Eating disorders are common, with an estimated one in 20 people in the UK affected by them (Beat, 2026). There is increasing evidence that social media use, including high screen time, is associated with increased disordered eating and body image disturbances. However, the reasons underlying this relationship remain under-researched (Dane & Bhatia, 2023; Holland & Tiggemann, 2016; Keeler et al., 2026).
Emerging evidence suggests that engaging with disordered eating content on social media may contribute to these associations (Griffiths et al., 2024; Jerónimo & Carraça, 2022; Mento et al., 2021). There are online spaces that promote eating disorder content, often termed pro-Ana and pro-ED communities, which a previous Mental Elf blog by Megan Buoey has explored in the context of Twitter. There is mixed evidence as to whether engagement in pro-Ana communities supports recovery and meaning making, or whether it maintains the disorder and endorses eating disorder behaviours (Mento et al., 2021; Mincey & Hollenbaugh, 2022; Rodgers et al., 2016).
Therefore, Stänicke et al. (2026) conducted a systematic review to better understand the experiences of individuals who have engaged with these spaces.
Methods
For analysis, the authors used a method called meta-ethnography, which involves synthesising existing qualitative research on a topic. The meta-ethnography was conducted through an iterative systematic search of eight databases, where the authors initially reviewed titles and abstracts for relevance before moving on to full texts. The review focused on studies specifically exploring first-person perspectives of individuals who had engaged with pro-Ana, using qualitative methods or qualitative data from mixed-methods studies.
The authors met for several meetings and used the CASP checklist to appraise the quality of the studies. The most common issue was being unable to determine if studies had adequately considered the relationship between the researcher and participants.
Overall, 27 studies were included to answer the following research questions:
- How do individuals ascribe meaning to the processes that led to their engagement in pro-Ana communities?
- How do individuals experience their participation in pro-Ana groups?
- How do individuals describe their relationships with other participants in pro-Ana communities?
The authors translated and synthesised these studies to generate meta-themes, themes and sub-themes exploring the lived experience perspective of being engaged with pro-Ana. Importantly, two individuals with lived experience of eating disorders and engaging in pro-Ana were also involved in discussion and review of the final manuscript.
Results
The 27 included studies came from six predominantly Western countries and used a range of methods, including interviews conducted in clinical or community settings and analysis of content from online platforms and blogs. Many studies did not report participants’ gender, ethnicity, age, socioeconomic status or diagnosis; however, where demographic information was available, participants were predominantly women aged 13-60 years, with four studies also including men. Most participants struggled with disordered eating and body image concerns.
Analysis generated three meta-themes:
Meta-theme 1: Pro-Ana feels like a safe space where I can be myself (n = 19)
Participants highlighted that pro-Ana felt like a community, where individuals experienced a sense of belonging, support and understanding; this was in contrast to their offline life, where they felt misunderstood and isolated. Participants reflected that pro-Ana is a digital safe space where they could be their ‘unfiltered’ self, opening-up about their struggles when they felt they could not in-person. However, they were also concerned about others discovering their engagement with pro-Ana, with some participants perceiving it as less acceptable than the eating disorder itself.
Meta-theme 2: Pro-Ana is a dangerous path (n = 14)
Participants in several studies described how pro-Ana could maintain and potentially trigger their eating disorder, through competing to be the thinnest and sharing harmful eating disorder behaviours and thoughts. Participants were aware that pro-Ana was not always good for them, although some felt ambivalent about their own engagement and warned others away from the community.
Meta-theme 3: Pro-Ana becomes a joint project for living with an eating disorder (n = 21)
Participants shared that pro-Ana felt almost like a ‘lifestyle’, and compared it to an ‘addiction’, where individuals work collectively and advise each other on disordered eating habits. They also highlighted that pro-Ana is an exclusive space where participants are wary of new and potentially younger individuals and drive them away from the space. Some participants even reflected that they viewed ‘Ana’ (the personification of anorexia) as a figure or friend to admire.
Conclusions
Overall, Stänicke and colleagues (2026) highlighted the complex and sometimes contradictory role of pro-Ana communities. Participants described these spaces as providing belonging, understanding and emotional support, particularly when they felt isolated or misunderstood offline. At the same time, they described how participation could reinforce thoughts and behaviours related to disordered eating. This ambivalence may help explain why people continue to engage with these communities despite recognising their potential harms.
Strengths and limitations
This paper used a rigorous methodology to address a focused and an under-researched area that is increasingly relevant given the widespread use of social media and prevalence of eating disorders. The authors conducted a systematic search across eight databases, used a quality appraisal checklist, and were transparent in describing how they generated the meta-themes, providing clarity in their methods. The inclusion of lived experience perspectives to inform and provide feedback on the manuscript is a further strength, helping to bring relevant lived experience perspectives into the interpretation and reporting of the findings.
Importantly, this research also develops our understanding of how digital spaces can create paradoxically supportive and harmful environments, highlighting the complexity of why individuals may engage with pro-ED spaces.
However, some limitations of the study include:
- Many of the included studies did not report participant demographics (e.g., socioeconomic status, race, age, gender) as noted by the authors. This may limit the generalisability of the findings, particularly in understanding how pro-Ana engagement and experiences may differ across cultures and communities. Minoritised groups and men remain underrepresented in eating disorder research, highlighting the need for future research to explore pro-ED engagement across a wider range of cultures, social contexts and communities (Wilkins, 2026; read more in this Mental Elf blog by Una Foye).
- The digital landscape has changed substantially over the period covered by the included studies, which were published from 2002 to 2025, including the rise of new highly visual platforms and changes to platform algorithms, that may reinforce engagement with pro-ED content. Therefore, pro-Ana and Pro-ED content, and patterns of engagement with these spaces are likely to have evolved alongside these changes in social media platforms. The included studies also varied in their participants and the online spaces explored, meaning the synthesis may not capture the diversity of experiences within pro-Ana and pro-ED communities.
Implications for practice
Social media is an ever-growing and ever-changing medium, with emerging harms and potential benefits to mental health. This paper informs new understanding of how individuals engage with pro-ED and pro-Ana spaces, and how this is simultaneously experienced as both helpful and harmful. This ‘ambivalence’ seems important to explore in treatment settings, through creating a space where patients feel able and safe to discuss their social media use. Exploring what individuals value about these communities, such as belonging, understanding and the ability to speak openly about their experiences, may also help clinicians understand what needs are not being met elsewhere.
Moreover, this research has potential implications for intervention strategies and policy. Increasing access to safe spaces where individuals can discuss their engagement with pro-Ana, alongside alternative sources of online and offline support, may help address experiences of stigmatisation and isolation that can contribute to engagement with these communities. Wider research also suggests a potential role for media literacy interventions (Harness et al., 2026; McLean et al., 2017). At a platform and policy level, the findings raise questions about how harmful pro-Ana content is moderated, particularly as algorithms may shape what content users are exposed to.
This research is important to explore further across diverse contexts and alongside individuals with lived experience, particularly as the digital landscape continues to change. This is especially relevant in light of changing policy around social media, including restrictions on social media access for under-16s in Australia (BBC, 2026) and ongoing discussions around similar restrictions in the UK (Beat, 2026). Future research will be important for understanding how these changing digital and policy contexts may shape engagement with pro-ED spaces.
Overall, this paper synthesises existing evidence whilst providing novel insights into why individuals engage with these digital spaces. As a researcher in eating disorders and someone with lived experience, I believe understanding how social media influences recovery, risk and maintenance of eating disorders is a key research avenue. This work will be important for informing interventions, policies and approaches to develop safer online environments.
Statement of interests
Rosie Tatham has no conflicting interests to declare.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Line Stänicke, Liselotte Rymoen, Tora Omdal, & Margrethe Halvorsen (2026). Pro-Ana—Balancing a Digital Safe Space and Indirect Self-Harming. Findings From a Meta-Synthesis. International Journal of Eating Disorders, 59(6), 1225–1245. https://doi.org/10.1002/eat.70067
Other references
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