On Friday, Netflix released “To the Bone,” a film about a young woman struggling with anorexia nervosa. The film has received a great deal of publicity, raising some questions and concerns among parents of children and adolescents with eating disorders.

Here are five questions you may have about the film.

 

My child is recovering from an eating disorder; should they watch this movie?

The question we would ask is why? If it is to gain “insight” into a complex brain illness in the hope that it will aid in recovery, the answer is no.

While this movie is at times emotionally touching and quite funny, in our opinion it doesn’t really represent well the current scientific understanding of anorexia or its evidence-based treatment practices, especially for children. It is a dramatic film much like any other: about imperfect people trying to navigate the challenges in life we all face. It simplifies and conflates many complex biological issues; it is at best a very personal journey through illness and not directly applicable to anyone but the author/director’s own biology and personal circumstances.

One of the most important things to bear in mind – at least for parents of minor children – is that this film is not about children at all (despite the emotional immaturity of several of the characters, including adults!). The scenes depicting treatment especially are very much from the perspective of adult treatment providers. While we would be the first to say we are not experts in adult eating disorder treatment, we can say with full confidence that this film does not depict the type of treatment that has been demonstrated to work best for children. And it is emphatically not the kind of treatment that we render at Kartini Clinic.

We might venture to say however that it could be an interesting movie for parents and therapists to watch and discuss together (without the child), as it does touch on important and quite common issues of family dynamics, and not just between parent and child, but between biological parents and step-parents, siblings, etc. In this sense it could provide some insight – or at least an opportunity for empathy – to those not directly suffering from this particular illness but whose lives are profoundly affected nonetheless.

 

How do I know if my child is ready to watch this movie?

Again, we would ask the question, what do you as a parent hope to gain from having your child watch this? As the basis of effective treatment we would say this movie is not what any child in recovery – or attempting to achieve recovery – needs to see. But we would also not want to discourage parents or other family members from watching and discussing its themes amongst themselves and/or with a family therapist.

 

My child’s friends and schoolmates have all watched this movie and are now talking about eating disorders more than ever before. How do I help my child handle the hype?

By reminding them that they are not defined by their illness and that this is not real life; it’s a movie. It is no more applicable to them and their own treatment needs than the latest installment of Guardians of the Galaxy.

 

How do I know if my child is relapsing? How should I react?

If you suspect your child has been affected by this movie, either directly or indirectly, contact your family therapist or current provider immediately. If currently in treatment, be sure to raise it at your next appointment. For signs and symptoms of relapse, please refer to this blog post by Dr. O’Toole.

 

This movie about eating disorders is getting a lot of attention in the media. Could this cause more kids to develop eating disorders?

Absolutely not. Dramatic depictions cannot “cause” a biological illness such as anorexia nervosa anymore than pictures of cheeseburgers can cause diabetes. It’s just not possible. Could it be triggering to someone with a biological predisposition to the illness or someone in treatment/recovery? Perhaps, and so exposure for those in treatment or recovery is probably best avoided altogether. Better to watch The Lego Batman Movie.

But in all seriousness, we are all exposed daily to these sorts of themes and yet (thankfully) anorexia remains a rare illness. If the media could cause an eating disorder you would expect many more cases of illness than are currently diagnosed, even as we get much better at spotting and treating this dangerous brain disorder in children. Biology causes anorexia nervosa, not motion pictures.