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ORIGINAL ARTICLES
Individual Differences Associated
with Exposure to ‘‘Ana-Mia’’ Websites:
An Examination of Adolescents
from 25 European Countries
Carlos A. Almenara, PhD, Hana Machackova, PhD, and David Smahel, PhD
Abstract
This study explores the individual differences associated with adolescents’ exposure to ‘‘ana-mia’’ websites
(i.e., websites where people discuss ways to be very thin, such as being anorexic). Participants were adolescents
from a large cross-national survey in 25 European countries (N=18,709, aged 11–16, 50% girls). Socio-
demographic and individual factors (i.e., variables related to Internet use and personality traits) were included in
a logistic regression performed separately for girls and boys. The results showed that sensation seeking and
online disinhibition were both associated with an increased risk of exposure to ‘‘ana-mia’’ websites in girls as
well as in boys, although some gender differences were apparent. In girls, but not in boys, the older the child
and higher the socioeconomic status, higher the chance of being exposed to ‘‘ana-mia’’ websites. Further
research is recommended to understand the real impact of ‘‘ana-mia’’ website exposure on adolescent health.
Introduction
The use of the Internet, and particularly social media,
is ubiquitous among adolescents. They spend several
hours per week engaged in online activities.
1
Consequently,
adolescents are exposed to a myriad of appearance-related
content/interactions. This exposure on the Internet contrasts
with conventional media, in which adolescents are specta-
tors of prefabricated content, such as the appearance-related
content of films and magazines. For instance, new media
offers youth a forum for discussion and feedback on their own
appearance-related content, such as receiving comments on
their looks after posting a new profile picture on Facebook.
2
In general, new media provides adolescents with the oppor-
tunity to create their own content online, to have their own
spectators, and to drive online discussion and get feedback on
their own content.
More importantly, the Internet offers the opportunity to
bring together like-minded individuals,
3
such as Internet users
who already have body image concerns. That is the case for
pro-eating disorder (pro-ED) websites that promote eating
disorders as authentic lifestyle choices, although they may
also provide help and support for recovery from an ED.
4,5
From personal websites or blogs to online social communities
and social networks, pro-ED websites encourage disordered
eating behaviors and can disseminate potentially harmful
information.
6,7
They do so with ‘‘tips and tricks’’ for weight
loss or for staying emaciated, by showing images of ultrathin
bodies, by containing inspirational words/images known as
‘‘thinspiration,’’ and by providing areas for discussion, such
as chat rooms, discussion threads in forums, and other out-
lets.
5
Furthermore, this potentially harmful online content
flows to different websites,
8
and the same content from pro-
ED websites can be found on websites not overtly pro-ED,
which are actually the majority of websites.
7
The potential risks and effects of pro-ED have recently
been outlined and include negative effect, body dissatisfac-
tion, and dieting, in addition to learning unhealthy strategies
to lose weight.
4,5
Nevertheless, it is important to keep in
mind that not all online content/interactions centered on
eating disorders can be classified as pro-ED. As a result, the
more neutral and representative term ‘‘ana-mia,’’ which la-
bels websites with content potentially related to anorexia
(ana) or bulimia (mia), but not necessarily pro-ED, has emerged
as an alternative.
9
So far, research attention is mostly focused
on overtly pro-ED websites, but little is known about the
wider range of ‘‘ana-mia’’ websites that are accessible on the
Internet. The aim of this study is, therefore, to identify the
individual factors associated with the exposure to ‘‘ana-mia’’
websites, with special focus on the personality traits as-
sociated with Internet use and risky online behavior (i.e.,
sensation seeking and online disinhibition).
Department of Psychology, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic.
CYBERPSYCHOLOGY,BEHAVIOR,AND SOCIAL NETWORKING
Volume 19, Number 8, 2016
ªMary Ann Liebert, Inc.
DOI: 10.1089/cyber.2016.0098
475
Individual differences that increase the risk of exposure
to ‘‘ana-mia’’ websites
Prior research has uncovered individual differences in
online behavior patterns,
3
such as sociodemographic factors
(e.g., gender), knowledge and skills (e.g., digital skills), and
individual characteristics (e.g., online disinhibition). Gen-
erally, it has been shown that higher Internet use, higher
digital skills, and personality traits such as sensation seek-
ing, are connected with increased risky behavior online,
10
which includes exposure to potentially harmful online content.
Nevertheless, few studies have examined the individual-level
factors specifically associated with an increased probability
of exposure to ‘‘ana-mia’’ websites. Typically, past studies
were limited to the examination of associations between
body image and eating concerns with the use or exposure to
‘‘ana-mia’’ websites,
11–13
social networks,
14
and problematic
Internet use.
15–17
Moreover, these studies are often focused on females,
although the few existing studies suggest that males also
participate on ‘‘ana-mia’’ websites.
18
For instance, in the
qualitative study by Wooldridge et al.,
18
the authors included
12 forums in their content analysis and identified 689 posts
by male participants, most of which were related to provid-
ing/seeking support and inspiration for weight loss.
18
Yet, we
still lack knowledge about males’ exposure to ‘‘ana-mia’’
websites. To the best of our knowledge, only one study on
‘‘ana-mia’’ websites included both adolescent girls and boys
and examined a personality trait (in this case, perfection-
ism).
13
Nevertheless, diverse personality traits, as well as
other individual-level factors, are associated with different
patterns of Internet use, as well as engagement in risky be-
havior online. For instance, a recent review revealed that
sensation seeking, as well as gender, play an important role
in shaping a person’s online behavior.
19
Furthermore, the
authors hypothesize that the strength and saliency of certain
factors on the Internet (e.g., anonymous communication with
strangers in chat rooms) may attract certain personality types
(e.g., online disinhibition among introverts).
19
For this study,
we take into account these general differences in online be-
havior patterns and focus specifically on their role in the
exposure to ‘‘ana-mia’’ websites, an issue that has not yet
been thoroughly studied. To fill this gap, the present study
is aimed at examining two salient personality traits asso-
ciated with Internet use and risky online behavior: sensa-
tion seeking and online disinhibition among adolescents of
both genders.
Sensation seeking is mainly characterized by the open-
ness to and seeking of new and intense sensations and ex-
periences.
20
Previous studies suggest that sensation seekers
offline tend to be also sensation seekers online, such as be-
ing more likely to communicate with unknown people on
the Internet.
21
Thus, considering that the Internet provides
opportunities to gratify sensation-seeking needs and the ex-
posure to ‘‘ana-mia’’ websites can be one of these opportu-
nities, it could be plausible that, among certain individuals,
sensation seeking is also associated with looking for ‘‘ana-
mia’’ websites. For instance, a study of college women found
that online appearance comparisons (i.e., comparing one’s
appearance to others’ on social media) and online ‘‘fat talk’’
(i.e., talking about others’ bodies and negatively about one’s
own) were both positively correlated with a measure that
indicated sensation seeking by a lack of premeditation/
perseverance.
22
Similarly, other studies have found a posi-
tive association between sensation seeking and problematic
Internet use in the general population,
23
as well as in female
patients with eating disorders, and particularly in those of the
binge/purge subtype.
16
In fact, sensation seeking is consid-
ered an important trait associated with disordered eating,
particularly with binge/purge behaviors.
24
Nevertheless, to
the best of our knowledge, no study has examined the as-
sociation between sensation seeking and the exposure to
‘‘ana-mia’’ websites in adolescents.
Although, ‘‘online disinhibition’’ has been considered a
difficult term to define,
25
it denotes being less inhibited to
exhibit/express behaviors, feelings, or thoughts online com-
pared with face-to-face interactions.
26
Thus, online dis-
inhibited individuals feel more comfortable online and are
more likely to talk online than in face-to-face interactions,
which can, in turn, become problematic, particularly for
more vulnerable individuals. For instance, it has been sug-
gested that vulnerable individuals, such as those who are
socially anxious or those with body image concerns, can get
caught up in a vicious circle by using online communication
as a coping mechanism for their psychological difficul-
ties.
17,27
Thus, online disinhibition can promote computer-
mediated communication, interactions, and online exposure
to diverse content. Therefore, special attention should be
given to the effects of online disinhibition during devel-
opmental periods, such as childhood and adolescence, and
particularly to vulnerable individuals, such as those with
body image concerns.
The present study
The aim of this study is to examine the association be-
tween the exposure to ‘‘ana-mia’’ websites (i.e., websites
where people discuss ways to be very thin, such as being
anorexic) and two salient personality traits associated with
Internet use (sensation seeking and online disinhibition) in a
large cross-national sample of adolescents of both genders in
25 European countries. Additionally, we considered poten-
tial confounding variables, specifically: the daily use of the
Internet; digital skills; socioeconomic status; and age. These
have been found to be related to different online behavior
patterns in prior studies.
13,17,28
Methods
Procedure
Data from the EU Kids Online II project (April/October
2010) was used. Approximately 1,000 Internet-using youth
in each of 25 participating European countries were sampled
using a stratified random probability sampling approach,
yielding an overall sample of 25,142 children (50% girls)
aged 9–16. Trained interviewers collected data at the child’s
home, where the child filled out both administered and self-
completed questionnaires focused on their online experi-
ences. The research study was conducted in accordance
with ESOMAR ethical guidelines and approved by the LSE
Research Ethics Committee. Confidentiality and anonymity
was guaranteed and all the information and questions were
explained. Informed consent was obtained from the parents
and children.
29
The sample for this study consists of children
who were asked about exposure to websites where people
476 ALMENARA ET AL.
discuss eating disorders (aged 11–16). Due to the low preva-
lence of the studied phenomenon, pooled data from all
countries were used for the analysis; N=18,709, M
age
=
13.50, SD =1.70, 50% girls.
Measures
Exposure to ‘‘ana-mia’’ websites. We asked participants,
‘‘In the past 12 months, have you seen websites where people
discuss ways to be very thin (such as being anorexic or bu-
limic)?,’’ with answers Yes (=1; 11.5%) and No ( =0; 82.5%).
Answers ‘‘Don’t know’’ (4.2%), ‘‘Prefer not to say’’ (1.4%),
and missing values (0.4%) were excluded from the analysis.
Daily use of the Internet. Children were asked, ‘‘How
often do you use the Internet?’’ and were divided into those
who use it ‘‘every day or almost every day,’’ that is, daily
users ( =1; 73.6%), and those who use it less often, that is,
nondaily users ( =0).
Digital skills. Children were asked, ‘‘Which of these things
do you know how to do on the Internet?’’ followed by eight
Yes/No items (e.g., ‘‘Delete the record of which sites you have
visited’’ or ‘‘Block unwanted adverts or junk mail/spam’’);
positive answers were counted to create a scale; M=4.43,
SD =2.58, a=0.76.
Online disinhibition. This was computed as the mean of
three statements (e.g., ‘‘I find it easier to be myself on the
Internet than when I am with people face to face’’) answered by
‘‘Not tru e’’ ( =0), ‘‘A bit true’’ ( =1), and ‘‘Very true’’ (=2),
M=0.53, SD =0.52, a=0.65.
Sensation seeking. This was computed as the mean of two
items,
30
‘‘I do dangerous things for fun’’ and ‘‘I do exciting
things, even if they are dangerous,’’ answered by ‘‘Not true’’
(=0), ‘‘A bit true’’ ( =1), and ‘‘Very true’’ (=2), M=0.39,
SD =0.53, a=0.78.
Socioeconomic status of the household. This was as-
sessed through the household’s main wage earner’s level of
education and occupation. Three levels of socioeconomic
status (SES) were calculated: Low ( =1; 20%), Medium ( =2;
45%), and High ( =3; 35%).
Gender. The child’s gender was coded by the interviewer.
Age. Parents reported the age of the child.
Table 1 includes the descriptive statistics separately by
gender.
Data analysis
We conducted three-step hierarchical logistic regression
analyses to predict the odds of children’s exposure to ‘‘ana-
mia’’ websites. Demographics (SES, age), factors related to
Internet use (non/daily use and digital skills), and individual
characteristics (sensation seeking and online disinhibition),
were added consecutively to the models. The analyses were
conducted separately for girls and boys.
In the model for girls (Table 2), all variables predicted the
outcome positively. Specifically, the older the age, the higher
the SES, the more the digital skills, the more the daily In-
ternet use, and higher the levels of sensation seeking and
online disinhibition, then higher the chance of being exposed
to ‘‘ana-mia’’ websites.
The results for boys (Table 3) were similar, with two ex-
ceptions. First, SES was not significantly linked to the out-
come, nor was the age of the boys after the inclusion of other
Table 1. Descriptive Statistics by Gender (M,SD)
Age
Digital
skills
Sensation
seeking
Online
disinhibition
Daily
Internet use (%)
SES
(low, %)
SES
(middle, %)
SES
(high, %)
Exposure
(%)
Boys 13.49 (1.69) 4.56 (2.63) 0.48 (0.57) 0.55 (0.53) 75 20 46 34 7.8
Girls 13.51 (1.66) 4.29 (2.52) 0.29 (0.47) 0.51 (0.51) 73 20 36 43 16.7
The percentages were computed from valid values only.
SES, socioeconomic status.
Table 2. Logistic Regression Predicting Exposure to ‘‘Ana-Mia’’ Websites Among Girls
Step 1 Step 2 Step 3
BSE OR BSE OR BSE OR
Constant -6.556 0.292 0.001*** -6.069 0.299 0.002*** -6.133 0.309 0.002***
SES 0.173 0.042 1.189*** 0.103 0.043 1.109* 0.108 0.044 1.114*
Age 0.332 0.019 1.394*** 0.233 0.021 1.263*** 0.215 0.021 1.24***
Daily Internet use 0.364 0.087 1.439*** 0.276 0.088 1.318**
Digital skills 0.155 0.015 1.168*** 0.139 0.015 1.149***
Sensation seeking 0.794 0.059 2.213***
Online disinhibition 0.291 0.06 1.338***
Cox & Snell, R
2
0.04 0.06 0.09
Nagelkerke, R
2
0.07 0.10 0.15
***p<0.001; **p<0.01; *p<0.05.
OR, odds ratio; SE, standard error.
EXPOSURE TO ANA-MIA WEBSITES 477
predictors. Second, the final model for boys explained less
than the final model for girls (Cox & Snell, R
2
=0.03; Na-
gelkerke, R
2
=0.07 for boys versus Cox & Snell, R
2
=0.09;
Nagelkerke, R
2
=0.15 for girls).
Discussion
The aim of this study was to examine if certain individ-
ual differences (sensation seeking and online disinhibition)
are associated with adolescents’ exposure to ‘‘ana-mia’’ web-
sites. We employed data from a cross-national sample of
adolescents in 25 European countries.
The results showed that sensation seeking and online
disinhibition were both associated with an increased risk of
exposure to ‘‘ana-mia’’ websites in girls as well as in boys.
Although the past literature examining these topics is scarce,
prior studies have found that sensation seeking and online
disinhibition are associated with online appearance-related
interactions, particularly with appearance-related teasing and
cyberbullying.
31,32
Thus, it could be possible that sensation
seeking and online disinhibition not only increase the prob-
ability of exposure to ‘‘ana-mia’’ websites, but also shape
the online interactions within these websites. However,
these ideas are speculative and further research would be
needed to help clarify which individual differences are the
most salient regarding the exposure to and interactions
within ‘‘ana-mia’’ websites.
In our investigation, about one out of 10 adolescents re-
ported being exposed to ‘‘ana-mia’’ websites, and this ex-
perience was more than double in girls than in boys. This
gender difference in the exposure to ‘‘ana-mia’’ websites is
very similar to previous reports
13
and can be explained by the
content and target population of these websites. As usually
happens with online weight loss advertising,
33
thinspira-
tional online content is represented by and directed to wo-
men, typically portraying thin or underweight women to
inspire weight loss.
34
Likewise, adolescent females place
notable importance on body image and weight concerns
35
and are more likely to develop body dissatisfaction and
eating disorders over time
36,37
; this can render them more
prone than boys seeking information or support through
‘‘ana-mia’’ websites. Indeed, our results showed that the
explained variance was much higher for girls compared with
boys, which could suggest that the exposure to ‘‘ana-mia’’
websites would be more intentional for girls with the studied
individual characteristics, whereas for boys it would be more
random or even unintentional. Moreover, while the odds of
exposure increased with age among girls, this did not apply
for boys. We controlled both daily Internet use and digital
literacy, which could help explain the link to (in some cases
probably also unintentional) exposure and the overall
amount of Internet use. Yet, we see that the older girls were
the more likely to visit an ‘‘ana-mia’’ website. This probably
reflects a growing focus on thin appearance in girls, and we
suggest that this also indicates that the visits were more often
intentional and in line with girls’ overall behavioral focus on
weight loss and appearance management. Nevertheless, the
fact that boys were also exposed to ‘‘ana-mia’’ websites, as
found in studies with community and clinical populations,
13,38
confirms that this phenomenon is not confined to girls and that
we should pay more attention to the male population.
18
Moreover, because of the future ubiquity of online infor-
mation and the difficulty to regulate its content, policy
stakeholders should ensure that the population receives edu-
cation and training in core critical media literacy skills.
39
In-
deed, media literacy is also considered a key contributor to the
prevention of eating disorders.
40
Furthermore, this knowledge
and these activities can be integrated within the promotion of
social responsibility (i.e., investment in the well-being of
others and the community).
41
For instance, girls can be edu-
cated to recognize the importance of taking an active role in
online communities to promote a climate of empathy, respect,
and ethical participation among members.
42
Finally, future research can examine the paths and ways
that promote selective exposure to specific online content,
such as ‘‘ana-mia’’ websites, as well as how adolescents
perceive this online content and why they do so. For instance,
it is known that the online content that users see on the
Internet is not entirely random since it is usually filtered by
computer algorithms that in turn influence online behavior
patterns.
43–45
Therefore, future research can examine how
this algorithmic regulation affects exposure to ‘‘ana-mia’’
websites. Similarly, an experimental study with adolescent
girls found that peer comments about extremely thin media
models exert influence on how girls perceive these media
models.
46
Therefore, future research can examine the exter-
nal factors that influence adolescents’ perceptions of ‘‘ana-
mia’’ websites. Future research should also differentiate
between intentional and unintentional exposure to ‘‘ana-mia’’
web sites. As already mentioned, it is crucial to further un-
derstand the real impact of ‘‘ana-mia’’ website exposure on
adolescent health.
Table 3. Logistic Regression Predicting Exposure to ‘‘Ana-Mia’’ Websites Among Boys
Step 1 Step 2 Step 3
BSE OR BSE OR BSE OR
Constant -4.592 0.374 0.01*** -4.077 0.386 0.017*** -4.441 0.395 0.012***
SES 0.028 0.059 1.028 -0.041 0.06 0.959 -0.037 0.06 0.963
Age 0.15 0.025 1.162*** 0.048 0.028 1.049 0.046 0.028 1.047
Daily Internet use 0.412 0.125 1.51*** 0.333 0.126 1.395**
Digital skills 0.138 0.02 1.148*** 0.105 0.021 1.11***
Sensation seeking 0.219 0.034 1.245***
Online disinhibition 0.562 0.076 1.755***
Cox & Snell, R
2
0.01 0.02 0.03
Nagelkerke, R
2
0.01 0.04 0.07
***p<0.001; **p<0.01.
478 ALMENARA ET AL.
Limitations
Although our study has strengths, such as a large sample
size, it also has limitations, and our results should be inter-
preted with caution. First, our findings cannot be interpreted
in terms of causality because of the cross-sectional nature of
our study. Second, although we included several potentially
confounding variables to account for individual differences
that can affect exposure to ‘‘ana-mia’’ websites, there are
other factors which can be linked to the studied outcome. For
instance, it could be possible that some parents use parental
control software to block their child’s access to specific
websites and perhaps this software could block the access
to ‘‘ana-mia’’ websites. Finally, we relied on self-reports,
which might, in some cases, deviate from the actual expe-
riences and which did not provide specific or detailed in-
formation about the duration of exposure, the kind of content
seen, and the number and nature of interactions maintained
within the ‘‘ana-mia’’ websites. Nevertheless, the charac-
teristics of our study, including a large sample of adolescents
of both genders, as well as the variables included in the
analyses, provide an important step toward a better under-
standing of the individual variables that increase the risk of
exposure to ‘‘ana-mia’’ websites.
Acknowledgments
The authors acknowledge the support of the Czech Sci-
ence Foundation (THINLINE—GA15-05696S) and the Fa-
culty of Social Studies, Masaryk University, the Czech
Republic.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Dr. Carlos A. Almenara
Department of Psychology
Institute for Research on Children,
Youth and Family (IVMDR)
Masaryk University
Jos
ˇtova, 10
Brno 602 00
Czech Republic
E-mail: carlos.almenara@mail.muni.cz
480 ALMENARA ET AL.