“Being sick means constructing an alternate reality, strapping it in place with sturdy mantras, surrendering to the beguiling logic of an old fairy tale.” —Katy Waldman
Anorexia is not just about striving for an idealized body image. It is an obsessive, relentless—and futile—quest to be pure, perfect, and clean.” —Cherry Jackson
Holy Anorexia, also known as Anorexia Mirabilis (“miraculous lack of appetite”), refers to a historical and religious phenomenon prevalent during the Middle Ages, in which predominantly young Christian women—often nuns or other aspirants to religious life—engaged in extreme self-starvation as a demonstration of their spiritual piety, purity, and devotion to God. Unlike the modern medical framing of anorexia nervosa as a psychiatric disorder, Anorexia Mirabilis was interpreted at the time as a form of divine grace or saintly asceticism. It’s this type of thing that stuffs my virtual filing cabinet (one of the functions of Freedom and Reason), in this case for when I return to my sociology of religion course.
The roots of Anorexia Mirabilis lie in the Christian tradition of bodily mortification and fasting, especially as practiced by anchorites (the religious recluse), ascetics (those living austere lives for God), and mystics. In an age when women had limited access to formal institutional and theological power, the control of the body through chastity, fasting, and suffering offered a spiritual and social outlet for religious agency. Refusing food was not only a way to imitate the suffering of Christ, but also a means of rejecting earthly pleasures and asserting moral superiority over the flesh.
Crucially, these practices were celebrated rather than pathologized. Women who could sustain long periods of fasting were said to be sustained by the Eucharist alone or the direct love of Christ. Here was a manifestation of the power of God. At least that was the explanation; wasted bodies were seen as evidence of their sanctity. This led to the widespread veneration of such women, many of whom became the subjects of hagiographies—i.e., religious biographies extolling their virtues—and, in some cases, were canonized as saints, for example Saint Catherine of Siena, who lived between 1347–1380.
In his influential 1985 book Holy Anorexia, historian Rudolph Bell argued that many of these women exhibited behaviors strikingly like modern anorexia nervosa, but within a radically different cultural and theological framework. Bell posits that Anorexia Mirabilis was the historical precursor to today’s eating disorders—especially among women—and served both as spiritual self-expression and a form of resistance to prescribed gender roles. However, more recent theological analyses contend that framing these women as proto-anorexics diminishes their religious agency and overlooks the sincere mystical experiences many reported (I don’t doubt their sincerity). Feminists emphasize the symbolic power of food refusal in a time when marriage and childbirth were seen as a woman’s destiny—abstaining from both sex and food became a path to autonomy and transcendence.
Religion is a powerful force, whether rationalizing or inspiring movements like Holy Anorexia. But we don’t have to travel to the Middle Ages to see this—although Anorexia Mirabilis and what it likely signifies is fascinating and relevant to the balance of this essay. Emerging in the late 1990s and early 2000s, with the rise of internet forums and online communities, there was a phenomenon associated with the “pro-ana” (pro-anorexia) subculture.
While not a formalized cult in the traditional sense (the conventionally understood definition of a cult is that it is typically a structured, often religious group with a charismatic leader, rigid hierarchy, rituals, and clear boundaries), the pro-ana movement functioned with many cult-like dynamics, developing its own ideology, language, and symbology—even its own icon. The pro-ana cult (on second thought, let’s call it a cult) often centered around the glorification of extreme thinness and anorexia nervosa (a species of eating disorder, or ED) as a lifestyle choice rather than a psychiatric illness. Indeed, pro-ana became an identity, and members of the community affirmed anorexia nervosa as a legitimate way of being.
The roots of the pro-ana movement can be traced back to early internet communities such as LiveJournal, Yahoo groups, and later, Tumblr and Pinterest. Young people—mostly girls and women—who felt isolated or misunderstood in their struggles with eating disorders found camaraderie in these online spaces, as do those with Tourette syndrome and other neurological and psychiatric disorders (see Why Aren’t We Talking More About Social Contagion?). These communities dismissed anorexia as a disorder, rejected recovery, and instead framed anorexia as a form of discipline, control, and even spiritual transcendence.
Out of this emerged the figure of “Anna,”or “Ana” a personification or deity-like representation of anorexia. “Anna” was sometimes treated as a guiding force, almost like a guardian spirit—a cruel but revered mistress. This anthropomorphizing of the illness helped users externalize and, paradoxically, embrace it—deepening their entrenchment in disordered behaviors. (People with bulimia also have a personification of their disorder named “Mia.” Personification of desire and phenomena is not uncommon to cultish and religious groups.)
The movement adopted strict “thinspirational” aesthetics—images of skeletal models, motivational quotes promoting starvation, sharing “tips and tricks” for extreme calorie restriction. These behaviors were often ritualized and reinforced communally, mirroring cultic social structures. Some forums developed rules, hierarchies, and even “commandments” issued in the voice of “Anna,” reinforcing the notion that to disobey was to fail a higher calling. Associated with this cult was the modern resurgence of extreme body modification practices like tight-lacing, i.e., extreme corset-wearing.
I followed this closely for a while, even delivering a lecture on the topic in the unit on patriarchy and misogyny in my Freedom and Social Control course some 15 years ago. Always changing the content of that course to keep it topical, I dropped the lecture from the unit. There was another reason why I dropped it, however—the same reason why I dropped my lectures on circumcision (including female genital mutilation) and stopped showing images of lynching and the Holocaust: thinspirational aesthetics and tight-lacing obviously disturbed students. I never came back to it and, over time, forgot about it.
I was reminded of the Anna cult yesterday morning thinking about the transgender phenomenon, where rather than treating body dysmorphia around gender identity as a mental disorder, those suffering from this disorder are instead affirmed in their delusion. It is much the same way that those suffering from anorexia were affirmed, at least in the Anna cult, the facts of which came rushing back to mind once I had reminded myself of the phenomenon. I imagined the absurdity of bariatric surgery or liposuction for girls and women who saw in the mirror obesity instead of emaciation. What psychiatrist would think to affirm girls and women suffering from this disorder in such a way?
You may not remember this cult, but media attention and increased scrutiny led to crackdowns on such content. I oppose censorship, but the response by Internet platforms was the right one for the sake of the vulnerable who get sucked into social contagion. Search engines and social platforms banned or filtered pro-ana material. However, in 2010-2015, there was a resurgence of the cult on Tumblr, where the “sad girls” aesthetic, self-harm, and mental illness fetishism overlapped with pro-ana ideas. During this time, the worship of “Anna” as a quasi-religious figure reached its more stylized and mythologized forms.
From 2015 onward, Tumblr’s adult content ban and broader mental health awareness campaigns led to a decline in centralized pro-ana communities. When I went down the rabbit hole on this subject disclaimers accompanied webpages directing those seeking this content to hotlines where they could speak to counselors. Instagram and TikTok began aggressively moderating pro-ana content. The movement fractured—some of it morphed into so-called “pro-recovery” spaces, albeit that still subtly romanticized disordered behaviors, while other remnants retreated to more encrypted platforms like Discord or Reddit. I am presently fighting the temptation to go down that rabbit hole, but there are so many and I have only so much time.
At any rate, having remembered this, I did inquire as to whether the cult still exists. While the explicit pro-ana culture has largely diminished in mainstream digital spaces due to increased regulation and public awareness, it hasn’t disappeared entirely. Instead, as noted, it has splintered and gone underground. In recent years, more nuanced discussions of “toxic recovery culture” and “eating disorder aesthetics” have emerged, pointing to the persistence of some of the same harmful ideologies in new forms. “Anna” as a deity figure is now far less common, but the spiritual or moralistic framing of anorexia—as a pure or superior way of being—still lingers in corners of the internet. Sad, but a reminder that the pathologies of internalized misogyny persist.
So, there’s good news. What once resembled a cult-like movement built around anorexia has mostly been dismantled. But there’s bad news, too, as misogyny makes sure of: the psychological and cultural underpinnings that enabled its rise are still active albeit in less overt ways. Perhaps describing something as “less overt” is a poor way of putting the way misogyny manifests in other disorders—pathologies that may affect men, as well (not that anorexia was exclusive to girls and women). I have in mind here so-called gender affirming care.
The similarity of the pro-ana cult with the gender identity movement is striking, with an equally striking difference: whereas with anorexia there was a determined effort to arrest a social contagion and get its victims the psychiatric help they needed, gender identity disorder has been normalized and the psychiatrists, endocrinologists, and surgeons make (literally) billions of dollars by affirming gender identity with puberty blockers, cross-sex hormones, and surgical procedures to manufacture simulated sexual identities. (See Simulated Sexual Identities: Trans as Bad Copy; see also The Persistence of Medical Atrocities: Lobotomy, Nazi Doctors, and Gender Affirming Care; Disordering Bodies for Disordered Minds; Fear and Loathing in the Village of Chamounix: Monstrosity and the Deceits of Trans Joy; Thomas Szasz, Medical Freedom, and the Tyranny of Gender Ideology; The Exploitative Act of Removing Healthy Body Parts).
There is a growing body of literature—especially from the last decade—that critically examines gender identity disorder (GID), redescribed as gender dysphoria (which is not inaccurate), and the broader transgender identification phenomenon, particularly among adolescents, through the lens of social contagion, online influence, and cultural shifts (if you’re interested in the literature on the normalization of anorexia, both contemporary and historical, I summarize it at the conclusion of this essay). As you might imagine, this line of inquiry is far more contested and politically sensitive than critical analysis of the pro-ana discourse. Still, some researchers have raised concerns about the rapid increase in youth identifying as transgender and the role of peer dynamics, internet subcultures, and sociocultural narratives in shaping identity development.
One of the most prominent and controversial contributions comes from Dr. Lisa Littman, whose 2018 study introduced the concept of “rapid-onset gender dysphoria” (ROGD). Published in PLoS ONE (later revised after peer review), Littman’s work suggested that for some adolescents, particularly natal females, gender dysphoria may emerge suddenly during puberty, potentially influenced by social factors such as friend groups and online content. The study was based on parental reports.
Unlike the work on the pro-ana phenomenon, Littman’s work has been criticized for “methodological limitations,” a standard debunking phase. The standard line, pumped out for example by Wikipedia (which feeds various AI system the consensus opinion of corporate captured sense-making institutions), is that ROGD is not recognized as a legitimate mental health diagnosis by any major professional organization. The American Psychiatric Association (APA), the World Professional Association for Transgender Health (WPATH), and over sixty other medical associations have called for its removal from clinical practice, citing a lack of “credible” scientific evidence and concerns that it promotes stigma against gender-affirming care for transgender youth. Nonetheless, Littman’s work has sparked significant academic and public debate about whether gender identity can, in some cases, be shaped by social contagion mechanisms similar to those observed in eating disorders and self-harm communities.
Further exploration of this idea can be found in Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020), a journalistic treatment that builds on Littman’s findings and interviews with clinicians, detransitioners, and families. Shrier’s book frames the rise in adolescent transgender identification as part of a broader cultural and ideological movement, drawing comparisons to historical phenomena such as eating disorders and multiple personality disorder (which also has a cult-like appearance). Again, critics (the medical-industrial complex and its army of organic intellectuals) argue that such comparisons risk minimizing the genuine experiences of those with longstanding or medically significant gender dysphoria. Here, those who campaign for legitimizing a mental disorder appeal to emotional blackmail to stifle criticisms of the gender identity movement.
As expected, academic counterpoints have come from gender studies, sociology, and trans-affirming clinicians, who argue that increased visibility and acceptance have simply enabled more individuals to come out safely. But isn’t this what pro-ana advocates sought to do: normalize anorexia nervosa? It appears based on the phenomenon of Anorexia Mirabilis that eating disorders have been normalized before—in the same way that a schizophrenic might assume the role of shaman in a gatherer and hunter society. I checked, and anorexia nervosa remains a recognized mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and its 2022 revision, the DSM-5-TR. It is classified under the category of “Feeding and Eating Disorders.”
A small but growing number of clinical researchers and bioethicists—including Marcus Evans (former clinician at the UK’s Tavistock Clinic) and Stella O’Malley—have voiced concern about affirmation-only models and the potential for misdiagnosis or premature medicalization. These discussions, while still emerging compared to the well-established literature on eating disorders, mean that a contested but active field of inquiry into the sociocultural dynamics of gender identity formation in youth is gaining momentum. While the framing of transgender identification as a form of social contagion is more controversial than in the context of eating disorders, this because of politics and profits, a similar debate is unfolding. With this essay, I aim to do my part to keep the debate going.
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Again, if you don’t know about or recall the pro-ana phenomenon, there is a considerable body of scholarly literature has critically examined the emergence and development of the pro-anorexia (or “pro-ana”) movement, particularly its roots in online communities and its framing of anorexia as a lifestyle or identity. Psychological and psychiatric journals such as the American Journal of Public Health and International Journal of Eating Disorders have published influential studies, including work by Bardone-Cone and Cass (2007) and Borzekowski et al. (2010), which explore how exposure to pro-ana websites can reinforce disordered thinking and behaviors.
Norris et al. (2006) provide a comprehensive review of these websites, shining light on their structure, content, and the risks they pose to vulnerable individuals. From a qualitative standpoint, Gavin, Rodham, and Poyer (2008) analyze how online group dynamics within these communities foster a sense of belonging while deepening participants’ commitment to the disorder, often through the adoption of rituals and coded language.
Beyond clinical psychology, cultural and media studies offer additional context. Sharlene Hesse-Biber’s The Cult of Thinness (2007) presents a sociological critique of Western beauty ideals and explores how thinness functions as a quasi-religious ideal in contemporary society—paralleling the reverence of anorexia seen in pro-ana spaces. In the broader sphere of digital culture, scholars like Alice Marwick have examined how online platforms facilitate identity formation and subcultural bonding, offering frameworks that help explain the stickiness of pro-ana ideology in digital environments. Together, these sources provide a multidisciplinary lens through which to understand how a psychiatric illness became mythologized, even spiritualized, in parts of the internet—and how that mythology still resonates today in fragmented forms.
For more on Holy Anorexia and related matters in the Medieval period, see Caroline Bynum’s 1987 Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women; Barbara Newman’s 1995 From Virile Woman to WomanChrist: Studies in Medieval Religion and Literature; Amy Hollywood’s 2002 Sensible Ecstasy: Mysticism, Sexual Difference, and the Demands of History; Virginia Burrus’ 2004 The Sex Lives of Saints: An Erotics of Ancient Hagiography. For a handy summary of these views, see “Holy Anorexia: How Medieval Women Coped With What Was Eating At Them,” by Student Whitney May writing for A Medieval Woman’s Companion.
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I want to add to this essay my introduction of it on social media to provide a more context and the importance of avoiding revisionist history. I have been going back through my inventory of ideas and lectures and this essay is one I would have published years ago but, like a lot of things I have studied over the years, this one slipped my mind. Once a thought pushes itself into consciousness, I start remembering all sort of things about the topic—and seeing its relevance for today’s concerns.
As note above, I followed the Anna cult closely for a while, even delivering a lecture on the topic in the unit on patriarchy and misogyny in my Freedom and Social Control course some fifteen years ago—before I became aware of the current wave of the transgenderism, which became a potent force in the early 2010s and gained momentum in the mid-2010s (when I presumed along with millions of others that trans was gay adjacent). It was during this period that the rise of transgender activism heightened public awareness that I went down the rabbit hole.
One note here about history of transgenderism (this is not in my essay, but I may add it now that it occurs to me): I am well aware that what the medical industry now calls “gender affirming care” has a long history (going back to the late-nineteenth and early-twentieth century). The history of belief that women can think they’re men is even longer. Trans activists are quick to argue that trans is not a new thing. It’s true: female-bodied individuals living or identifying as male (and visa versa) is not a new phenomenon.
The fact that anorexics can be found in history makes it an even more powerful analog for the gender identity phenomenon. Sociologically, it shows how psychiatric disorders are rationalized in various ways in different times and places. The schizophrenic is a shaman in a gatherer-and-hunter village, etc. Some will flip this and decry the medicalization of ways of being (Gabor Maté, for example, a Canadian pediatrician whom I admire but disagree with on this matter). But this ignores science. It’s a postmodernist notion. Cultural relativism is a useful methodological technique, but to conflate epistemology and ontology is a fallacious move.
freedom and reason 