A colleague recently brought to my attention a ‘pro-ana’ thread he had noticed on Twitter. He was horrified by what he read and I can see why. Twitter exchanges and message boards like this, consist of young women swapping tips on how to maintain a dangerously low weight and provide each other with ‘thinspiration’ pictures of sinewy celebrities. Pro-ana networks are a world of women with glossy hair, gleaming skin and sculpted cheekbones. There are no pictures of bad skin, thinning hair or infertility (difficult to photograph I accept), and there are certainly no stories about the death toll of eating disorders. I, like my colleague, initially recoiled from these groups. It’s hard to avoid concluding that they maintain distorted thinking, fetishise a dangerous aesthetic and uphold judgments of women based on their weight. I started to think about writing a blog about shutting them down. However, when my initial horror abated, I began to wonder why people access them and what needs pro-ana groups seek to fulfil.

The overall message of pro-ana groups is that young people can support each other by encouraging and celebrating weight loss while helping to overcome barriers such as hunger and familial concern. While this makes for uncomfortable reading, I cannot help but notice that among the negative images there is an undercurrent of validation and hope for the future. When the administrators of pro-ana groups are challenged, they invariably respond that they are not promoting anorexia but are helping to support people who choose to live a ‘low weight lifestyle’. Indeed, it appears that they are utilising the cornerstones of a therapeutic alliance to do so. Our initial anxiety about pro-ana groups is not misplaced, but I do feel it is a complex issue. A point I have seen made several times is that, without access to the pro-ana network, some individuals might be more at risk. I confess that I think this argument may have value.

While those perpetuating the sites clearly have views I contest about the benefits of a ‘low weight lifestyle’, they are correct that the young people who access them would be likely to receive no support at all if they did not use their online profiles to reach out to others. While I think we have good reason to believe that what these groups provide is potentially unhelpful, especially given the competitive element of the condition for some anorexia sufferers, it is apparent that they fulfil real needs for some, especially those who struggle to access alternatives.

I know that there are support groups out there, run both by charities and the NHS, for those suffering from eating disorders. However, mental health professionals are trained to be change focused. If people are not ready to change we tend to view them as ‘not ready for therapy’ and, often with heavy hearts, we discharge them. In my short career I have already had numerous experiences of ending therapy with people who ‘just aren’t at the point of change yet’. So what is there for these people? What does society provide for people with eating disorders who are living exhausted, confused, anxious lives but don’t yet feel strong enough to give up their perceived sources of emotional support? Well, unfortunately one answer might be the pro-ana community who, so far as they are concerned, will provide them with validation without the pre-requisite of change.

While we recognise that for many sufferers eating disorders provide a sense of stability and control, we make no attempt to provide them with an alternative before asking them to state an intention of giving this up. There are no assertive outreach teams commissioned to get alongside these people and provide the support which may eventually enable them to think about change. So why does someone need to be contemplating change before we will help them?

Perhaps it is our perception of people with eating disorders which limits our sense of responsibility to help. These people often appear to live relatively functional lives compared with others accessing secondary mental health services. We are not often openly confronted with the risk of death associated with anorexia in our therapy rooms as few express openly suicidal thoughts. In addition, there is a tendency to see anorexia as a middle class problem, a side effect of privilege that afflicts those without ‘real’ problems as well as teenagers seeking attention from busy parents. The difference in service provision, when you compare eating disorders with early intervention for psychosis and drug and alcohol services, is stark. Perhaps we need to ask ourselves if this is acceptable given the fact that anorexia has the highest mortality rate of any psychiatric diagnosis and 20% of people suffering from it will die prematurely as a result of their condition.

Of course, there would be ethical, practical and financial hurdles to consider if we were to consider intervening in a supportive rather than change focused way. However, we overcome those barriers when we provide assertive outreach for other groups – and, if we are seriously concerned by pro-ana groups, we surely need to provide a legitimate alternative. Perhaps this could be a friendly voice at the end of a phone, or someone who is available for a cup of tea and a chat when the pressures of living on the point of exhaustion and starvation threaten to overwhelm. Many people suffering with anorexia clearly recognise that they need support, hence the popularity of pro-ana communities. Why can’t we provide it in a format that is not only palatable to them, but manages the risks involved?

Perhaps, as well as being critical of pro-ana groups for what they offer to young people, we should consider what we provide for this vulnerable group and how the provision of supportive, non judgmental services could render them obsolete.