Anorexia Nervosa in "To the Bone": Diagnosis and Treatment
This paper examines the character Ellen from the 2017 film "To the Bone" through the lens of abnormal psychology. Using DSM-5 diagnostic criteria, the paper identifies Ellen's condition as anorexia nervosa, citing specific evidence from the film including her food restriction behaviors, intense fear of weight gain, and distorted body image. The paper also explores contributing factors such as family dysfunction and emotional neglect, considers co-occurring diagnoses including major depressive disorder, and proposes a multidisciplinary treatment plan involving nutritional counseling, psychotherapy, and ongoing medical monitoring. Finally, it evaluates how accurately the film portrays the realities of anorexia nervosa and notes areas where its depiction may inadvertently reinforce stigma.
- Introduction: Ellen and Her Eating Disorder: Character overview and diagnosis of anorexia nervosa
- DSM-5 Diagnosis of Anorexia Nervosa: DSM-5 criteria applied to Ellen's symptoms
- Contributing Factors and Co-Occurring Conditions: Family dysfunction, neglect, and possible comorbidities
- Proposed Treatment Plan: Multidisciplinary care including therapy and nutrition
- Portrayal of Anorexia Nervosa in the Film: Accuracy of the film's depiction and stigma concerns
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What makes this paper effective
- Grounds clinical observations directly in the film by citing specific timestamps, making the diagnostic argument concrete and evidence-based rather than speculative.
- Follows a logical four-part structure — character introduction, diagnosis, treatment, and media critique — that mirrors a professional clinical case write-up.
- Acknowledges diagnostic nuance by noting DSM-5 subtypes (restricting vs. purging) and considering co-occurring conditions such as major depressive disorder and OSFED.
Key academic technique demonstrated
The paper demonstrates applied diagnostic reasoning: the student maps observed character behaviors onto formal DSM-5 criteria, citing peer-reviewed sources (Gorwood et al., 2016; Takakura et al., 2019) to support clinical claims. This technique — moving from observable symptom to criteria-based diagnosis — is a foundational skill in abnormal psychology coursework and clinical training.
Structure breakdown
The paper is organized into four clearly labeled sections. The first introduces the character and her general condition. The second applies DSM-5 criteria to reach a formal diagnosis, supported by direct film evidence. The third proposes a multidisciplinary treatment plan grounded in current literature. The fourth critically evaluates the film's portrayal, noting both its strengths and its potential to perpetuate stigma. This structure moves logically from observation to diagnosis to intervention to critique.
Introduction: Ellen and Her Eating Disorder
The character examined in this case study is Ellen, who later changes her name to Eli. She is a 20-year-old confronting a serious eating disorder — specifically, anorexia nervosa. A college dropout, Ellen is constantly challenged by a range of personal fears and family problems. After failing to make progress in earlier inpatient programs, she joins a group treatment program managed by an unconventional physician. The other participants in the program are young adults who are similarly struggling with eating and related disorders. From this point onward, Ellen embarks on what can be described as a journey of self-acceptance and self-discovery, ultimately finding herself before it is too late. To a large extent, Ellen and others depicted in the film project an image of genuine perseverance.
As noted above, Ellen is suffering from anorexia nervosa, which, according to Gorwood et al. (2016), is a serious eating disorder. The film showcases a number of presenting symptoms of the disorder and highlights the challenges that individuals diagnosed with anorexia nervosa encounter on an ongoing basis.
DSM-5 Diagnosis of Anorexia Nervosa
To be diagnosed with anorexia nervosa, an individual must meet the criteria set out in the DSM-5. First, restriction of food intake must be apparent, resulting in significant weight loss such that the individual's body weight is substantially lower than what would be expected for a person of similar height, sex, and age. Second, the individual must exhibit an unusual or intense fear of weight gain. Third, the person's perception of their own body and circumstances — particularly regarding weight — must be distorted. For example, a person may perceive themselves as "fat" when they are objectively underweight. Such thought patterns are referred to clinically as cognitive distortions. It is also worth noting that under DSM-5, anorexia nervosa is further divided into two subtypes: the restricting type and the purging type.
Ellen meets the diagnostic criteria for anorexia nervosa. She repeatedly restricts her food intake, and the resulting, all-too-apparent loss of body weight is evident throughout the film. She has also demonstrated an intense fear of weight gain on multiple occasions. For example, at timestamp 00:47:52, she states: "I get all panicky even thinking about it, like, the world is gonna fall apart." This remark refers to her compulsion to maintain her weight by consuming only very small amounts of food. Additionally, in the early stages of the film, Ellen does not perceive her condition as a problem. During her engagement with earlier treatment programs — before enrolling in the group program — it is clear that she does not even want to recover, which is why she is eventually sent home.
References
Gorwood, P., Blanchet-Collet, C., Chartrel, N., Duclos, J., Dechelotte, P., Hanachi, M., & Epelbaum, J. (2016). New insights in anorexia nervosa. Frontiers in Neuroscience, 20, 256–261.
Takakura, S., Aso, C. Z., Toda, K., Hata, T., Yamashita, M., & Sudo, N. (2019). Physical and psychological aspects of anorexia nervosa based on duration of illness: A cross-sectional study. BioPsychoSocial Medicine, 13(32), 74–83.
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