Dying to Be Thin

Just one click of the mouse grants you immediate access to the disturbing and deadly domain of the women who are literally starving to be thin. Welcome to the world of "pro-ana, "an online community dedicated not to offering support and advice for anyone battling life-threatening eating disorders such as anorexia but to preventing their recovery.

These 1,000 or so sites feature "thin-spiration galleries" -- picture after picture of skinny celebrities such as Victoria Beckham and images of emaciated women with their ribs on show and close to death. These cyber-galleries and chatrooms, which claim that "being thin is more important than being healthy," were yesterday condemned by experts who say they deliberately encourage users to compete against each other to lose weight. Ministers have already held talks with internet providers to find ways of clamping down on them.

However, some clinicians say young women are turning to these websites because of a lack of proper support elsewhere and a postcode lottery in treatment for eating disorders. They blame the fact that adolescents and children are being fed conflicting messages about diet and health.

On one hand, they are the focus of anti-obesity campaigns, but then only have to switch on the television to be bombarded with images of junk food or read magazines featuring images of impossibly thin women.

The Eating Disorders Association says the focus on obesity takes the attention away from anorexia and bulimia, which are all about excessive weight loss and represent the flipside of a negative relationship with food.

"Not only does it take funding away but it means government messages are focusing on diet and exercise, which is what these people want to do to extinction," said Susan Ringwood, the charity's chief executive.

The fashion industry has also been singled out for criticism. Psychiatrists say that while the use by designers of size 0 models -- such as Lily Cole and Erin O'Connor -- on the catwalk does not trigger eating disorders in an impressionable teenager, they can prolong the time it takes for them to recover.

This is backed up by new findings published last week. The first major study into female attitudes to thin fashion models has found that their images can lower levels of self-esteem and lead to higher levels of depression. Published in the journal, The Psychology of Women Quarterly, the research found that exposure to "thin-ideal" advertisements increased body dissatisfaction.

Eating disorders now affect more than one girl in every 100. Although 90 per cent of cases are female, boys are not immune. Increasing numbers of male patients who have an unhealthy relationship with food are being referred by doctors for treatment.

The deadly compulsion to starve or purge to stay thin also no longer respects class or race. Once anorexia and bulimia only afflicted well-educated and white, middle-class women. Now Asian and black people are seeking help, as well as those from working-class backgrounds.

Anorexia nervosa, in which sufferers restrict their food intake or starve themselves, is the third most common chronic illness of adolescence. Bulimia nervosa is even more common, but the secretive nature of the disorder coupled with the reluctance of sufferers to seek help means that it can go undetected.

And now experts have identified a new type of bulimia, unheard of 10 years ago. A third of patients seen by psychiatrists in eating disorder clinics are "multi-impulsive," which means not only do they binge on food then purge themselves, but they also express their inner despair by cutting, overdosing and abusing alcohol. Sane, the mental health charity, has picked up on this worrying new trend. Its helpline staff report a rise in callers suffering from eating disorders who are also self-harming.