July 20, 2017 To the Bone: Eating disorder awareness or doing harm?

To the Bone – a film about a turning point in a young woman’s battle with anorexia nervosa – has attracted comment from mental health professionals and advocates. Critics have concerns it could cause or worsen eating disorder symptoms.

The writer-director of To the Bone assured audiences she wished to dispel myths, not do harm. So which aspects of the new film might do harm, and which might educate the audience in a positive way?

How might the film cause harm?

It’s important to be clear that this film isn’t going to cause an eating disorder in anyone who isn’t already vulnerable. Eating disorders develop from a complex combination of biological, psychological and social factors.

But when vulnerabilities are present, it’s possible scenes in the film may be distressing. Netflix does provide a warning to this effect. Unfortunately, there’s no guarantee this advice will be taken. And not all people with eating disorders know they’re unwell, so it’s not quite as simple as avoiding the film.

One criticism of the film is that it could act as a “how-to” manual for eating disorder behaviours by providing, for example, information about purging (vomiting) and disguising true weight. We know people learn eating disorder behaviours from films, books and the internet.

Another concern is the film glamorising eating disorders. Most people who watch the film will see the depictions of eating disorders as particularly unglamorous – Lily Collins, who plays the main character, Eli, looks frighteningly thin.

But people with anorexia frequently view images of emaciation as beautiful and respond in an emotionally positive way, while healthy individuals tend to have an aversive reaction.


Another criticism is the risk preparation for the film posed for Collins, who has a history of an eating disorder but lost weight for the film. Losing weight can be dangerous for people with a history of eating disorders, as restriction can reduce anxiety and reinforce dangerous habits. Collins did this under the supervision of a nutritionist, but it’s to be hoped it has no lasting negative effects for her.

How might the film have a positive influence?

People in the community tend to have low knowledge about eating disorders and hold stigmatising attitudes, which can create a barrier to seeking help. Because To the Bone depicts people with eating disorders, it could help educate the public and reduce stigma and stereotypes. But does the film succeed in doing this?

The belief people are to blame for their eating disorders is a common one, and the film somewhat dispels this myth. It touches on the complex causes of eating disorders and asks us to empathise with people with anorexia and their families. It also depicts the serious consequences of anorexia, including social isolation, miscarriage and death.

One notable absence from the film is a depiction of the recovery process. Recovery is achievable for many people with eating disorders. Depicting this could encourage sufferers to seek help by sending a message of hope.

If you or someone you know wishes to seek help for eating disorder or body image issues, please contact The Butterfly Foundation on 1800 ED HOPE.

Joanna Doley, PhD Candidate, School of Psychology and Public Health, La Trobe University and Susan J Paxton, Professor, School of Psychology and Public Health, La Trobe University

Joanna Doley and Susan J Paxton
are academics from La Trobe University
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This article was originally published on The Conversation. Read the original article.