Psychology of Men & Masculinities © 2018 American Psychological Association

2019, Vol. 20, No. 3, 368 –378 1524-9220/19/$12.00 http://dx.doi.org/10.1037/men0000169

Embracing or Resisting Masculinity: Male Participation in the Proeating

Disorders (proana) Online Community

Cherry Quiniones Candice Oster

University of Adelaide Flinders University

The proeating disorders (EDs) phenomenon is a controversial and thriving online community (referred
to as “proana”) that aims to promote the maintenance of EDs as a lifestyle choice. Despite the widespread
perception of EDs as uniquely and exclusively female conditions, new research indicates an increased
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

prevalence of ED behaviors in men. Yet men’s experiences are underreported in the ED literature and,
This document is copyrighted by the American Psychological Association or one of its allied publishers.

in particular, within the proana context. Examining men’s engagement with the proana community can
provide insight into how men think about and experience EDs, and the issues they face with EDs in their
day-to-day lives. The aim of this study was to examine how men are represented, and represent
themselves, within a proana online community. A qualitative thematic analysis was conducted of 217
forum posts authored by men across 16 online threads from one of the largest proana communities on the
Internet. Analysis indicates that men positioned themselves in relation to masculinity by either embracing
or resisting social norms around masculinity. For proana website users that embraced masculinity, EDs were
constructed in ways that engaged with masculine norms of heterosexual power, control, and accomplishment.
In contrast, those who represented themselves in resistance to masculine norms challenged traditional
masculine body ideals, stereotypes, and stigma. Within these representations were patterned responses that
constituted four stages: acceptance, ambivalence, disillusionment, and support. Stigmatization of EDs in men
and lack of adequate services supported engagement in the proana online movement, perpetuating a cycle of
progression through these stages and limiting the potential for recovery.

Public Significance Statement

The proeating disorders (proana) online phenomenon is a controversial community aiming to
promote eating disorders as a legitimate lifestyle choice. Given the growing numbers of men with
eating disorders, this study sought to understand how men represent themselves on public forum
posts on a proana website. The main finding was that forum participants both embraced and resisted
masculine norms, with stigmatization of eating disorders in men and lack of adequate support
services limiting the potential for recovery.

Keywords: eating disorder, masculinity, online, proana

Men are reportedly becoming increasingly dissatisfied with their
bodies, leading to their induction into eating-disordered behaviors
(Griffiths et al., 2016). Delays in seeking support for eating dis-
orders (EDs) in men reflects the additional stigma of disclosing
what is widely regarded as a female condition (Raevuori, Keski-
Rahkonen, & Hoek, 2014; Weltzin et al., 2005). Men with EDs are
often reluctant to express their feelings in conventional face-to-
face settings, increasing the likelihood that they will go online to
This article was published Online First July 12, 2018.
Cherry Quiniones, Faculty of Health and Medical Sciences, School of
Psychology, University of Adelaide; Candice Oster, Flinders Human Be-
haviour and Health Research Unit, Department of Psychiatry, Flinders
University.
Correspondence concerning this article should be addressed to Candice
Oster, Flinders Human Behaviour and Health Research Unit, Department
of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Aus-
tralia 5001, Australia. E-mail: candice.oster@flinders.edu.au
seek support. A controversial online community is the proeating
disorders phenomenon, with the term proana being the established
term used online to refer to this phenomenon (Arseniev-Koehler,
Lee, McCormick, & Moreno, 2016). Proana began online in the
late 1990s with discussion-based forums and websites, and more
recently has expanded to include social media platforms such as
Twitter and weblogs (Cobb, 2017). Although proportionately
many more women are represented in this phenomenon, this article
explores male engagement in the online proana community, and in
particular their engagement on discussion forums of a proana
website.
Background
There are four recognized categories of ED, the most common
categorized by voluntary starvation (anorexia nervosa) and binge
eating with purging (bulimia nervosa). A further category is bing-
ing without purging (binge eating disorder; Yeshua-Katz & Mar-
tins, 2013). Most individuals fall under the residual category
“eating disorder not otherwise specified”.

368
 EMBRACING OR RESISTING MASCULINITY 369

Drawing accurate conclusions regarding the prevalence of EDs
in men has been difficult. Recent research suggests that a number
of factors account for a lack of accurate data, including gender-
based diagnostic criteria, the absence of large scale population
studies, denial, poor insight, and perceived stigma associated with
disclosure of mental health problems in men (Crosscope-Happel,
1999; Mitchison & Mond, 2015; Murray et al., 2017; Sweeting et
al., 2015). Epidemiological data indicate that both anorexia ner-
vosa and bulimia nervosa are significantly more common in
women than in men (Weltzin et al., 2005). However, some studies
report that men may account for up to 25% of EDs (Sabel, Rosen,
& Mehler, 2014; Weltzin et al., 2005; Wooldridge, Mok, & Chiu,
2014). Since its inclusion as a new diagnostic entity, binge eating
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controversial and potentially dangerous content (Norris et al., 2012).
These groups differ from mainstream ED communities in that they
sometimes adopt an “antirecovery” position (Bates, 2015; Talbot,
2010). Proana refers to a large web-based community that promotes
the maintenance of anorexia and other eating-disordered practices
(Bates, 2015; Connor, Coombes, & Morgan, 2015). This community
is run by individuals who themselves have an eating disorder and has
allowed those with (or claiming to have) an ED to form a thriving
online community (Boero & Pascoe, 2012; Brotsky & Giles, 2007;
Csipke & Horne, 2007).
Proana groups are composed of individuals who do not perceive
EDs as psychological disorders (Wilson, Peebles, Hardy, & Litt,
2006). Rather, proana communities are accepting of an individu-

disorder appears to be the most prevalent ED practice in men, with al’s desire not to seek treatment (Csipke & Horne, 2007). This
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close to equal prevalence to women (Mitchison & Mond, 2015).
Furthermore, there is evidence that ED practices are increasing at
faster rates among men (Mitchison & Mond, 2015).
Men, like women, experience psychosocial impairment and
significant distress associated with EDs (Bentley, Mond, & Rod-
gers, 2014; Griffiths et al., 2016; Striegel, Bedrosian, Wang, &
Schwartz, 2012). Harshbarger, Ahlers-Schmidt, Mayans, Mayans,
and Hawkins (2009) proposed that loneliness and isolation are
likely to be more intense in men, who feel they are alone in
suffering from a female problem. Research into help seeking
indicates that men approach ED support services late in the tra-
jectory of their illness (Räisänen & Hunt, 2014, p. 3; Robinson,
Mountford, & Sperlinger, 2013) and that alienation (Greenberg &
Schoen, 2008) and ambivalence (Williams & Reid, 2007, 2010,
2012) contribute to men’s reluctance to seek support. Online
forums may serve to counter feelings of alienation in men who are
looking to access information and social support. The anonymity
of the Internet allows isolated individuals to find like-minded
others with whom they can share information or discuss their
experience in a relatively safe virtual space (Mulveen & Hepworth,
2006).
There is substantial diversity within the ED community online,
which encompasses a range of groups and views. Some groups define
an ED as a serious mental illness and disease, and exist to offer
support for recovery (Csipke & Horne, 2007; Strife & Rickard, 2011).
However, some highly accessible online groups reportedly endorse
online community attracts members who want to initiate, maintain,
or advance their ED (Strife & Rickard, 2011). A proana philoso-
phy advocates EDs as a legitimate lifestyle choice (Borzekowski,
Schenk, Wilson, & Peebles, 2010; Sharpe, Musiat, Knapton, &
Schmidt, 2011; Rodgers, Skowron, & Chabrol, 2012), where EDs
are encouraged and valued (Santos, 2012; Williams & Reid, 2007).
Proana websites explicitly encourage an extreme thin ideal or
indirectly promote EDs by virtue of their content (Delforterie,
Larsen, Bardone-Cone, & Scholte, 2014; Talbot, 2010). Content
analyses of proana websites (Norris, Boydell, Pinhas, & Katzman,
2006) have revealed common features (Table 1). However, it is
important to note that the proana community does not reflect a
single philosophy, particularly with regard to their views of recov-
ery. Whereas some proana websites are antirecovery, promoting a
proana lifestyle as the ideal and only choice (Davies & Lipsey,
2003; Fox, Ward, & O’Rourke, 2005; Pollack, 2003), others sup-
port those contemplating recovery.
The proliferation of proana as a highly visible and controversial
community has raised alarm over its potential harmful effects.
Given the high mortality rate of anorexia, it is no surprise that
embracing the condition as a way of life is often met with disap-
proval (Yeshua-Katz & Martins, 2013). Public concern is rein-
forced by academic research that characterizes proana content as
deviant, promoting a deadly disease, and misappropriating medical
knowledge (Connor et al., 2015; Dias, 2003). Recently, the level of
alarm around this phenomenon has led to attempts to shut down

Table 1
Proana Website Content

Content Description

A Disclaimer A warning to visitors about site content that could be “triggering” to those with EDs and to enter at their own risk (Dias, 2003;
Gavin, Rodham, & Poyer, 2008).
“How to” section A range of information and other content offering guidance to users experimenting with ED practices
Archived journals Diaries written by website users
Tips and tricks Suggestions for weight loss and the maintenance of ED practices (Harshbarger, Ahlers-Schmidt, Mayans, Mayans, & Hawkins,
2009)
Advice Advice on how to prevent the discovery of an ED by suspicious siblings and parents (Giles, 2006; Talbot, 2010)
Thinspirations Content provided as a source of inspiration/goals to reach for with the aim of encouraging viewers to maintain a proana
lifestyle. These contain motivational quotes and commonly photo galleries of emaciated models and celebrities (Csipke &
Horne, 2007).
Photo galleries Usually of thin models but occasionally users’ own bodies (Giles, 2006)
Doctrine Rules or beliefs governing an anorexic lifestyle (Csipke & Horne, 2007)
Forums Open discussion forums that allow users to share information or experiences, seek advice about extreme weight loss methods,
and offer support and encouragement to one another (Gavin et al., 2008)
Note. ED ⫽ eating disorder.
 370 QUINIONES AND OSTER
and even outlaw proana websites in France (Segal, 2015). In
Australia, the presence and accessibility of proana websites has
attracted media and public health concerns about the need for
regulation (Carbonell, 2016). Despite criticism about the harmful
risks to vulnerable individuals, these websites offer health re-
searchers unique opportunities to research this stigmatized, hard-
to-reach community (Gavin, Rodham, & Poyer, 2008). Often,
members produce accounts that openly challenge mainstream
views of EDs (e.g., psycho-medical models; Day & Keys, 2008;
Malson, 1999); therefore, proana websites offer greater insight into
the meanings proana individuals attach to their conditions (Brotsky
& Giles, 2007; Hardin, 2003).
Only a handful of proana studies have included men, reflecting
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the focus on women in ED research more broadly. For instance,
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Juarez, Soto, and Pritchard (2012) evaluated the effect of viewing
a proana website on both genders and found that muscularity-
oriented as opposed to thinness-oriented body image concerns
distinguished men from women. These authors concluded that for
men, exposure to proana content was related to a drive for mus-
cularity, a relatively new term not classified under any specific
disorder but conceptualized as the male equivalent to the drive for
thinness in women (Mitchison & Mond, 2015). This finding sup-
ports current literature that unlike the appearance ideal targeted at
women, which promotes slimness, the male appearance ideal pro-
motes muscularity (Giles & Close, 2008; Lavender, Brown, &
Murray, 2017; Murray et al., 2016; Weltzin et al., 2005).
Wooldridge et al. (2014) conducted a qualitative content anal-
ysis of proana websites to learn about men’s engagement with the
proana community. These researchers identified the themes of
social support, community appreciation, and ambivalence about
recovery (also identified in previous proana research; Dias, 2003;
Wooldridge, 2014), with themes specific to men also identified,
namely, alienation and teasing. Similarly, in their exploration of
the male body and eating disturbances, Murray et al. (2016)
conducted a thematic analysis of proana websites; yet this exam-
ination focused solely on muscularity-related content and did not
examine men’s constructions of EDs in the wider proana move-
ment. There remains little specific reference to men’s participation
in the proana community.
Proana websites provide a significant venue for exploring men’s
accounts of their ED. Examining how men represent themselves on
a popular proana website can provide further insight into how men
think about and experience EDs, and the issues they face with EDs
in their day-to-day lives. With a better understanding of how men
self-present in this virtual setting, health professionals and family
members may be better equipped to address EDs in men. In the
absence of any qualitative analyses of this kind, this investigation
explored male-relevant themes presented on the online postings of
male proana website users. The aim of this research was to explore
how men are represented, and represent themselves, on a promi-
nent proeating disorder website.
Methodology
Data Collection
A purposive approach to sampling was used, which involves
selecting data sources on the basis that they will provide an
indicative range of possible constructions on the topic of interest
(Braun & Clarke, 2006). After undertaking a Google Boolean
search, entering the keywords “pro eating disorder,” “pro-
anorexia,” and “pro ana,” the searches yielded several links to
websites and blogs. Websites were considered if they contained
common features of proana websites identified by Norris et al.
(2006; Table 1). Following Gavin et al. (2008), nonpassword-
protected public discussion forums were chosen because of their
accessibility. The study focused on the analysis of open, public
thread postings on one of the largest proana communities on the
Internet. This was determined by the relatively high number of
members registered to this website and an even higher volume of
visitors (see Table 2 for website information). Guided by the aims
of this research, posts on the proana website were sampled retro-
spectively from a dedicated male discussion forum.
The search and data collection occurred in May, 2016. The
selected male ED forum page yielded a number of topics, many of
which were unrelated to the male experience of EDs. Therefore,
exclusion criteria were created (Gavin et al., 2008), detailed in
Table 3.
A total of 16 forum threads were included in the data, with 1,105
excerpts analyzed from 217 posts. Table 4 describes the thread
titles contained within the male-dedicated forum. Each thread was
numbered for analysis and referencing in the results. For example,
T5, U1 references forum user 1 in Thread 5.
In accordance with previous studies of ED groups online, an
unobtrusive passive method of observation was used (Dias, 2003;
Gavin et al., 2008). Revealing the researcher’s presence either
preemptively or retrospectively was avoided to prevent intruding
the “sanctuary” nature of this already marginalized, difficult-to-
access community (Dias, 2003). Unobtrusive, passive observation
was also used as a means to access this unique form of uncontam-
inated naturalistic data (Hewson, 2016; Hewson, Yule, Laurent, &
Vogel, 2003).
Ethical Considerations
Consistent with research undertaken by Mulveen and Hepworth
(2006), this investigation was compared with naturalistic observa-
tion. Posts constituted open messages available to anyone with
Internet access and therefore did not raise concerns about viola-
tions of privacy (Bates, 2015). Although forum data were consid-
ered in the public domain, care was taken to respect users’ privacy
(Dias, 2003). The analysis presented here is based on an honors
thesis, and the study was exempt from a full review by the
university’s human research ethics committee as all data evaluated
was extracted from the public domain.
Table 2
Information About the Website
Number of members
(February, 2018) 315,148
Total number of posts
(February, 2018) 16,489,032
Alex Global Traffic Ranka 28,144
Audience Geographya 51.7% United States, 9.6% United Kingdom,
8.1% Australia, 6.2% Canada, and 2.8%
Germany
a
Website metrics from alexa.com.
 EMBRACING OR RESISTING MASCULINITY 371

Table 3 These attributes were constructed in relation to forum users’ mas-

Exclusion Criteria for Valid Posts
Exclusion criteria
Non-English-based text
Forum posts that contained imagery, video, or audio information
Online forum posts authored by female users of the selected proana
website, including transgender individuals
Gender of poster must be male (e.g., content of post/previous posts)
Data Analysis
Text was downloaded from the forum page and then saved in a
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culine identity and self-worth and followed a pattern of progres-
sion of their ED, with most being in the earlier stages.
Acceptance: controlling the male body. In the early stage,
this group of men expressed acceptance of their EDs through
narratives of control, “I began because I felt confused, unhappy, so
I tried to control myself, by restricting what I ate” (T8, U4).
Control of the male body, both through quantification and physical
activity, allowed forum users to accept their ED as a way to
emphasize their attractiveness and heteronormativity, and their
male identity (through a competition and achievement orientation).
By exhibiting control over one’s food and body, forum users
constructed their induction into eating-disordered behaviors as a

rational lifestyle “choice.”

word file format for analysis. Following the six phases of a
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Quantification. Quantification allowed forum users to de-

thematic analysis outlined by Braun and Clarke (2006), the anal-
velop and maintain a sense of control and avoid negative emotions,
ysis was conducted inductively, driven by the content of the data
evident through a preoccupation with calories and numbers: “I’m
and not through the lens of any preexisting theory (Braun, Clarke,
counting everything I eat and drink” (T11, U1). Quantification
& Terry, 2014). The first two phases were completed simultane-
empowered forum users to exercise control and therefore accept
ously. Each thread and posts contained within it were read to
ED practices as a normal part of their day-to-day lives. Restriction
become familiar with the data (Phase 1) and to generate initial
was also a way for forum users to quantify themselves, where
codes (Phase 2). An inductive process was used to derive first and
self-monitoring was normalized, and even routine: “I just quietly
second order codes, compiling a list of codes from each thread.
restrict and count calories and weigh myself day in and day out”
Phase 3 involved collating and organizing potential post excerpts
(T13, U1). In accepting their ED, some anorexic forum users used
around themes. Phase 4 involved reviewing and refining themes,
restriction to invoke their masculinity: “restricting actually makes
where some were collapsed into one another and others separated.
me feel more masculine” (T5, U2). Another forum user referred to
Phase 5 involved defining and further refining themes; earlier
restriction in terms of “the feeling of self-control and power I get”
codes along with their descriptions were compared, combined with
(T14, U3). In addition, forum users were able to embrace their
one another, and then refined to form overall themes (Santos,
masculinity through physical activity.
2012). Phase 6 involved the final analysis and write up. The online
Sport/physical activity. Forum users used physical perfor-
data analysis software Dedoose (2016) was used to facilitate the
mance to exert further control on their bodies. As a masculine
coding, collation, and analysis. The early stages of the analysis
pursuit, physical activity was a means to exhibit masculinity
were conducted by Cherry Quiniones, with emergent themes dis-
through the qualities of strength and endurance. Weight lifting was
cussed and refined in regular meetings with Candice Oster.
a common method used to construct themselves as archetypal men,
enacting traits of persistence, individual performance, and domi-
Results nance:
Two overarching themes illustrated how forum users repre-
sented themselves in relation to their ED: “embracing masculinity”
Table 4
and “resisting masculinity.” In the first group, forum users de-
Forum Threads Selected for Analysis
picted themselves as supporting and conforming to hegemonic
masculine traits (Connell & Messerschmidt, 2005), whereas the Thread
second group represented themselves in resistance to social norms code Thread title
around masculinity when describing their ED. Within these reac-
T1 Manorexia/Guys with EDs Stereotypes? I want you’re guys
tions to masculinity were patterned responses that constituted four opinion
stages: (a) acceptance, (b) ambivalence, (c) disillusionment, and T2 Would you rather be thin and fragile or muscular and
(d) support (Figure 1). Through each stage, it became clear how “fit”?
forum users used the notion of control to reinforce and justify their T3 Calling all guys
T4 Anybody worry about being able to defend themselves
proana lifestyle. T5 Ana Males
T6 Please help me
Embracing Masculinity T7 Calories I’m eating
T8 What got you into it
The theme “Embracing Masculinity” refers to conforming to T9 What’s your goal and where the men at
norms of hegemonic masculinity, the dominant form of masculin- T10 Feeling awkward as a guy
T11 I can’t be the only one
ity that embodies the most aspired way of “being a man” within the T12 Males get less crap
forum users’ proana stance. ED practices enabled these forum T13 Boy anorexic situation
users to engage in masculine norms such as control, heterosexual T14 Why do you do it
attractiveness and power, competition, and success (Drummond, T15 Bulimic men
1999, 2002) to legitimize having an ED. Underpinning these traits T16 Manorexia
was control, typically practiced through individual performance. Note. ED ⫽ eating disorder.
 372 QUINIONES AND OSTER
Figure 1. Embracing and resisting masculinity in forum users’ representations.
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I was the fat kid growing up. Was the last picked for sports teams . . .
Started lifting weights and running, lost the weight, made the sports
teams even became captain of the hockey team. (T5, U3)
Acceptance of an ED through physical activity thus empowered
forum users to engage in both masculinity and a proana lifestyle.
Furthermore, physical activity allowed forum users to accentuate
their attractiveness and heteronormativity.
Attractiveness and heteronormativity. Physical appearance
was of primary importance to forum users’ sense of self. As a
standard of attractiveness, forum users in this group internalized,
and aspired to, the cultural ideal of a masculine male, where “very
lean muscular boys seemed to me the most attractive” (T8, U10).
As an appearance-based norm, forum users embracing their mas-
culinity measured themselves against a physique devoid of fat and
defined by greater muscularity:
I want to look muscular. I want a very low body fat percentage so my
muscles show through my skin. I want a visible six-pack. . . . I want
to be the envy of men and the desire of women. I want to be attractive
to women . . . to attain the form most attractive to women. (T3, U1)
This excerpt illustrates the perception that lower body fat and
increased muscularity is the standard of attractiveness, frequently
depicted as an exemplary form of masculinity. Fitting this cultural
ideal further reinforced the proana habits needed to maintain this
ideal.
In their representations, forum users drew upon heteronormative
assumptions and, specifically, depicted themselves as heterosex-
ual. For instance, this forum user reflects on the masculine appear-
ance ideal as the standard of heterosexuality: “women will always
find you more attractive so long as you are at a low body fat” (T10,
U1). Forum users further reproduced heteronormative assumptions
by invoking their heterosexual dominance: “I’ve dated several
very attractive women, even married one” (T10, U3). However, it
was through competition, individual performance, and achieve-
ment orientation that forum users effectively embraced their mas-
culinity.
Forming a masculine identity: being competitive and
achievement-oriented. Forum users embracing their masculin-
ity demonstrated acceptance of their ED by constructing a com-
petitive and achievement-oriented masculine identity. Although
often seeing themselves in comparison to other men (e.g., “I feel
like if I was muscular I would have somebody already. I get
jealous of guys like that”; T2, U1), it was through competition in
terms of personal targets that they enacted their identity as proana:
“I’m constantly driven to be the best at everything I do no matter
what, even if no one else is competing” (T5, U4). This achieve-
ment orientation was discussed in terms of desired outcomes, a
means to assert the masculine trait of success:
Actively working every day to hit my goal weight. I wouldn’t say it
makes me feel better— but it helps me anchor myself. I know what I
want. I know how I’m going to get there. And I actively participate in
these behaviors to accomplish that. And seeing the number on the
scale is a reaping of those rewards. (T16, U1)
For these forum users, individual performance was a worthy act in
itself. When they fell short of achieving a particular goal, an ED
was still a worthwhile pursuit. There was therefore a tendency not
to label eating and exercise practices as disordered but as tools to
achieve fitness goals. The act of working toward goals was con-
structed as demonstrating successful individual performance.
Achievement orientation was a way these forum users simulta-
neously endorsed their ED and embraced masculinity. Yet, as an
ED progressed, forum users expressed ambivalence about their
proana lifestyle.
Ambivalence. Forum users engaging with masculine norms
indicated ambivalence relating to either admitting or denying an
ED was a problem. Both options had positive and negative aspects,
causing conflicting emotions and, therefore, ambivalence. This
ambivalence had implications for whether forum users wanted to
maintain their proana lifestyle.
Ambivalence through identifying a problem. At first, forum
users constructed their ED as a way to exercise self-discipline. An
ED was a positive and functional tool, a way of achieving valued
outcomes. Gradually, however, as negative consequences of an ED
set in, forum users framed their situation as a problem: “it’s how
I express, and control myself. Sadly, at this point in my life I’m
admittedly addicted to it” (T5, U6). Entrenched behaviors were
now described as addictive or obsessive.
Without using the words “illness” or “disease,” forum users
identified their ED as a problem, prompting them to contemplate
recovery. Yet while questioning their proana lifestyle, forum users
felt ambivalence around their ability to give up: “every time I get
to the point where I try to recover I start binging and purging” (T5,
U7). Although some forum users did have a desire to disengage
from ED behaviors, because they actively embraced certain “mas-
culine” attributes such as competition and control, the addictive
 EMBRACING OR RESISTING MASCULINITY
nature of their ED was reinforced: “. . . that’s the worst thing for
me because I just compete with myself and I can’t stop because I
can never be good enough” (T8, U11).
Ambivalence was furthermore evident when forum users de-
scribed their concerns about losing muscularity. A reduction in
muscle and a fear of regaining body fat was frequently cited as a
negative consequence of giving up an ED: “my muscle is always
the first to go and it took a long time to build it” (T9, U4). Another
way in which forum users demonstrated their ambivalence was
through difficulty admitting to an ED.
Ambivalence through denial. Ambivalence was seen in some
forum users’ denial. In not having to admit to engaging in harmful,
rather than healthy practices, these forum users avoided labeling their
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
behaviors as problematic: “male here, honestly I don’t have an ED,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
only times I purged were because I was bulking too hard and felt sick”
(T9, U5). Rather than acknowledging an ED, ED practices were
constructed as methods to maintain fitness and achieve their ideal
body. Men stuck in ambivalence attempted to further legitimize their
EDs as normal ways to enhance their health and well-being, drawing
on the language of health and fitness to construct their EDs as normal,
healthy, and legitimate, denying harms to their health:
I put a lot of time and energy in to learning about food, diet and
exercise. For me it’s about being healthy and maintaining a level of
physical health that enables me to enjoy physical activities as well
providing a source of confidence and self-esteem. (T9, U6)
Following ambivalence about whether to maintain a proana life-
style, the next stage was characterized by disillusionment.
Disillusionment. Initially, forum users who were embracing
masculinity perceived their ED to be a positive attribute, a way they
represented themselves as dominant and in charge. Ambivalence was
a stage of swinging between positive and negative framing. As an ED
progressed, and unexpected negative consequences set in, forum users
framed their EDs negatively. This was evident in forum users’ de-
flated and disappointed remarks about their ED: “I can’t make it go
away. I’m missing out on my whole life” (T5, U9).
Along with negative consequences such as declining health or a
loss of control, forum users identified stigma associated with their
conditions. Not being perceived as a “real man” was a source of
disillusionment: “I think it’s slightly insulting if a really masculine
guy has an ED, it doesn’t make him any less of a man” (T5, U10).
Problem recognition meant that an ED was now represented dif-
ferently. For instance, this forum user emphasized on the amount of
self-discipline required to maintain his body: “friends envy my body
but they don’t realize how hard I work for it, how much daily restraint
I must exert to keep it” (T9, U7), going on to express a sense of defeat,
even deflation when he perceives his ED as unsustainable. This was
evident in the disappointment others forum users felt toward their ED:
“it spiralled out of what I originally wanted” (T8, U14). With this was
the perception that seeking support might be valuable.
Support. In the final stage, forum users embracing masculinity
acknowledged EDs as a problem and contemplated support. How-
ever, accessing professional support was perceived as difficult, lead-
ing to a reengagement with online support in the proana community.
Seeking support for a “female problem.” Despite expressing
a need for support, forum users felt confronted by the social stigma
associated with what they perceived to be a psychological and
female problem:
373
No one will ever suspect you of an eating disorder as a guy. It’s a
blessing and a curse. I’m not even sure if people care. (T4, U2)
Furthermore, forum users expressed reluctance toward seeking
support, particularly because this was not a “masculine” thing to
do: “I feel that society believes ladies need protecting while men
can take care of themselves” (T12, U2). Based on the perception
that men did not suffer from EDs, disclosing an ED was associated
with fears about appearing weak:
. . . it’d be way too awkward to let people know. I think a lot of us are
really hidden as we do not like to talk openly in public about it, nor
do the majority of us even want to seek help for a “disorder for
teenage girls.” (T13, U4)
Even before contemplating the use of professional treatment pro-
grams, negative perceptions of men with EDs meant that men
perceived little benefit to seeking support.
Professional support. Receiving treatment for an ED was
constructed as inconsistent with traditional masculinity. This was
evident in the perceived stigma associated with being a man in a
treatment setting:
I’m sick of this shit that it makes me feel worthless and undeserving
of help. I’m at a point where I kinda want to go inpatient or to some
kind of residential treatment for my ED but there’s literally nowhere
that will take me. I do not know what I have to do to prove that I’m
sick. (T13, U5)
Negative views about professional support were based on past
treatment experiences. Dissatisfaction with professional support
services and problems with treatment acceptability reinforced the
assumption that male EDs were not taken seriously, leading to
feelings of marginalization. Forum users felt misunderstood and
therefore found it easier to express and find support online.
Support online. Difficulty with stigma led many forum users
to seek support online where experiences of alienation were alle-
viated by finding like-minded others. However, it was here that
forum users reasserted their masculinity and represented them-
selves as regaining control. Forum users offered support and
encouragement to others sustaining a proana lifestyle:
When you run out of emotional energy and give up for a moment or
time, we are here to encourage and help you find the strength to get
back on track. I need it too—that’s why I’m here. (T9, U9)
Rather than seeking support for recovery, the perceived support from
other proana men encouraged forum users to reengage in ED practices
with a view to embracing and enhancing their masculinity. In the
following section on resisting masculinity, it is apparent that forum
users in the second group followed a similar cyclical progression,
although their concerns within these stages were different, reflecting
their different response to norms of masculinity.
Resisting Masculinity
The second way in which forum users responded to masculinity
was through resistance to social norms of masculinity, while follow-
ing the same stages described earlier. As with those embracing mas-
culinity, these forum users were predominantly in the earlier stages.
Accepting one’s ED. Forum users distanced themselves from
traditional notions of masculinity during the stage of accepting
 374 QUINIONES AND OSTER

their ED. They endorsed their EDs through their resistance to nothing unique about me. Having an eating disorder . . . is kind of just
masculine norms, pursuit of thinness over muscularity, rejection of “my thing”. (T14, U4)
the stereotypical male with an ED, and formulating a proana
Forum users demonstrated their belief in the proana movement
identity.
because they “want” an ED identity. Following from this is the
Resistance to masculine norms. In response to the perception
ambivalence forum users experienced by simultaneously endors-
that EDs were not masculine, these forum users drew upon a
ing their ED and challenging masculine norms.
resistant position: “I couldn’t care less about masculinity, I’ll
Ambivalence.
starve and purge. If these things make me NOT masculine, so be
A desire to be thin versus discomfort with stepping outside of
it!” (T5, U12). Resistance was expressed as rejecting masculine
masculine norms. Unlike forum users who were embracing mas-
norms, not caring about what others thought and how culture
culine norms, where ambivalence related to admitting versus de-
expected them to be: “I don’t believe a man has to be anything at
nying an ED was a problem, here forum users demonstrated
all, except that which he wants to be” (T5, U13). Endorsing a
ambivalence in terms of both resisting masculine norms and ex-
proana lifestyle was a way of resisting the expectations placed on
pressing discomfort associated with stepping outside of these
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

them to “be a man.”

norms. Thus although forum users resisted masculine norms by
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Pursuit of thinness over muscularity: rebelling against a mas-

demonstrating a preference for a thin body, they also expressed
culine ideal. Forum users also challenged masculine appearance
concerns about the negative consequences of having little physical
ideals by pursing thinness over muscularity. Rather than trying to fit
strength, such as a concern about being able to defend themselves
the cultural ideal where “male eating disorders are characterized by an
in a physical confrontation: “I know if I go much lower then my
obsession to build muscle and lose as much body fat as possible” (T5,
ability to physically defend myself like in a fight will decrease
U15), acceptance of a thin body shape was a rejection of masculine
greatly” (T2, U3). Although resisting masculinity, there was still
norms. Promoting a proana lifestyle, which involved maintaining a
the norm around being a strong man able to exercise physical
thin physique, was also described as easier than trying to fit the
strength. In another example, a forum user expressed this ambiv-
masculine ideal: “there are certain archetypes and bodies that people
alence in terms of wanting to be “very thin and fragile . . . but
try to fit into . . . it’s easier to fit into the skinny young boy image”
capable/strong . . . not muscular at all” (T4, U5). Such conflicting
(T5, U15). Forum users also engaged in resistance by challenging the
emotions led to feelings of ambivalence when it was perceived as
stereotype of the eating-disordered man.
a problem to be “outside” the norm of a masculine man. This led
Challenging the stereotype of an eating-disordered man.
to the next stage of disillusionment.
Forum users resisting masculinity demonstrated acceptance of
Disillusionment. Although these forum users resisted mascu-
their ED by rejecting the stereotype that men engaging in ED
linity and actively sought a thin body through their eating-
practices have “a young girls and feminine gay guy’s problem”
disordered behaviors, disillusionment about their EDs character-
(T16, U2). They acknowledged that the identity of a typical ED
ized the later stages. This was expressed through frustration at the
man was based on generalizations. However, through accep-
lack of recognition of their efforts to achieve a thin ideal and also
tance of their ED, these forum users illustrated that ED men
the inability to disclose their struggles due to stigmatization of men
could be something other than homosexual or feminine. Some
with EDs.
forum users challenged this stereotype by specifically referenc-
Girls get attention. As discussed earlier, for those forum users
ing their gender: “I myself am a 26-year-old hetero male. I am
resisting masculinity, one reason for engaging in eating-disordered
not trans gender, not gay, nor bisexual, or confused” (T9, U10).
behavior was the desire for attention, linked to the construction of
Forum users further demonstrated acceptance by formulating a
a proana identity. However, in the disillusionment stage, forum
proana identity.
users discussed how the expectation of attention that came with
Endorsing a proana identity. Forum users resisted masculin-
engaging in a proana lifestyle was not met. Unlike the disillusion-
ity by constructing a distinct and unique proana identity. With the
ment associated with not being perceived as a “real man,” ex-
act of accepting and endorsing a proana lifestyle, these forum users
pressed by those embracing masculinity, for those resisting mas-
took up a rebellious position and positioned themselves as differ-
culine norms, disillusionment arose because, unlike women, men
ent to other men. The production of self through an eating disorder
were not praised and celebrated for their proana lifestyle:
was the result of the desire to be noticed:
Most girls get praised for their weight loss, get used as thinspiration,
I worked hard on my body with exercise and fasting and avoiding
get told they’re gorgeous and so forth. You do not see a guy who is
food so by all means PLEASE LOOK AT ME! . . . I will be very open
a 15 BMI be told “goals!” but flip the gender table and that’s exactly
about my eating habits. If someone asks “why don’t you eat?”—
what you get. (T3, U3)
because I do not want to get fat! “are you anorexic?”—yes! (T16, U4)
Related to this was the difficulty of sharing their experiences due
Like others forum users who were resisting masculinity, accep-
to stigmatization of EDs in men.
tance of an ED was a means of both receiving attention and
Stigma. Like those embracing masculinity, these forum users
constructing a proana identity.
expressed disillusionment about their ED in terms of the stigma of
Often, ED practices were a response to a perceived lack of
not being able to disclose their struggles: “I’ve lost friends, I’ve
identity. As a result, forum users redefined their identity by con-
been ridiculed and right now I’m definitely not in a good place
structing themselves as special or unique in some way:
mentally” (T13, U8). Although forum users found it easier to
I think I’ve kind of made an identity out of my eating disorder as conceal their EDs due to a lack of recognition of EDs in men, they
shitty as that sounds. Like I’m such a boring and dull person. I have expressed loneliness of being a man with an ED:
 EMBRACING OR RESISTING MASCULINITY 375

I do not tell anyone about my ED . . . It’s not only too personal to tance, (b) ambivalence, (c) disillusionment, and (d) support. The
share but it’s very embarrassing for straight adult male to admit. (T13, current analysis indicates this pattern is cyclical. Reinforced by
U9) responses to masculine norms, men’s engagement with the proana
community perpetuated this cycle of progression.
Early in the progression, resisting masculinity allowed forum users
Prior research suggests that men engage in pro-ED practice to
to form a proana identity that is quite distinct from the normative
achieve an idealized muscular, rather than a thin, physique (Drum-
“masculine” man, but at this stage, forum users found themselves
mond, 1999, 2002; Greenberg & Schoen, 2008; Lavender et al.,
feeling alienated and disillusioned because their ED was not what
2017; Núñez-Navarro et al., 2012; Pope, Olivardia, Gruber, &
they expected or hoped. Following on from this, forum users then
Borowiecki, 1999), yet forum users in the current study repre-
contemplated support.
sented themselves as having varying body preferences. Those
Support.
embracing masculinity were preoccupied with achieving a muscu-
Lack of awareness from peers and professionals. In the final
lar body shape, whereas those resisting masculine norms pursued
stage, forum users resisting masculinity also contemplated support.
a thin ideal. This has important implications for the development
However, because they were disregarding masculine norms, espe-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

of support services, suggesting the need for adopting a person-

cially those around being tough and independent, these forum
This document is copyrighted by the American Psychological Association or one of its allied publishers.

centered approach that recognizes the individuality of men’s ex-

users were more open about their EDs, and therefore about seeking
periences of EDs.
support, than those embracing masculinity. They were not con-
Similar to women, control was an attribute of proana men,
cerned about exhibiting masculine qualities, nor the additional
particularly those representing themselves as “masculine.” Like
stigma of seeking help for a female problem, but were concerned
women, men also used restriction as a method of control. How-
more broadly about the lack of support for men in general:
ever, consistent with prior studies of male EDs (Drummond, 1999,
If a guy talks about a problem or even has one he is gay. I saw a doctor 2002), physical activity was the primary tool for controlling the
for this before. She asked me if I was gay and when I told her no, she male body. A focus on normative masculine practices, namely,
just sat there. She didn’t know what to do and openly told me she had sports and weightlifting, allowed forum users to reproduce mas-
no real experience with a male anorexic. I think there should at least culine qualities such as dominance, discipline, competition, and
be more awareness. (T13, U10) goal achievement (Drummond, 1999, 2002), whereas a focus on
quantification allowed them to enact the self as embracing or
Given past treatment experiences, professional support services
challenging masculine norms. In quantifying the self, proana men
were likewise viewed as inadequate. A lack of awareness from
rationalized the pursuit of muscularity or thinness as tools to
others was related to the desire of forum users who resisted
maintain one’s health or ideal body. This reinforces prior proana
masculine norms to increase awareness. Despite endorsing a
research (Ascari, 2013; Gavin et al., 2008) that proposed that
proana lifestyle, forum users acknowledged that other men might
discourses of health and fitness contribute to the normalization of
require support. By disclosing an ED, forum users attempted to
disordered eating and exercise behaviors.
raise awareness of male EDs: “That’s kinda why I try not to hide
Ambivalence reflected feelings of conflict between positive and
or lie about having an ED. I feel like people should know that it
negative aspects of an ED and appeared to be a natural phase in the
affects males too” (T12, U4).
progressive experience for both those embracing and resisting
Support online. Finding support, being understood and ac-
masculine norms. The results reflect the broader research on EDs
cepted, and being able to express oneself openly without feeling
and ambivalence (Williams & Reid, 2007, 2010, 2012), and find-
shame or fearing recrimination are important to the users of proana
ings on ambivalence and male EDs specifically (Greenberg &
groups. Proana groups provide an important form of emotional and
Schoen, 2008). Consistent with Williams and Reid (2007), ambiv-
social support that was often missing from the lives of those affected
alence stemmed from the tendency to acknowledge adverse effects
by EDs. As a result, the online context was constructed as a valuable
but being unwilling to “give up” ED habits that were central to the
source of support for men who would otherwise feel alienated: “we
formation of the self in relation to masculine norms. As negative
need a place where we can feel accepted, appreciated and safe. And
outcomes outweighed perceived benefits, ambivalence about a
this is it” (T13, U11). In many cases, forum users expressed appre-
proana lifestyle often progressed to disillusionment.
ciation for finding a place where they could communicate with other
Regardless of their response to masculinity, disillusionment
men who were struggling with EDs, with this supportive online
related to perceived stigma determined how forum users viewed
environment viewed by some as an avenue for broader understanding
support. Men represented themselves as subject to the additional
and acceptance of EDs in men: “I think society will soon largely
stigma of being a man with a “female” disorder, in keeping with
accept male ana” (T12, p. 4). Seeking support by engaging in a proana
existing studies on support seeking in men (Drummond, 1999;
website, however, ultimately reinforces the legitimacy of resisting
Greenberg & Schoen, 2008; Raevuori et al., 2014; Räisänen &
masculinity through eating-disordered behaviors, reengaging forum
Hunt, 2014; Robinson, Mountford, & Sperlinger, 2013; Weltzin et
users in the ongoing cycle of ED progression.
al., 2005). Professional services were framed negatively or per-
ceived to have little benefit. Similar to prior research, forum users
Discussion
expressed that their needs were minimized and that there was a
This study examined how men are represented, and represent lack of awareness about male EDs (Thapliyal & Hay, 2014).
themselves, in the proeating disorder (proana) online community. Whether embracing or opposing masculine norms, forum users
Forum users represented themselves in relation to social norms conveyed a desire to be acknowledged if there was a perceived
around masculinity by either embracing or resisting these norms. need for support. To alleviate the isolation of living with a stig-
Within these two responses, four stages were defined: (a) accep- matized illness (Yeshua-Katz & Martins, 2013), forum users en-
 376 QUINIONES AND OSTER
gaged in online forums as a form of social support. Contrary to
research on the negative consequences of proana website use
(Bardone-Cone & Cass, 2006; Peebles et al., 2012; Santos, 2012),
the current analysis supports the more nuanced perspective of
other proana studies. Consistent with studies of proana forums
(Brotsky & Giles, 2007; Csipke & Horne, 2007; Gavin et al., 2008;
Mulveen & Hepworth, 2006; Wooldridge et al., 2014; Yeshua-
Katz & Martins, 2013), men in the current analysis found a space
to receive and offer support. Yet, there is a tension between
potential dangers versus potential benefits of proana participation.
The paradox of the proana phenomenon is that it offers a sense of
being understood, supported, and accepted, while simultaneously
providing encouragement to pursue self-destructive practices
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
(Wooldridge et al., 2014). Offering little space to disengage from
This document is copyrighted by the American Psychological Association or one of its allied publishers.
disordered practices, together with stigmatization of and lack of
support for men with EDs outside of the proana community, online
engagement perpetuated the ED cycle.
Limitations
A potential limitation is that the sample may be biased to those
with Internet access, and a researcher cannot ensure complete and
truthful disclosure from forum users. Users identified themselves
as male; however, the use of online data and passive observation
can limit access to information about individuals on a forum.
Generalizability of the findings is limited by the qualitative study
design, and research on the effects of male participation in proana
websites warrants further study. For example, it would be useful to
explore to what extent the finding of two different responses to
masculine norms is reflected in the proana community more
broadly, particularly with regard to proana on social media plat-
forms. It would also be worthwhile to explore whether the drive for
thinness rather than muscularity in men extends beyond the proana
community.
Conclusion
This study provides insight into the views and experiences of a
stigmatized and hard–to-reach community, namely men within the
proana online environment. Unlike prior research that identified a
drive for muscularity in men with EDs, this study demonstrates
that EDs mean different things to men depending on whether they
embrace or resist social norms of masculinity. The study further-
more demonstrates that men in proana communities, while em-
bracing a proana identity, also see the need for both formal and
informal support for men with EDs. However, stigmatization of
EDs in men and lack of adequate services perpetuated a cycle of
engagement in the proana community, limiting the potential for
recovery. To address the support needs of men with EDs both
within and outside of the proana online environment, attention and
resources should be focused on reducing stigma and providing
individualized support tailored to men’s individual experiences
and needs.
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Received December 12, 2017
Revision received February 26, 2018
Accepted March 27, 2018 䡲