for stress (84%), meeting others with eating disorders (50%), and finding triggers for eating disorder behaviors (37%). [51] Finally, behaviors first learned after visiting a pro-ana site include using thinspiration (63%), hiding eating disorder behaviors (60%), fasting (57%), using diuretics and laxatives (45%), vomiting (23%), using alcohol or other drugs to inhibit appetite (22%), and self-harm (22%). [51]

Some studies, however, claim that the link between pro-ana websites and increased incidence of eating disorders are not strongly linked; instead, these communities have just increased the visibility of those affected. [52] [53] [54] [55] It's possible that health professionals and academics are eager to place blame on these communities because of this increased visibility and being an "easy target" for understanding the complex problem of root causes of eating disorders. [56]

Controversy and criticism

Many medical professionals and some anorexics view pro-ana as a glamorization of a serious illness. [57] Pro-ana began to attract attention from the mainstream press [4] when The Oprah Winfrey Show aired a special episode in October 2001 focusing on pro-ana. [58] Pressure from the public and pro-recovery organizations led to Yahoo and GeoCities shutting down pro-ana sites. [18] In response, many groups now take steps to conceal themselves, [36] disclaim their intentions as neutral and recovery-supportive (58% of sites in a 2006 survey), [12] or interview members to screen out the non-eating disordered. [59]

Medical profession

Health care professionals and medical associations have generally negative views of pro-ana groups and the information they disseminate: [60]

Media

In October 2001, The Oprah Winfrey Show hosted a special on anorexia; the pro-ana movement was discussed briefly by the guest panel, who expressed alarm at the appearance of pro-ana websites and recommended the use of filtering software to bar access to them. [58]

In July 2002, the Baltimore City Paper published an investigative report into pro-ana on the web. [70]

"Growing up Online", a January 2008 episode of the PBS Frontline television program, also featured a brief discussion of pro-ana. [71]

The 2009 novel Wintergirls features a protagonist with anorexia, who at one point in the novel seeks support from a pro-ana forum, referring to the people there as “her sisters” and “the only people that understand”.

In April 2009, The Truth about Online Anorexia, an investigative documentary about pro-ana on the Internet, aired on ITV1 in the UK presented by BBC Radio 1 DJ Fearne Cotton.[ citation needed ]

In April 2012 speech at Harvard University, Vogue Italia editor Franca Sozzani conceded that the fashion industry may be a cause of the recent rise in eating disorders, but that the industry was being unfairly singled out for blame: "How can all this be possibly caused by fashion? And how come that Twiggy, who would be surely considered an anorexic today, did not arise controversy in the Sixties and did not produce a string of anorexia followers?" According to Sozzani, pro-ana sites were more effective at promoting eating disorders, and obesity was the more pressing public health problem that food industry was not being likewise attacked for exacerbating. [72]

The existence of pro-ana blogs and forums was featured in the 2014 Lifetime film Starving in Suburbia , which starred Polish actress Izabella Miko as "ButterflyAna", a beautiful model and moderator on the internet who promotes anorexia religiously to the followers of her blog. This entices teenager Hannah (Laura Wiggins) to become severely anorexic; this was also the first Lifetime film to address the subject matter of anorexia among men and boys, when Hannah's brother, Leo, is revealed to suffer from anorexia and later dies due to health complications from the disorder. [73] [74]

Arts

An image from Ivonne Thein's Thirty-two kilos, a collection of digitally altered photographs satirizing thinspiration Thirty-two kilos (5).jpg
An image from Ivonne Thein's Thirty-two kilos, a collection of digitally altered photographs satirizing thinspiration

Thirty-two kilos, an exhibition by photographer Ivonne Thein, went on display at the Berlin Postfuhramt art exhibition center in May 2008 [75] and the Washington Goethe-Institut in January 2009, featuring photographs of young women digitally manipulated to appear skeletally thin. Thein said that the photographs were intended as a mocking and satirical take on pro-ana. However, many images from the exhibition were nevertheless later shared online as thinspiration. [76]

Social networking services

In July 2001, Yahoo—after receiving a letter of complaint from ANAD—began removing pro-ana sites from its Yahoo Clubs (now Yahoo Groups) service, stating that such sites endorsing self-harm were violations of its terms of service agreement. [77] [78]

LiveJournal has not made a position statement on pro-ana. In August 2007, however, a staff member declined to act on an abuse report filed against a pro-ana community hosted on its network, stating that:

Suspending pro-anorexia communities will not make anyone suffering from the disorder become healthy again. Allowing them to exist, however, has several benefits. It reassures those who join them that they are not alone in the way they feel about their bodies. It increases the chance that the friends and loved ones of the individuals in the community will discover their disorders and assist them in seeking professional help. [79]

Facebook staff seek out and regularly delete pro-ana related groups. A spokesperson for the online service has stated that such pages violate the site's terms of service agreement by promoting self-harm in others. [80]

MySpace does not ban pro-ana material and has stated that

"it's often very tricky to distinguish between support groups for users who are suffering from eating disorders and groups that might be termed as 'pro' anorexia or bulimia. Rather than censor these groups, we are working to create partnerships with organisations like b-eat."

MySpace has chosen instead to cycle banner advertisements for pro-recovery organizations through pro-ana members' profiles. [60]

In November 2007, Microsoft shut down four pro-ana sites on the Spanish-language version of its Spaces social networking service at the behest of IQUA, the Internet regulatory body for Catalonia. [81] A Microsoft spokesperson stated that such sites "infringe all the rules on content created by users and visible on our sites". [82]

In September 2008, San Sebastián-based Spanish-language web portal Hispavista  [ es ] removed its pro-ana forums at the request of the provincial prosecutor for Guipúzcoa and the Children's Ombudsman of Madrid  [ es ], who stated that "while not illegal, the harmful and false information in such forums being disseminated to minors will impair their proper development." [83]

In February 2012, after consulting with NEDA, [84] the blog-hosting service Tumblr announced that it would shut down blogs hosted on its microblogging service which "actively promote or glorify self harm," including eating disorders, [85] and display warnings with names of organizations that can help facilitate recovery in people affected by eating disorders, on searches for common pro-eating disorder terms. [86] Despite this, Tumblr remains a large hub for pro-ana microblogging. [87] Pinterest, a social photo-sharing site, similarly amended its TOS [88] in March 2012 to ban pro-ana content, [84] but was similarly unsuccessful. [89] Instagram followed suit and announced in April 2012 that it would summarily disable any accounts on its photo-sharing service with pro-ana specific hashtags on images. [90]

TikTok's algorithm has been criticized for amplifying pro-ana content. [91]

Politics

In the United Kingdom, 40 MPs signed an early day motion tabled in February 2008 by the then Liberal Democrats member for Cheadle, Mark Hunter, urging government action against pro-ana sites. [92] The motion was timed to coincide with the UK National Eating Disorder Awareness Week. [93] [94]

In the United Kingdom, Jo Swinson, the Liberal Democrat member for East Dunbartonshire, called for advertisers to voluntarily adopt similar disclaimers in an adjournment debate in October 2009, and later in an early day motion tabled in February 2010. She has stated that such "photos can lead people to believe in realities that, very often, do not exist," and that "when teenagers and women look at these pictures in magazines, they end up feeling unhappy with themselves." [95]

In April 2008, a bill outlawing material which "provokes a person to seek excessive thinness by encouraging prolonged restriction of nourishment" was tabled in the French National Assembly by UMP MP Valérie Boyer. It imposes a fine of €30,000 and two years imprisonment (rising to €45,000 and three years if there was a resulting death) on offenders. [96] [97] [98] Health minister Roselyne Bachelot, arguing for the bill, stated that "giving young girls advice about how to lie to their doctors, telling them what kinds of food are easiest to vomit, encouraging them to torture themselves whenever they take any kind of food is not part of liberty of expression." [99] The bill passed the National Assembly, [100] but stalled in the Senate, where a June 2008 report by the Committee of Social Affairs emphatically recommended against such legislation and instead suggested early-screening programs by schools and physicians. [101]

Boyer subsequently introduced another bill in September 2009 to mandate disclaimers on photographs in which body parts have been retouched, with the aim of reducing the impact of unrealism in photography on young girls and women. [102] The bill was ostensibly targeted at advertising photography but could be broadly applicable to digitally manipulated photography in general, including thinspirational montages. It imposes a penalty of €37,500 per violation, with a possible rise to 50% of the cost of each advertisement. [103] The bill did not pass its first reading and was relegated to the Committee of Social Affairs. [104]

In April 2009, Dutch Minister for Youth and Family André Rouvoet called for click-through warnings to be added to all pro-ana sites on Dutch hosting services, citing a successful trial of such warnings by blog host punt.nl in 2006. The Dutch Hosting Provider Association, however, has stated that "the Internet is simply a reflection of a world with many undesirable things", and that its members cannot be held responsible for monitoring and disclaiming all hosted content. [105]

In March 2012, the Israeli Knesset passed a bill sponsored by Kadima MK Rachel Adato and Likud MK Danny Danon requiring advertisements which have been retouched to alter the body shape of models to fully disclose the fact. The bill, which applies to both foreign-produced and locally produced advertising, also sets a lower BMI limit for models featured in advertisements of 18.5 (the threshold of underweight under World Health Organization guidelines). [106] [107] [108]

In a November 2009 interview with Women's Wear Daily , model Kate Moss gave a popular thinspirational slogan as her motto: "Nothing tastes as good as skinny feels." [109] Moss came under widespread criticism—particularly by eating disorder recovery organizations—for endorsing pro-ana. Her agency, Storm, stated: "This was part of a longer answer Kate gave during a wider ranging interview which has unfortunately been taken out of context and misrepresented." [110] Still, Moss has been known in the fashion world to have helped popularize the "heroin chic" trend, which uses models with disheveled, ultra-skinny, and waif-like body types on the runway. [111]

See also

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known simply as bulimia, is an eating disorder characterized by binge eating, followed by purging or fasting, as well as excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Orthorexia nervosa is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, who suggested that some people's dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other healthy human activities, and, in rare cases, severe malnutrition or even death.

Perfectionism, in psychology, is a broad personality trait characterized by a person's concern with striving for flawlessness and perfection and is accompanied by critical self-evaluations and concerns regarding others' evaluations. It is best conceptualized as a multidimensional and multilayered personality characteristic, and initially some psychologists thought that there were many positive and negative aspects.

<span class="mw-page-title-main">Beat (charity)</span> Charity in United Kingdom

Beat is the UK's leading charity supporting those affected by eating disorders and campaigning on their behalf. Founded in 1989 as the Eating Disorders Association, it celebrated its 30th anniversary in 2019.

Sexual anorexia is a term coined in 1975 by psychologist Nathan Hare to describe a fear of or deep aversion to sexual activity. It is considered a loss of "appetite" for sexual contact, and may result in a fear of intimacy or an aversion to any type of sexual interaction. The term largely exists in a colloquial sense and is not presently classified as a disorder in the Diagnostic Statistical Manual.

Some claim that the history of anorexia nervosa begins with descriptions of religious fasting dating from the Hellenistic era and continuing into the medieval period. A number of well known historical figures, including Catherine of Siena and Mary, Queen of Scots are believed to have suffered from the condition. Others link the emergence of anorexia to the distinctive presence of an extreme fear of being overweight despite being underweight which emerged in the second half of the 19th century and was first observed by Jean Martin Charcot and other French psychiatrists at the Salpetrière

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

Wannarexia, or anorexic yearning, is a label applied to someone who claims to have anorexia nervosa, or wishes they did, but does not. These individuals are also called wannarexic, "wanna-be ana" or "anorexic wannabe". The neologism wannarexia is a portmanteau of the latter two terms. It may be used as a pejorative term.

<span class="mw-page-title-main">Anorexia mirabilis</span> Near-starvation religious fasting

Anorexia mirabilis, also known as holy anorexia or inedia prodigiosa or colloquially as fasting girls, is an eating disorder, similar to that of anorexia nervosa, that was common in, but not restricted to, the Middle Ages in Europe, largely affecting Catholic nuns and religious women. Self-starvation was common among religious women, as a way to imitate the suffering of Jesus in his torments during the Passion, as women were largely restricted to causing themselves voluntary pain by fasting, whereas holy men experienced suffering through physical punishment.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

Cognitive remediation is designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved psychosocial functioning.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Paul E. Garfinkel is a Canadian psychiatrist, researcher and an academic leader. He is a professor at the University of Toronto and a staff psychiatrist at Centre for Addiction and Mental Health (CAMH).

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Atypical anorexia nervosa is an eating disorder in which individuals meet all the qualifications for anorexia nervosa, including a body image disturbance and a history of restrictive eating and weight loss, except that they are not currently underweight. Atypical anorexia qualifies as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), under the category Other Specified Feeding and Eating Disorders (OSFED). The characteristics of people with atypical anorexia generally do not differ significantly from anorexia nervosa patients except for their current weight.

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