To The Bone: A Film Review From A Mental Health Professional

Content warning: This post deals with eating disorders and may be triggering for some readers.

To The Bone is a new Netflix original movie about a 20-year-old woman, Ellen, who suffers from anorexia nervosa and ends up in a group recovery home for individuals with eating disorders. The official  trailer is included at the very end of this post.

Just like with 13 Reasons Why, there is a ton of controversy surrounding the appropriateness of this film. Many individuals, including many mental health professionals believe that this movie is very dangerous because they believe it will glamorize eating disorders. Some are even calling for Netflix to take the movie down.

Once again, just like with 13 Reasons Why, the majority of these individuals have not even seen the movie yet. Their fears however have some legitimacy.

Research suggests that it’s triggering for those who already have an eating disorder or who are  struggling with unhealthy thoughts surrounding eating, body image and weight issues to watch other people displaying eating disorder behaviors, even if it’s a story of hope and recovery.

With that said, I do not think that those individuals should watch this movie.

If you are someone or you are the parent of a child or friend of someone who is suffering from an eating disorder, I do not think this is a movie you should watch with them. Watch it yourself for sure, as I believe the movie gives some great insight into what it’s like to suffer from an eating disorder, but do not watch it with them  in hopes this will be a great conversation starter between the two of you. It could possibly do more harm than good.

There are definitely some images and events in the movie that can be triggering to certain individuals, such as the main character herself who is scary thin, to the calorie counting and food avoiding behaviors displayed throughout the movie.

Banning this movie however I do not agree with because it is just that, a conversation starter. It’s a movie that needed to be made.

My Issue With The Movie

My only issue with the movie is that Ellen, played by British actress Lily Collins is scary thin. This in itself can trigger individuals who already have issues with their body weight or have an eating disorder.

The real issue is that Lily Collins herself struggled with anorexia nervosa and bulimia nervosa at some point in her 27 years of life and writes a chapter about it in her book, “Unfiltered: No Shame, No Regrets, Just Me.”

For the movie she had to lose a lot of weight to look the part of a very unwell young woman. Although she reports that they did it in a healthy way with the help of a dietician, I still found it alarming that anyone would subject someone who already has a history of struggling with eating disorders, to losing so much weight and then this almost skeletal person is the main character that millions of viewers, some of who will be susceptible to triggers, have to watch on-screen for two hours.

As I watched the movie, before I did my research, I couldn’t tell if she was really that thin or if it was some tricks of the camera or make-up, but upon learning that she actually had to lose such a large amount of weight to play her character, it was just a bit unsettling.

I’m not sure if this film could have been done any other way.

Anorexia Nervosa Versus Bulimia Nervosa

Unless I missed it, the one thing I don’t think the movie did a good job on was differentiating between anorexia nervosa and bulimia nervosa. People tend to think that the only difference is that those with anorexia nervosa severely restrict their calories while those with bulimia nervosa eat and then purge (vomit) in order to control their food intake.

However, there are two types of anorexia nervosa.

One is the restrictive subtype that is more of what people are familiar with. They rarely eat, count calories religiously and may use laxatives, but usually do not purge. The second subtype is the bingeing and purging subtype. These individuals are more like those with bulimia nervosa as they will binge (over eat) and then purge their food.

The main difference between the two is that individuals with anorexia nervosa have a difficult time maintaining the minimal amount of weight considered healthy and individuals with bulimia nervosa are usually at a healthy weight or even overweight.

While anorexia nervosa and bulimia nervosa are the two eating disorders people are most familiar with, other common eating disorders include pica, binge eating disorder, and avoidant/restrictive food intake disorder.

Most eating disorders last 6 to 8 years which is a large part of someones life.

While body image, food and weight loss are generally the focus of an eating disorder, they usually aren’t the underlying causes.

Issues that may trigger eating disorders include a history of abuse or trauma, bullying, parent relational problems, low self-esteem, personality disorders, substance abuse, difficulty dealing with conflict, genetics and feeling as if they have no control over their lives.

Millions of Americans suffer from disordered eating and they’re not all thin, young white girls. People who suffer from eating disorders come in all shapes, sizes and ethnicities from the rail thin to the morbidly obese.

I worked with a 10th grade Haitain-American girl, along with another therapist who specialized in eating disorders as well as a dietician for two years. She struggled with anorexia and it was some of the most difficult work I have ever done.

Eating disorders, just like most mental health disorders, are always hard and uncomfortable topics to discuss and many people would prefer to act like they simply do not exist or are something they never will have to deal with. That is why 13 Reasons Why faced such backlash and why To The Bone is as well. Avoiding these issues will not make them go away.

If people want to be angry with Netflix for making movies such as To The Bone then we also need to be angry with our media in general because it glamorizes weight-loss and thinness. Girls as young as elementary school have started engaging in unhealthy diets and calorie counting due to the images they see on a daily basis through our media.

Marti Noxon, the writer and director of To the Bone says that the movie is based on her experience of struggling with an eating disorder and that the film is intended as “a conversation starter about an issue that is too often clouded by secrecy and misconception”.

So with some warning I recommend this film to anyone interested in learning more about what it is like to struggle with an eating disorder, but not to anyone who is already struggling with body image issues or unhealthy issues about food and weight.

The hope is that this film increases the conversation without increasing the risk of triggering others, but honestly I don’t know if it’s possible to have these type of conversations without anyone ever being triggered. It’s the nature of the beast.

If you or anyone you know are struggling with an eating disorder, please contact The National Eating Disorder Association (NEDA)at



Urban Outfitters Pulls “Depression” Shirt

depression-teeUrban Outfitters came under fire after it began selling this shirt that has “depression” written all over it as if depression was something to be advertised. For Urban Outfitters to initially not see anything wrong with this (they have since pulled the shirt after public outcry), shows how much society has not only minimized mental illness, but even romanticized it. Granted, Depression is the name of the clothing company out of Singapore, but Urban Outfitters no doubt knew that they were pushing the envelope when they decided to sale the shirts in their stores.

This isn’t the first time urban Outfitters has come under fire for tasteless shirts. In 2010 they had a shirt that read “Eat Less” which seemed to make light of eating disorders, and another one that read “Syringe Shot Shooters” which addiction organizations protested.

The problem with shirts like this is that they minimize and make light of serious disorders and addictions. They also make it seem “cool” to have these issues.

You don’t know how many young girls I’ve worked with who are “cutters” and while most of them had some mental instability behind their self-mutilating behaviors, at least some of them did it for attention and because it made them seem complexed. The same is true with some of the depressed teens I worked with. Some of them were indeed truly depressed, but some of them carried around the bleakness and darkness like a badge of honor.

It also, in my opinion, takes some of the responsibility away from people who have these issues and then broadcast it with these types of shirts. The type of people who would wear these shirts aren’t saying “I’m depressed and I am fighting it with all my might”, but “I am depressed so excuse my darkness”.

People who truly suffer from these disorders and addictions don’t advertise it. Teens I see who seriously self-mutilate attempt to hide it, cutting in places you wouldn’t even think of and wearing excessive clothing to cover their scars. People I’ve worked with who suffer from eating disorders hate the disorder and the fact that they have to fight it everyday or risk dying or causing other serious medical issues to themselves. How are these people supposed to feel when their condition is being advertised and sold on a t-shirt? How is it supposed to make society take their condition seriously?2010-06-03-Screenshot20100603at8_24_13AM

While these shirts may seem harmless, they are not. They are sending some hidden and unhidden messages to the public which can be dangerous. Shirts that say “Alcoholic”, “Crack Head” and “Suicidal” may seem harmless and even amusing to some, but for people who actually suffer, know or worse, have lost someone to those conditions, it is not funny.

Watch the documentary The Bridge which is a film about suicides committed by people jumping off the Golden Gate Bridge in San Francisco. You won’t see anyone who jumped to their death wearing a shirt advertising their pain or issues. Mental illness is nothing to glamorise. It is not something that can be fixed by giving someone a little more attention, but instead it takes hard work and dedication by both the person suffering from it and those that love them, including professional help and sometimes medication.

The best thing that I’ve seen come from this situation is the public outcry, for society to say that in the face of all the recent tragedies that have been linked to mental illness, we will not make light of it and forced Urban Outfitters to remove the shirts. Now only if Urban Outfitters and other companies that sale similar shirts would think about humanity more than profitability.