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I laid awake tossing and turning. Every tick of the clock was a reminder of the dreaded seven o'clock wakeup call. Frustrated with another brief bout with insomnia, I switched on the television, hoping to find something adequately mind-numbing to coax my brain to sleep. Somewhere between reality and my sleep-deprived delirium, two people were speaking in Italian. The melodic language was soothing like a cup of chamomile tea. The languid drawl of the Venetian accent was a magnetic lure and unwittingly I was sucked into a twisted psychodrama called Primo Amore.

Vittorio, a quiet, deeply troubled goldsmith, is looking for a woman who matches his standards. Through a classified ad he meets Sonia, a model at the art academy. Initially, he is reluctant to enter into a liaison with this woman, as she weighs an "unacceptable" 125 pounds. But through a series of turns and twists of fate he falls in love with Sonia's head (testa) before he does with her physique (corpo). Once in the clutches of amore Vittorio becomes obsessed with the desire to shape the body and mind of the object of his affection as he does gold with fire. Sheepishly Sonia becomes a passive participant in a sadistic relationship that grows into a reciprocal masochistic game. When the two lovers retreat into an isolated country house in the Veneto Hills, they sever the cord with sanity. Manohla Darghis of the New York Times wrote, "Set in Italy and the darkest recesses of a woman's heart, Primo Amore is a horror movie about desire and the toxic pursuit of perfection."

Primo Amore got me thinking about the unspeakable dramas played out in broad daylight. Sadly, Vittorios and Sonias walk among us, trying desperately to conceal a dangerous preoccupation with an unattainable ideal. But in the face of denial, shrunken bodies, twig-like legs, dark undereyes, and tormented smiles speak volumes. Let's face it: our society is captivated by a warped idea of beauty. This phenomenon really comes to the fore in the fashion business. Vogue's NY office is renowned for having zero tolerance for body fat. Ms. Wintour was infamously quoted saying she would never hire a fat editor even if she were brilliant. As for Lagerfeld; since dropping an astounding 90 pounds, the designer extraordinaire has been utterly fixated on weight. After collaborating with H&M for an affordable collection "Kaiser Karl," he declared he would never work with the Swedish retailer again because it produced his designs in larger sizes. Clearly distressed, the designer lamented, "What I designed was fashion for slender and slim people. That was the original idea."

In all fairness, the opposite of "fat" is not "emaciated." Somewhere in between obesity and anorexia lies a healthy balance. But oblivious to sense and sensibility, hordes of teens and adults march steadily toward withered destinations. The Pro-ana movement is a recent manifestation of the effort to legitimize self-induced starvation. Pro-ana promotes a view of anorexia nervosa as a lifestyle choice rather than a disorder. A number of Pro-ana websites and discussion groups provide a platform for self-identified people with anorexia to come together to talk about their condition, which some claim creates a reinforcing support network. A related movement, Pro-mia, promotes binge-purge eating habits as a similarly positive "lifestyle choice."

These movements have caused controversy because they contradict current prevailing psychological and medical views that define the condition as a psycho-physiological disorder usually occurring in young women. Experts agree anorexia is an illness characterized by an abnormal fear of becoming obese, a distorted self-image, a persistent unwillingness to eat, and severe weight loss. Bulimia nervosa, meanwhile, involves a binge-purge cycle of excessive behavior that has grave consequences—like anorexia, it has among the highest death rates of all mental illnesses.

Pro-ana and Pro-mia advocates disagree and argue that to classify these sets of behavior as illnesses unfairly pathologizes what they consider to be lifestyle decisions and unjustly situates them in the realm of the unwell. It is worth considering that the names themselves suggest a kind of familiarity ("Ana" and "Mia" sounding very much like female names) and "Mia" even connotes a possessive "mine." The suggestion seems to be that the disorders belong to these individuals and as such are exempt from judgment—even, perhaps, the opinion of medical experts. While some anti-psychiatric movements have gained traction in recent years it seems unlikely that Pro-ana and Pro-mia can obtain legitimacy, given the manifestly self-destructive behavior that they condone. It may be a personal choice to engage in this behavior, but it is a perilous choice to make.