Eating Disorders and the Internet: A Descriptive Cross-sectional Study Monitoring the Pro Ana Phenomenon in an Italian Sample

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.