The ugly, sad, lonely truth about eating disorders

For someone in the grip of illness, triggers are everywhere.

For someone in the grip of illness, triggers are everywhere.

COMMENT: ​One of the most insidious things about eating disorders is that they often affect exactly the type of people who think they're too smart to get eating disorders - or, perhaps more accurately, the sort of people who think they're smart enough to play around with disordered eating, carefully gleaning the supposed benefits without suffering the frightening, often fatal, consequences.

As a teenager, I was one of these people: painfully insecure, yet dangerously arrogant at the same time, convinced I could keep my plummeting weight under control.

Watching To the Bone, a moving new Netflix film written and directed by Marti Noxon and based on her own experiences of anorexia nervosa, I was acutely reminded of my own battle. Ellen, the film's protagonist (played by Lily Collins) is clever, cynical, a talented artist and, at the stage we meet her, completely lost to her disease.

Lily Collins says she was initially reluctant to star in To the Bone because of her own illness about a decade earlier.

Lily Collins says she was initially reluctant to star in To the Bone because of her own illness about a decade earlier.

Inevitably, To the Bone has attracted a huge amount of controversy. A little like Netflix's previous drama 13 Reasons Why, which was accused of "glorifying" teen suicide (perhaps with some justification) the film has been accused of "glamorising" eating disorders, with experts raising concerns that it could trigger recovering sufferers to relapse, and inspire copycat behaviour.

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Collins, who has herself suffered from eating disorders in the past, lost weight to portray her character, and the film contains a number of shots of her emaciated body, which many have compared to the "thinspiration" images used by some sufferers to spur themselves on.

Are these fears justified? Should the film be censored or even banned? In all honesty, it's something I find hard to be objective about. Had I watched To the Bone when I was ill or recovering, I am sure I would have compared myself to Collins, needing to know that I was as thin, or thinner, than she is on screen. The shots of her body, whether exposed or diminished by her outsized clothes, may well have triggered me. Furthermore, while I understand that Noxon wanted to recreate the invasiveness of anorexia treatment, the story could still have been told just as effectively without lingering on Collins's ribs, shrunken stomach and spine.

The problem is, for someone in the grip of the illness, potential triggers are everywhere, and it's impossible to guard against them all. Once I had begun restricting my eating, and experienced that addictive, irresistible pull, countless everyday situations, from a biology lesson on daily energy intakes, to a cereal box with a slim model on it, to a Sunday newspaper supplement about ballet dancers, were able to spur me on.

As a society, we are collectively obsessed with thinness - and, sadly, there are no triggers in To the Bone that sufferers won't be able to find elsewhere. In my own case, it would be impossible to say exactly what "caused" my anorexia. But I do know that when I first began experimenting with systematic calorie reduction, at the age of 15, I felt like I was at last doing something positive for myself. I knew I wasn't overweight, but I desperately, obsessively wanted slimmer legs.

Looking back, it's hard to credit or explain the level of daily paranoia I suffered over this particular issue. An elderly female science teacher once commented that the "legs" on a diagram I'd drawn of a tripod were "too fat" and I was mortified, convinced it was a veiled insult. As a child, I tried sticking a needle into my thighs and calves, to see if I could squeeze out the fat. When I discovered that liposuction existed, I fantasised about turning 18 and having it done.

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The realisation that I could simply slim the offensive limbs by skipping meals and reducing calories gave me a gratifying sense of power, coupled with relief that I'd at last hit upon a sensible way of coping with one of my appearance-related problems. Unflattering glasses? Get contacts. Fat legs? Skip breakfast and lunch for a month or two and just eat a bowl of cereal every evening.

But my initial jubilation at being a bit smaller, legs and all, soon turned to tense, constant anxiety. I knew that I needed to maintain and continue my weight loss without arousing suspicion. People with eating disorders tend to become experts in subterfuge, habitually lying about their condition and disguising it with any number of tricks, and I was no exception. My friends knew that I wasn't eating properly, but I managed, at first, to downplay what I was doing. After all, everyone always wants to lose "a few pounds".

The problem was, I hadn't just lost a few pounds. I'd been at a healthy but low weight before I started, with (I can see looking back) completely normal legs. Now, thanks to my dieting, I was underweight. The meal skipping, too, had become physically addictive: a potent combination of secret euphoria and dizzy numbness. Convinced I was in control, I persisted in doggedly sticking to a dangerously low number of calories a day.

While I knew what I was doing wasn't healthy, I didn't think I had anorexia: real anorexics, I erroneously believed, ate nothing at all. Soon, however, secrecy became redundant, and the second, public stage of the illness - the one where I was made to take off my clothes and be weighed each week at a clinic; the one during which we would have daily family rows, parents barging into the bathroom to check I wasn't flushing away food or purging; the one during which my dad would ask embarrassing questions about my stopped periods - began in earnest.

It was ugly, sad, lonely, and, above all, humiliating. My body wasn't my own any more: it belonged to the NHS, and its intrusive doctors, nurses and scales. The people who treated me were lovely - but lying to them, trying to covertly fight back and retake control, became my life.

Though I found To the Bone difficult to watch at times, it is bold, brave and honest about the despair that prolonged time battling this illness can induce. By showing that it's still possible to find some bleak humour in this situation, it reminds us that anorexia is something that happens to real people, destroying the lives of funny, witty, talented, flawed, loved, loving human beings. Ellen feels painfully real; tired, and sad, and sick to death of her anorexia, in both the literal and physical sense - but unable to stop.

The film is adept at showing the impact that one person's illness can have upon their wider family, but also demonstrates how being the cause of such strife can be exhausting and alienating for the individual. Ellen's close yet troubled relationship with her sister is sensitively portrayed, while a surreal yet heartbreaking moment of tenderness, during which she allows her mother to feed her like a baby at the end, made me sob my eyes out.

I understand the criticism it has received. But while many are clued up about how people behave when they are first lapsing into anorexia, Noxon's film offers an unflinching look at what it's like to be at the lowest point of the illness, when death is frighteningly close, and the possibility of a turnaround seems incomprehensible. Denying her the right to share her story would be wrong - because, at heart, To the Bone is not a story about romanticising mental illness, but a story about deciding to survive. At the peak of my own illness, between the ages of 15 and 17, I felt like there was no end in sight. Now 29, the story of my own recovery is complex, involving relapses, depression and an overdose, before I ultimately decided I wanted to focus on being alive.

To the Bone has no magical, fairy-tale ending, but by documenting Ellen's journey towards a crucial psychological turning point, it shows that, even for people who have spent years in the grip of anorexia, recovery - and life - is possible. This might sound trite, but for sufferers, there's a huge difference between objectively knowing this, and actually believing it could, and should, apply to you.


The Mental Health Foundation's free Resource and Information Service (09 623 4812) will refer callers to some of the helplines below:

Lifeline (open 24/7) – 0800 543 354

Depression Helpline (open 24/7) – 0800 111 757

Healthline (open 24/7) – 0800 611 116

Samaritans (open 24/7) – 0800 726 666

Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

Youthline (open 24/7) – 0800 376 633. You can also text 234 for free between 8am and midnight, or

0800 WHATSUP children's helpline – Phone 0800 9428 787 between 1pm and 10pm on weekdays, and from 3pm to 10pm on weekends. Online chat is available from 7pm to 10pm every day at

Kidsline (open 24/7) – 0800 543 754. This service is for children aged 5 to 18. Those who ring between 4pm and 9pm on weekdays will speak to a Kidsline buddy. These are specially trained teenage telephone counsellors.

* Your local Rural Support Trust – 0800 787 254 (0800 RURAL HELP)

 - The Telegraph, London


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