Since the late 1990s, people living with anorexia nervosa have turned to the internet for solace and support. They formed blogs, started websites and YouTube channels, and created forums in order to connect with other people also suffering from what is considered a life-threatening eating disorder. For many, these online groups provide a space to cope and recover — to form bonds with others who understand exactly what it means to live with anorexia.

But underneath this circle of support is an alarming subculture that promotes dangerous behaviors, exacerbates eating disorders, and threatens lives.

This subculture is known as pro-ana — shorthand for pro-anorexia. There are similar pro-bulimia communities (known as pro-mia). As the names indicate, these online communities inform people on how to work anorexic or bulimic practices into their lives.

“There’s this whole dark side where people will encourage other people to be anorexic or bulimic,” says Maria Rago, PhD, president of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). According to Rago, pro-ana websites and blogs will often feature diet tips, photos, personal stories, and memes meant to encourage people to starve themselves and drop down to unhealthy weights.

People who run or visit pro-ana sites typically post images of extremely skinny bodies, explain ways to suppress hunger pains and other symptoms of anorexia nervosa, or share memes with body-negative quotes to inspire starvation. “You can even say they’re marketing sites where people are trying to market this idea that it’s OK to be anorexic and bulimic,” Rago says. “That these are good lifestyles.”

The pro-ana subcultures extend beyond blogs, websites, and forums. They also exist through hashtags and keywords. Words like “thinspiration,” “thinspo,” and “thigh gap” are often tacked to the end of Instagram photos showing small waists and protruding hip bones. Other less popular terms like “ribcage” and “collarbone” will also find their way into pro-ana (and pro-mia) posts on social media.

But, unlike pro-ana sites, hashtags are harder for advocates to pin down and depopularize, says Lauren Smolar, director of helpline services for the National Eating Disorders Association (NEDA).

“Hashtags can change all the time,” Smolar points out. “Even if you can ‘hijack,’ per se, a negative hashtag and make it positive, you can just create another one.”

Not all pro-ana sites share the same mission or viewpoint. Some pro-ana communities claim to be nonjudgmental spaces for people living with anorexia, while others say they exist as support groups to help individuals cope with their disorder.

Many pro-ana sites, though, disavow the medical community’s consensus that anorexia is a mental illness. Instead, these types of sites push anorexia nervosa as a “lifestyle choice” stigmatized by family and doctors.

Advocates say all pro-ana websites present a danger to people who are vulnerable to disordered eating or are suffering from anorexia. Particularly, pro-ana communities are harmful because they support and normalize unhealthy behaviors characteristic of anorexia until a person’s eating disorder gets “worse and worse,” Rago says. “You could lose your life if it gets fed into that way.”

Some researchers, though, believe that efforts to ban or criminalize online pro-ana and pro-mia communities can do more harm than good. Their argument is that these sites provide people living with an eating disorder with a way to release their anxieties and frustrations. By censoring pro-ana communities, people living with anorexia lose spaces to work through their disorder, they claim.

But that’s a problematic viewpoint, Rago says. These sites may provide “a release,” but they still encourage “self-starvation and the worshipping of emaciated bodies,” she counters.

“Certainly ANAD does not want anyone to be treated like a criminal for starting a pro-ana site,” Rago says. “But we do not believe that these are helpful to people suffering from eating disorders. We really encourage people to stop feeding into these kinds of messages and work to change their view of body acceptance, and other reasons they and others are beautiful.”

Smolar understands that pro-ana sites are popular because they give people struggling with eating disorders a place to express themselves candidly. Individuals living with anorexia — or any eating disorder for that matter — tend to be socially isolated, so pro-ana sites provide a way for them to connect and find support with like-minded peers thousands of miles away from the safety of their own home.

“These sites are harmful,” Smolar says, but “the reason that those sites are available and that there is such a high rate of involvement is [because] those people are looking for a place to talk to other people about what they’re going through. That’s why it’s vital for healthcare professionals and advocates to provide safe, positive spaces to combat these harmful sites and social media groups.”

There are many pro-recovery eating disorder communities like We Bite Back that use social media to provide healing advice and wellness tips, as well as counter the harm caused by pro-ana sites. Mobile apps, such as Recovery Record and the Kissy Project, are also available to help teens and adults cope with their disorders and make the journey through recovery. “And body-positive bloggers and influencers like BodyPosiPanda,” Smolar says, “can serve as healthy and safe alternatives to pro-ana communities.”

Smolar notes that NEDA runs a Tumblr page and forums where people can find peer support and recovery assistance. The organization’s pro-recovery community offers people who are struggling with an eating disorder “a place that’s safe” where they can vent and share experiences in “a positive and healthy way.”

“It can be really difficult to struggle with a lack of support,” Smolar says. “Recognizing that allowing a space for people to talk to each other and also making it easier for them to get help when they’re looking for it is something that’s really important.”

NEDA’s website offers a list of resources for anyone wanting to get help and into treatment for an eating disorder. NEDA also has a live helpline that people who are in crisis can call 24 hours a day, seven days a week. To reach the helpline, dial 800-931-2237. You can also talk to your primary care physician for a referral.