Pro‐Ana—Balancing a Digital Safe Space and Indirect Self‐Harming. Findings From a Meta‐Synthesis

OBJECTIVE: Harmful consequences of having an eating disorder can be exacerbated by engagement in digital groups that promote eating disorder-related content, particularly related to anorexia nervosa, and are often called pro-Ana. This study aims to synthesize qualitative research regarding individuals' experiences of participating in these digital groups to elucidate the underlying personal drivers of the engagement and how it can affect eating problems. METHODS: A systematic database search for first-person experiences yielded 27 relevant studies. We used an ethnographic approach and a thematic analysis for the meta-synthesis. RESULTS: We identified three meta-themes across the studies: (1) "Pro-Ana feels like a safe space where I can be myself", (2) "Pro-Ana is a dangerous path", and (3) "Pro-Ana becomes a joint project for living with an eating disorder". DISCUSSION: Participants' experiences in pro-Ana communities relate to concepts on offline stigmatization, fundamental needs for belonging, and the inherent ambivalence toward the online community-balancing the pursuit of emotional support with the risks of indirect digital self-harming. Helpers and clinicians are recommended to directly engage with clients regarding their digital activities and associated risks, including engagement in pro-Ana, with openness and respect to mitigate feelings of shame and guilt.