Eating Disorders and the Internet: A Descriptive Cross-Sectional Study Monitoring The Pro Ana Phenomenon in An Italian Sample.

Abstract

Background: The Internet is a significant source of information for adolescents, affecting their life and health. The online Pro Anorexia (Pro Ana) phenomenon is a growing danger. The purpose of this study is to evaluate the presence of the Pro Ana phenomenon in an Italian sample of patients affected by Eating Disorders.Methods: This study is a descriptive cross-sectional analysis that examines two different samples of patients affected by eating disorders at different points in time, in 2017 and 2020. This study was conducted by using a seven-item anonymous questionnaire specifically developed by the authors to collect data on knowledge and visitation of websites and Social Networks Sites related to "pro-ana" and "thinspiration" content. Results: More than 80% of the respondents in both samples use the Internet daily. From 2017 to 2020 we observed a rise of the phenomenon among the adolescents of our sample. In 2020 76% of the patients knew of sites emphasizing a marked thinness as an ideal of beauty, 60% knew of Pro Ana sites and 22% visited them. Conclusions: Our data confirm that in Italy too, Pro Ana is a diffused phenomenon, of which clinicians need to be consistently aware especially when treating adolescents with ED. Patients with ED mainly visit diet and nutrition sites, and it is important to acknowledge this practice in order to prevent and address ED in early adolescence. Although few subjects claim to visit Pro Ana websites, the majority is aware of these sites and therefore they are potential users. Many patients assert that they are familiar with websites promoting excessive thinness as ideal beauty, which supports the bio-psycho-social etiopathogenetic model of Anorexia Nervosa. Information sharing and prevention work are important forms of interventions for families, teachers and clinicians, who together care for adolescent patients with ED.Level of evidence: Level IV (descriptive, cross-sectional study examining case series of patients with Eating Disorders)

The use of TikTok among children and adolescents with Eating Disorders: experience in a third-level public Italian center during the SARS-CoV-2 pandemic

“…A recent cross-sectional study conducted in Italy on patients with ED [13] documented that more than 80% of the respondents used Internet daily. From 2017 to 2020, the authors observed a rise of the pro-Ana phenomenon among adolescents.…”

“…Due to the absence of previous surveys on TikTok use in the medical literature, we developed an anonymous questionnaire to survey our patients. The questionnaire included items that we drew from the medical literature on the general use of the Internet and of social networking sites among children and adolescents with ED [13,20,35,38]. Two authors (J.P., M.D.R.)…”

“…Specifically, multifactorial hypotheses on the pathogenesis of ED distinguish among predisposing (genetic, biological, individual and family psychological, social), precipitating (abuse, illness, divorce) and maintenance (hormonal and neurotransmission imbalances) factors [10,11]. In recent years, the role of Internet use in the pathogenesis of ED has been repeatedly studied [12,13].…”

“…This may refer to websites, blogs, or communities that enhance AN and provide users with advice on how to achieve AN and its commonly-referred features. Similarly, pro-Mia, which stands for pro-Bulimia, means "promoting Bulimia Nervosa" (BN) [13,14]. Pro-Ana and pro-Mia (pro-ED) communities promote ED as a lifestyle choice rather than as disorders that ought to be treated [15][16][17][18].…”