Anorexia used to be shrouded in shame and silence. Now for some young women it's become a positive lifestyle choice, with militant chatrooms sprouting up in support of those who have the will to ride out the hunger pains.
Elaine Williams reports on the pro-ana movement
They call the club the Feel Good Factor at the Perse school for girls in Cambridge. It opened last September and is aimed at building up the esteem of 12 to 14-year-olds before they enter the full turbulence of adolescence and before they hit the party circuit. To catch these high-achieving girls before they are caught by the insecurities of growing up or gripped by eating disorders.
Dozens of girls have signed up. They play games, such as a version of snakes and ladders which charts life's ups and downs; they take part in exercises which hone the art of feeling positive about themselves and about each other; they talk about family life, about issues of concern. Liz Curry, a teacher who runs the club, is trained in raising self-esteem. She is also trained in awareness about eating disorders, as are many other staff. She says: "If you can say about yourself, 'I am a good listener, a good, kind friend'; if you truly believe this then you're not going to start thinking, 'I need to be a size 8 to be better than the next person'.
It won't matter that you're not thin, or that your sister got 12 A*s and went to Cambridge."
Young people are increasingly vulnerable to eating disorders. White, middle-class, high-achieving girls are particularly at risk, subsuming the pressures they face into control of their bodies. If they control nothing else, they can control what they eat - or don't eat.
Research by the Schools Health Education Unit has shown that half of all teenage girls skip meals regularly, and girls between 13 and 19 account for 50 per cent of the 1.1 million anorexia and bulimia sufferers in the UK.
Some will die; according to the Eating Disorders Association, anorexia has the highest mortality rate of all psychiatric conditions, at around 13 to 20 per cent a year. Boys are affected, too, but make up only around 10 per cent of sufferers.
There are more worrying signs. Growing numbers of young people see anorexia as a lifestyle choice, not an illness. Rather than being ashamed, they are adopting a more militant attitude to the disease, calling themselves "pro-ana" (pro-anorexia). A burgeoning number of websites and chatrooms of the pro-ana movement support wannabe anorexics and encourage starvation regimes. Many adopt a fetishistic, pseudo-religious language, referring to "ana" as their role model, their "goddess". Others put forward the "positive" side of starvation.
"Proactive anorexia is not a disease or a disorder," says one pro-ana website. "There are no victims. It is a lifestyle choice that begins and ends with a particular faculty human beings seem in drastically short supply of today: the will...
"If we ever completely tapped the potential in our midst and applied it to other areas outside eating habits and body sculpting, we could change the world. Maybe even rule it."
Advice on other sites includes: "The mirror never lies. Good girls don't swallow; "When you start to get dizzy and weak, you're almost there"; "Eating is conforming"; "Bones are clean and pure. Fat is dirty and hangs on your bones like a parasite."
These "ana" shrines are adorned with pro-anorexia poetry, drawings and pictures of models and actresses such as Calista Flockhart or Mary-Kate Olsen, recently treated for eating disorders herself but idolised by starving girls as a "thinspiration" pin-up. Sometimes the images are manipulated to make them appear more skeletal. To confirm membership of this "elite" group, ana followers can wear red wristbands which they hold on to for "strength" when they suffer hunger pangs, which are celebrated as a sign of a "strong" will.
The sites are used to swap tips for successful starvation as well as ways of hiding from family and friends the evidence of extreme dieting. One promotes "lifestyle without food" and recites the "ana" creed: "You can never be too thin... Thou shalt not eat without feeling guilty." Eating food is equated with losing control. Another advises pro-anas to "check the fridge when nobody else is around. Find foods that you would have eaten and get rid of them... then if someone asks you can say you had scrambled eggs and are really full. And if they check, the ingredients are gone." If forced to eat, the site advises followers to "drink a ton of water while bingeing. Say, a full glass of water between every couple of units of food... Not only does this fill you up faster... it makes purging a hell of a lot easier." Anorexics vomit if they eat more than they want and this site advises them to "keep a box of baking soda" by the bed. Baking soda dissolved in water "neutralises acids and spares your teeth", so they drink it after purging.
It also advises eating healthy food first - fruit and vegetables - which will be harder to vomit so the "high-cal junk" comes up first. Egg whites are a favourite low-calorie but "filling" food. Other sites extol the virtues of soup made from a stock cube; even of "filling up" with cotton wool balls soaked in orange juice.
Sites adopt names such as "Fragile innocence" and display images of thin, blonde, wispy girls, like dreamy, sexless sprites; a far cry from real bodies and real people engaged in the bruising routine of everyday life.
Experts such as Dr Dee Dawson, medical director of Rhodes Farm, a clinic near London for young people with severe eating disorders, say the sites are particularly dangerous because they encourage the competitive aspect of anorexia by making sufferers feel they are part of an "elite". As many anorexics are high-achievers, they respond well to the extreme weight loss targets. "These girls are often the best," says Dr Dawson. "They are the best musicians, the best at sport, strong academically, and they become the best at starving themselves." The internet community, she says, also mimics the culture of support that exists in some schools. "You will often find an epidemic of anorexia in a school; three, four, five girls needing hospital treatment at the same time. They will support each other, they will cover up for each other, but they will also try to out-do each other."
Natasha (not her real name), now 20 and a student at the University of East Anglia, well remembers such a culture at her independent London day school.
She became anorexic with two other girls in her local drama club, one of whom was in the year below her at school, where there were "at least" five other anorexics. She describes a culture of adulation of the "in-crowd" - stick thin, high-achieving, coke-snorting girls who hung around with the "coolest" boys. She echoes the language of the pro-ana websites: "These girls are always blonde, they are butterflies, angelic spirits who are always fainting because they are so thin. But they always have a crowd around them; everybody wants to be like them."
Natasha was a size 16 at the age of 17; loud, rebellious, a tomboy, to hide the fact that life was falling apart at home. "Dad had gone off with a Nicole Kidman lookalike and Mum was obese and vulnerable. I just thought if I was thin then everything would fall into place and I too would be an object of desire."
As soon as she started dieting, she says, "it was like magic. Something just clicked in my head." She started on the Atkins diet, then turned vegetarian, then vegan, then stopped eating meals altogether, turning to the pro-ana sites for support. As the weight dropped off, the praise from peers began. When it came from the very girls she desired to be, the attention went to her head. "They were coming up to me and saying, 'Wow! You're losing pounds, looking good, how do you do it?' We started to cover up for each other, making excuses when we were going off to be sick, hiding for each other the fact that we weren't eating. Vomiting was accepted in school as something girls did to keep slim. They only stopped talking to me when I became thinner than they were."
Her weight dropped from 12st 7lb to just over 6st and she spent days off school coping with bulimic episodes. But she still managed to gain As at A-level and her two anorexic peers both went to Oxford. Schools, she says, can do much to help young people make the right choices and provide a bulwark against powerful youth cultures such as the pro-ana movement. They cannot stop young people accessing sites but, like the Perse school, they can flag up alternative lifestyle choices.
Natasha believes schools should work hard to provide role models, successful people who have a "normal" body shape, to encourage students to feel good about themselves and optimistic about their prospects. She also feels teachers should try to be aware of cliques forming, and try to weaken groupings by not letting pupils choose who they sit next to in class.
Sports teachers should be particularly sensitive. "They should not allow girls to pick their own teams; heavy girls like me are always the ones who get left out. Also they should think about the consequences of school policies. At my school girls could choose between two regulation swimming costumes. One was more skimpy and streamlined, the other large and red and granny-like. Guess which one I ended up with."
Dr Brenda Despontin, headmistress of Haberdashers' Monmouth school for girls, a boarding school in Wales, and the new president of the Girls'
School Association, says schools must be vigilant in "keeping an eye" on girl culture. "We have to show them that there are other ways to prove themselves without being stick thin. If a girl is seeking security, the easiest way to find it is in how she looks. Often parents don't want to address it because of the guilt and anxiety they feel themselves.
"We can't stop girls going on to sites, but we must give them role models who are comfortable with who they are, whether they are short, tall, fat, thin, white, Asian, black. We cannot do too much of this kind of reinforcement."
Dying to Eat, a 30-minute programme about the dangers of starvation diets, is available from the Rhodes Farm Clinic, on 0208 906 0885. The Eating Disorders Association website has information and help on all aspects of eating disorders: www.edauk.com.Thesite.org offers support and guidance for young people on a number of issues:
: www.thesite.orghealthandwellbeingmental healtheatingdisordersSee also http:www.channel4.comlearning micrositesTthinclubindex.htm and www.tes.co.ukeating_disorders
Addiction that becomes an illness
Grace Bowman (pictured) was a bright A-level student. Then one day she went on a 'diet'
In Year 13, when the build-up to mock A-levels was intensifying, I decided to go on a diet. As an academically successful pupil, there was a self-imposed pressure to keep up my standards, and raised expectations from teachers and parents: "Of course you'll do well - no question." But there was for me.
Success did not breed confidence; it masked my lack of it. The super-succeeding pupil was terrified of leaving home and finding herself in a woman's body that didn't feel like it fitted. I was aware that I had grown. A teacher, commenting on a gap between two desks, said that I could squeeze through because I was "slim". "Slim" not "thin", I noted, and was unhappy with the description. My fragile self-esteem wavered. I began by cutting out chocolate or fast food. Then I cut down more. Next, I avoided school dinners. The routine of school was broken by study leave, so I made up my own: I ate low-calorie soup between strictly timed revision periods.
Everything, I thought, was under my control.
But an addiction had taken hold. The outside world - teachers, parents, friends - had become my opposition, and food restriction my only ally. I couldn't and didn't speak up. I didn't know what an eating disorder was.
And anyway, talking was embarrassing. The high-achiever in me wouldn't admit anything was wrong. When my parents realised that this obsession was not a phase, but an illness, I had achieved my A-levels (all As) and had my cases packed for university. But instead of taking me there, they took me to the doctor. She quickly diagnosed anorexia. My teachers heard the news.
All I could think was that I'd let them down. They asked me to get better.
I said I would, but had no idea how.
Aged 19 and weighing 5st 7lb, I was an outpatient at a psychiatric hospital and then at an eating disorders unit. In a bid to avoid further medical intervention, I recovered enough weight to make it to Cambridge the next year, where I battled with the aftermath. By the end of university I was more aware of my self-determination and realised that anorexia would never solve my anxieties. In my twenties, as I matured emotionally, I reflected on my goals before the eating disorder. I wanted to write. My writing turned into a book, a story of growing up, and of accepting that growth.
I'm glad that pro-ana sites weren't around 10 years ago when I was very ill. I don't think I would have used them, because I saw my eating disorder as my personal issue not a shared experience. Exposure to such images and words in an online community would have supported my disordered behaviour, taking me even further away from the outside world and the possibility of a future without my eating disorder.
As a teenager today, in a society where slim equals success, and obesity is a frightening word, finding a shape to fit is harder than ever, especially when images of thinness and "perfection" dominate the media. The pressure of perfection easily transfers from schoolwork to the body. Eating disorders need to be discussed before they take root instead of being closed up in shame and silence. Early awareness might help someone identify what they are feeling before it is too late.
Grace Bowman lives in north London. She works in marketing and is now writing her second book. Her first,A Shape of My Own, is published this month by Viking (pound;14.99)