In Session with “To the Bone”

February 25, 2021

In honor of National Eating Disorders Awareness Week, we’re putting Netflix’s 2017 drama To the Bone on the couch. Starring Lily Collins, this film tells the story of Ellen, a young woman battling anorexia, including her treatment at a residential facility led by the unconventional methods of Dr. Beckham, played by Keanu Reeves.

Dr. Sam and Dr. Fran discuss whether or not Ellen meets criteria for anorexia as well as the prevalence of anorexia in the US. We also review what Ellen’s treatment looks like in the film and explore the broader treatment of eating disorders by level of care (or setting) and type. Even beyond the subject of eating disorders, this is an especially helpful breakdown for anyone navigating the mental health system.

Finally, we discuss some of the controversy surrounding the film and rate the portrayal of anorexia and its treatment on our DSM-5 (Diagnosing Shows and Movies). Plus, we share some certified PhDonts that the movie definitely got wrong.

We hope this episode provides help and hope. If you or someone you know is struggling with an eating disorder, you can get help by calling the National Eating Disorders Association Helpline at 1-800-931-2237.

Glossary of Terms

Medical stability – when referring to eating disorder treatment, includes the improvement/normalization of vital signs, cardiac stability, and other physical health indicators to the point that someone is ready to transition to a lower level of care

Psychiatric inpatient hospitalization – located in a psychiatric hospital or medical unit dedicated specifically to addressing mental heath concerns, admissions are typically briefer and address acute concerns

Residential treatment facility – generally considered a step-down from psychiatric inpatient hospitalization, typically designed to be more comfortable and feel less like a traditional hospital setting

Partial Hospitalization Program (PHP) – outpatient therapy program occurring for 6+ hours per day on most days of the week, patients typically do not stay overnight but rather return home in the evenings

Intensive Outpatient Program (IOP) – similar to PHP, but typically runs for fewer hours (e.g., 3-4 hours) each day, enables patients to continue with their normal, day-to-day lives

Acceptance and Commitment Therapy (ACT) – type of therapy that uses acceptance and mindfulness strategies, as well as behavior change strategies, to increase contact with the present moment and move towards one’s values

Dialectical Behavior Therapy – type of therapy focused on building mindfulness skills, effectiveness in interpersonal relationships, emotion regulation strategies, and tolerating distress

Family-Based Treatment (Maudley Approach) – type of therapy that avoids placing blame on the family for the developing of an eating disorder, but rather considers the family as essential to the treatment, sessions often involve the entire family

Cognitive Behavior Therapy-Enhanced (CBT-E) – type of therapy that works to modify maladaptive beliefs and attitudes about weight, shape, and appearance, which may be related to the development and maintenance of an eating disorder

Dissonance – the mental discomfort that results from holding two conflicting beliefs, values, or attitudes

Person-centered language – language that emphasizes the person first rather than the illness

References

If you or someone you know is struggling with an eating disorder, you can get help by calling the National Eating Disorders Association Helpline: 1-800-931-2237.

If you or someone you know is struggling with or at risk for suicidal ideation, you can get help by calling the National Suicide Prevention Lifeline (Hours: Available 24 hours. Languages: English, Spanish) 1-800-273-8255.

Check out these resources on eating disorder symptoms, treatment, and awareness.

We highlight how there are many factors that can be correlated with the development of eating disorders. Learn more about how genetics and family factors may play a role.

We discuss the differences between types of inpatient, residential, and outpatient treatment. Learn more here.

Was the depiction of eating disorder treatment accurately portrayed in To the Bone? Read about typical components of eating disorder treatment here.

There are several types of therapy that have been shown to be effective in treating eating disorders–check them out here.

Dr. Sam highlighted the importance of using person-centered language when discussing mental health and other concerns, see why here.