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THE ANOREXIA NERVOSA DISORDER THAT REFLECTED IN TO THE BONE FILM BY MARTI NOXON

THESIS

Submitted to the Board of Examiners in Partial Fulfillment of the Requirement for Literature Degree

at English Literature Department

by

GUSTIA MEGA PUTRI NIM: 403170873

ENGLISH LITERATURE DEPARTEMENT ADAB AND HUMANITIES FACULTY

STATE ISLAMIC UNIVERSITY SULTHAN THAHA SAIFUDDIN JAMBI

2021

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ii

NOTA DINAS

Jambi, 29 April 2021

Pembimbing I : Dr. Diana Rozelin, S. S., M. Hum Pembimbing II : Ulfatmi Azlan, S. S., M. A

Alamat : Fakultas Adab dan Humaniora UIN STS Jambi Kepada Yth,

Dekan Fakultas Adab dan Humaniora UIN Sulthan Thaha Syaifuddin Jambi

Di-

Tempat Assalamu’alaikum, Wr, Wb

Setelah membaca dan mengadakan perbaikan seperlunya, maka kami berpendapat bahwa skripsi saudari: Gustia Mega Putri, Nim. 403170873 yang berjudul The Anorexia Nervosa Disorder that Reflected in To The Bone Film by Marti Noxon telah dapat diajukan untuk di munaqasahkan guna melengkapi tugas- tugas dan memenuhi syarat-sayarat mencapai gelar Sarjana Strata Satu (S.1) pada Fakultas Adab dan Humaniora UIN Sulthan Thaha Syaifuddin Jambi. Maka dengan ini kami ajukan skripsi tersebut agar dapat diterima dengan baik.

Demikianlah, kami ucapkan terima kasih semoga bermanfaat bagi kepentingan kampus dan para peneliti.

Wassalamu’alaikum, Wr, Wb

Dosen Pembimbing I Dosen Pembimbing II

Dr. Diana Rozelin. S. S., M. Hum Ulfatmi Azlan, S. S., M. A

NIP.197604282005012004 NIP.198411272011012012

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iii

APPROVAL

Jambi, April 29th 2021

Supervisor I : Dr. Diana Rozelin, S. S., M. Hum ………

Supervisor II : Ulfatmi Azlan, S. S., M. A

Address : Adab and Humanities Faculty .. ………… State Islamic University

,,,,,,,,,,,,,,,,,,,, ,,,,,,, Sulthan Thaha Saifuddin Jambi.

To:

The Dean of Adab and Humanities Faculty

State Islamic University In

Jambi

Assalamu’alaikum wr. Wb

After reading and revising everything extend necessary, so we agree that the thesis entitled is The Anorexia Nervosa Disorder that Reflected in To the Bone Film by Marti Noxon can be submitted to Munaqasyah exam in part fulfillment to the Requirement for the Degree of Humaniora Scholar. We submitted it in order to be received well. Thus, we hoped it can be useful for all.

Wassalamu’alaikum wr. Wb

Supervisor I Supervisor II

Dr. Diana Rozelin. S. S., M. Hum Ulfatmi Azlan, S. S., M. A

NIP.197604282005012004 NIP.198411272011012012

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iv

LETTER OF RATIFICATION

This thesis had been examined by the board of Adab and Humanities Faculty examiners, State Islamic University Sulthan Thaha Saifuddin Jambi on May 28st 2021 and accepted in partial fulfillment of the requirement for literary degree (S1) at English Literature Department.

Jambi, May 28th 2021

Dean of Adab and Humanities Faculty

Dr. Halimah Dja’far. S. Ag., M. Fil. I NIP: 19601211 198803 2001

Chairwoman Secretary,

Dian Mukhlisa, M.A Rahmat Fajar, MA

NIP. 198909112015032006 NIP. 196602261994021001

Examiner I Supervisor I

Chandri Febri Santi, M. Pd Dr. Dian Rozelin, M.Hum

NIP.198902032018012002 NIP. 197604282005012004

Examiner II Supervisor I

Firdiansyah, M.A Ulfatmi Azlan, MA

NUPN. 2004118102 NIP.198411272011012012

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v

ORIGINAL THESIS STATEMENT

I who signed this letter:

Name : Gustia Mega Putri

NIM : 403170873

Department : English Literature Department

Faculty : Adab and Humanities

By signing this letter, I state that the thesis entitled “The Anorexia Nervosa Disorder that Reflected in To the Bone Film by Marti Noxon” is my original work. If this thesis is not original or cheating from other researcher, I will be ready to be responsible and get punishment based on the role of Adab and Humanities Faculty of State Islamic University Sulthan Thaha Saifuddin Jambi.

Therefore, I make this statement in good health and mind.

Jambi, 10 Mei th 2021

The Researcher

Gustia Mega Putri Nim: 403170873

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vi MOTTO

رْسُي ِرْسُعْلا َعَم َّنِاَف ا

ۙ

َّنِا َعَم ِرْسُعْلا ا رْسُي

ۙ

Meaning :

Surely with difficulty is ease, With Difficulty is surely ease.

(Asy-Syarh, 5-6) Artinya:

Karena sesungguhnya bersama kesulitan itu ada kemudahan.

Sesungguhnya bersama kesulitan itu ada kemudahan.

(Al-insyirah, 5-6)

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vii DEDICATION

Bissmillahirrahmanirrahim

“In the name of Allah, The most Beneficial, The most Merciful”.

I dedicated this thesis to:

Allah SWT, the most Merciful

Prophet Muhammad SAW, who brought us from the darkness to lightness Myself who never give up no matter what happen.

To my beloved mother (Nunung Ernawati) and father (Gimin Ashari) who always give me the best prayers, supports, and love.

To my beloved sister (Ermasari Wiyana) and brother-in-law (ismail) who always give me the best prayers and suports.

To my beloved friends who always there for me in any circumstances.

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viii

ACKNOWLEDGEMENT

Firstly, the researcher would like to say Alhamdullilahirabil’alamin, all the praise to Allah SWT the lord of all creatures, for His Blessing from the starting point of my study until now the end of my study. After that, Shalawat and salam be upon to our Prophet Muhammad SAW, hopefully we will get His syafa’at later at The Last Day. Secondly, I would like to express his deepest gratitude to people who helped the researcher in accomplishing this thesis. I would like to thank my supervisors Dr. Diana Rozelin, S.S., M.Hum and Ulfatmi Azlan, S.S., M.A who have helped, adjusted, supported and suggested me in writing this thesis. I also would like to say thanks for all classmates English Literature 2017 who have given additional suggestion and support to finish this thesis.

To accomplish this thesis, the researcher had been given one great deal to many people. So, the researcher would like to say thanks for their contribution, they are:

1. Prof. Dr. Suaidi, MA., Ph. D as a Rector of State Islamic University of Sulthan Thaha Saifuddin Jambi.

2. Dr. Halimah Dja’far. S. Ag., M. Fil. I. as the dean of Adab and Humanities Faculty

3. Dr. Ali Muzakir, M. Ag as the first Vice Dean of Academic. Dr. Alfian, S.Pd, M.Ed as the second Vice Dean of Finances, and Dr. Roudhoh, S.Ag.SS M.Pd.I as the third Vice Dean of University Student of Adab and Humanities Faculty.

4. The Head of English Literature Department Dian Mukhlisa, M.A, and The Secretary of English Literature Department Chandri Febri Santi M.Pd.

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ix

5. All the Lecturers and staffs of Adab and Humanities Faculty, then contribution and assistant during studying in UIN of Sulthan Thaha Saifuddin Jambi.

6. The Head and officers of the library of UIN and public library of Jambi province.

7. The last but not least, to my beloved parents, brother, sister and friends who gave fully supporting to the researcher.

This thesis is still far from perfection, the researcher humbly request some critiques and suggestions in order to make it better in the future time. Finally, the researcher wishes that this thesis could extend useful contribution to the readers, especially for the students of English Literature Department of Adab and Humanity Faculty.

Jambi, 17 Mei 2021

Gustia Mega Putri NIM: 403170873

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x ABSTRACT

Putri, Gustia Mega, 2021 : The Anorexia Nervosa Disorder that Reflected in To the Bone Film by Marti Noxon

Supervisor I : Dr. Diana Rozelin, S. S., M. Hum Supervisor II : Ulfatmi Azlan, S. S., M. A

This research examines anorexia nervosa disorder in the film To the Bone, where eating disorder of anorexia nervosa causes a person to have a very small body or weight below normal due to a deviant diet. The analysis is directed how a deviant diet is carried out in this film, thus made a person experience the eating disorder of anorexia nervosa. The purpose of this research is to identify the characteristics of anorexia nervosa, the factors that cause it, and how to treat anorexia nervosa as depicted in the film To the Bone. The focus of this research is the main character in the film, namely Ellen, played by Lily Collins. This research used qualitative research with descriptive method. The Source of data in this research is in the form of pictures, dialogues, and the film script itself, namely To the Bone film by Marti Noxon. In the process of data collecting, researchers used documentation techniques by Moleong. While in the process of analyzing data, researchers used content analysis techniques by Bodgan & Biklen. The results of this study, researchers found that (1) there are four characteristics of anorexia nervosa indicating that Ellen has anorexia nervosa, there are maintain of body weight, fear of gaining weight, showing a significant disturbances in body shape perception, and amenorrhea. (2) As for the factors that cause anorexia nervosa experienced by Ellen, the researcher found that one of the factors causing is psychological factors. Then (3) the treatment used in this film is psychosocial treatment. Where psychosocial treatment is divided into several therapies, first structured inpatient, individual therapy, family therapy, and support groups.

Keywords: Eating Disorder, Anorexia Nervosa, Diet

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xi ABSTRAK

Putri, Gustia Mega, 2021 : The Anorexia Nervosa Disorder that Reflected in To the Bone Film by Marti Noxon

Supervisor I : Dr. Diana Rozelin, S. S., M. Hum Supervisor II : Ulfatmi Azlan, S. S., M. A

Penelitian ini mengkaji kelainan anoreksia nervosa dalam film To the Bone, dimana kelainan makan anoreksia nervosa menyebabkan seseorang memiliki tubuh yang sangat kecil atau dibawah normal akibat pola makan yang menyimpang. Analisis diarahkan pada bagaimana diet yang menyimpang dilakukan dalam film ini, sehingga membuat seseorang mengalami gangguan makan anoreksia nervosa. Tujuan dari penelitian ini adalah untuk mengidentifikasi ciri-ciri anoreksia nervosa, faktor-faktor penyebabnya, dan cara penanganan anoreksia nervosa seperti yang digambarkan dalam film To the Bone.

Fokus penelitian ini adalah tokoh utama dalam film tersebut yaitu tokoh Ellen yang diperankan oleh Lily Collins. Penelitian ini menggunakan jenis penelitian kualitatif dengan metode deskriptif. Sumber data dalam penelitian ini berupa gambar, dialog, dan naskah film itu sendiri yaitu film To the Bone karya Marti Noxon. Dalam proses pengumpulan datanya, peneliti menggunakan teknik dokumentasi menurut Moleong. Sedangkan dalam proses analisis data, peneliti menggunakan teknik deskriptif menurut Bodgan & Biklen. Dari hasil penelitian ini, peneliti menemukan bahwa (1) terdapat empat ciri anoreksia nervosa yang menunjukkan bahwa Ellen mengalami anoreksia nervosa yaitu menjaga berat badan, takut bertambah berat badan, menunjukkan gangguan persepsi bentuk tubuh yang signifikan, dan mengalami amenore. (2) Adapun faktor penyebab anoreksia nervosa yang dialami oleh Ellen, peneliti menemukan bahwa salah satu faktor penyebabnya adalah faktor psikologis. Kemudian (3) perawatan yang digunakan dalam film ini adalah perawatan psikososial. Dimana perawatan psikososial dibagi menjadi beberapa terapi, pertama program rawat inap terstruktur, terapi individu, terapi keluarga, dan kelompok pendukung.

Kata kunci: Gangguan makan, Anorexia nervosa, Diet

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TABLE OF CONTENT

PAGE OF TITLE ... i

NOTA DINAS ... ii

APPROVAL ... iii

LETTER OF RATIFICATION ... iv

ORIGINAL THESIS STATMENT ... v

MOTTO ... vi

DEDICATION ... vii

ACKNOWLEDGMENT ... viii

ABSTRACT ... x

ABSTRAK ... xi

TABLE OF CONTENT ... xii

ABBREVIATIONS ... CHAPTER I ... 1

A. Background of Research ... 1

B. Formulation of Problem ... 4

C. Purpose of Research ... 4

D. Limitation ... 5

E. Significance ... 5

CHAPTER II ... 6

A. Psychological Approach... 6

B. Anorexia Nervosa ... 7

C. The Characteristic of Anorexia Nervosa ... 8

D. The Factors Causing of Anorexia Nervosa ... 11

E. The Treatments of Anorexia Nervosa ... 14

F. Review on Previous Research ... 18

CHAPTER III ... 20

A. Design of Research ... 20

B. Source of Data ... 22

C. Technique of Data Collection ... 22

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xiii

D. Technique of Data Analysis ... 24

CHAPTER IV ... 26

ANALYSIS ... 26

A. The characteristic of anorexia nervosa ... 26

1. The individual maintains a body weight ... 26

2. Intensely afraid of gaining weight ... 31

3. Exhibits a significant disturbance in the perception of the shape or size of his or her body ... 34

4. Postmenarcheal females with this disorder are amenorrheic .. 36

B. The factors causing of anorexia nervosa ... 37

1. Psychological factor ... 37

C. The treatments of anorexia nervosa ... 40

1. Structured inpatient and partial hospitalization programs ... 40

2. Individual psychotherapy ... 42

3. Family psychotherapy ... 44

4. Support groups ... 45

CHAPTER V A. Conclusion ... 47

B. Suggestion ... 48

REFERENCES ... 49 APPENDIX I

APPENDIX II APPENDIX III

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xiv

ABREVIATIONS

AN : Anorexia Nervosa

DSM-IV : Diagnostic and Statistical Manual for Mental Disorders Fourth Edition

APA : American Psychiatric Association

HT : Hydroxytryptamine

REE : Resting Energy Expenditure FSH : Follicle-Stimulating Hormone LH : Luteinizing Hormone

ICD : Diagnostic Criteria for Disorders

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CHAPTER I INTRODUCTION

A. Background Of Research

Every human being with different types of personalities. This personality will describe how an individual thinks, behaves, and interacts with others. The personality of a human is often interpreted as characteristics that stand out in individuals, such as shy people, they are said to be shy, quiet people are said to be quiet personalities, and so on. Based on psychology, Gordon Allport states that personality an organization (various psychological and physical aspects) that is both a structure and a process1. From this statement, it can be interpreted that personality regularly grows and changes.

In literature, personality is studied in the field of psychology, where this field studies personality and its variations. This psychological study aims to show how each person has a different personality.

The fields of psychology and literature are inextricably linked. The study of measurable patterns of human behavior is the subject of literary psychology. Literature demonstrates how people respond to problems and their surroundings. Personality in literature is studied in the discussion of psychoanalytic. Psychoanalytic is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating mental disorders. As a psychological problem, anorexia nervosa is an eating disorder often experienced by those who experience excessive worries about their weight. Sufferers are people who are very obsessed with getting slimmer and thinner by limiting their diet, it is dangerous for them and can have fatal consequences. The British doctor, Richard Morton, first described it in 1989. In the 21st century, the Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV-TR) classifies anorexia nervosa as a psychiatric condition or mental disorders and

1 Gordon Allport, Personality: A psychological interpretation. (New York: Henry, Holt and company, 2005) p. 15

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published by the American Psychiatric Association. The essential features of Anorexia Nervosa are that the individual refuses to maintain minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body.2 Diet, often a trigger that leads to anorexia. Prospective anorexics may start by skipping meals or eating very small portions.

People with anorexia always have reasons not to eat, for example, not being hungry, being sick, eating with others, or disliking the food served.

They also started reading food labels to figure out how much calories and fat were in each item they consumed. Many individuals who suffer from anorexia cut out both fat and sugar from their diets and seem to live only on diet soda and lettuce. Some prospective anorexics start exercising with great force to burn extra calories. Ultimately, these practices can have serious health implications. With the problem of eating disorders, the researcher uses psychoanalytic criticism where psychoanalysis can be used to investigate a person's personality disorders such as mental disorders and eating disorders, including the kind of mental disorder. The kind of eating disorder in this study is anorexia nervosa.

Related to the study that the researcher wants to research, To the Bone film is suitable for researcher’s research because this film discusses about people who have eating disorders including anorexia nervosa. This film was directed and written by Marti Noxon and released on January 22, 20173. Duration of To the Bone Film is 107 minutes or 1 hour 47 minutes. The film tells the story of a girl who has to fight against anorexia that she suffers from.

This film is also adapted from a true story, from the film director Marti Noxon and Lily Collins (as Ellen), who are people that have successfully

2Diagnostic and Statistical Manual for Mental Disorders. Fourth Edition. (Washington, DC:

APA. 2013)P. 539

3Restu Wahyuning. “Film – To The Bone (2017)”. Accesed from

https://www.tribunnewswiki,com/2020/04/07/film-to-the-bone-17 . ( 7 April 2020).

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recovered from anorexia in the past. They want to share their experiences through the film To The Bone to inspire others to do what should be done is to eat enough and not be too obsessed with excess weight.

Picture 14 Picture 25

In the first picture is a snapshoot when Ellen gone to the doctor and the second picture when Ellen is undergoing treatment. From the dialogue in the screenshot 1, there is an Ellen condition which shows that she has anorexia nervosa.

Doctor: “you do much sit-ups”

Ellen: “not that many”

Doctor: “That’s not a question. That’s why you have bruises on your spine”

Based on the dialogue above, the doctor knew that Ellen did a lot of sit-ups, which made her spine was very prominent and there are bruises on her spine as seen in the picture. The appearance of a very thin body and prominent bones, that show there are signs of anorexia nervosa, which sit up or do excessive exercise is one of the characteristics of anorexia nervosa.

The researcher chose this topic because anorexia nervosa is quite interesting to research. It relates to a person's diet problems that make person

4 Duration 00:13:27- 00:13:39

5 Duration 00:49:45- 00:49:50

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suffer from an eating disorder. In this day and age, most women are obsessed with their weight, to the point where they engage in an excessive or deviant diet. As a result, the researcher recognize that diet is not only a healthy way of life, but it can also lead to people endangering themselves by following extreme diets. Here, researchers are interested in conducting research on To the Bone film because this film can describe what a diet is like so that it makes a person suffer from eating disorders like anorexia nervosa. This research can also provide information to many people that are worried about being overweight or having a deviant diet that can harm themselves and affect their behavior or their bodies. The researcher hopes that by conducting this study, they will become less obsessed with excess body weight, preventing them from following a deviant diet and allowing them to follow a healthy diet properly.

B. Formulation of Problem

The research questions are as follows :

1. What are the characteristic of anorexia nervosa experienced by Ellen in To the Bone film?

2. What are the factors causing of anorexia nervosa experienced by Ellen in To the Bone film?

3. What are the treatments of anorexia nervosa used by Ellen in To the Bone film?

C. Purpose of Research

The following is a list of the study's objectives:

1. To find out the characteristics of anorexia nervosa experienced by Ellen as person who has anorexia nervosa in To the Bone film

2. To know the factors causing of anorexia nervosa experienced by Ellen in To the Bone film

3. To know the treatments of anorexia nervosa used by Ellen in To the Bone film

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D. Limitation

There are many aspects that can be analyzed in To the Bone film by Marti Noxon, which was released in 2017. However, to make this research focus, in this case, the researcher limits the analysis to Ellen's character, what factor causes that make Ellen to be anorexic and what the treatment that used by Ellen in this film. The focus of this research is the main character in To the Bone film that a person who has an eating disorder of anorexia nervosa, it is Lily Collins as Ellen.

E. Significance

This study is intended to aid in the development of literature, especially in the field of psychology, and can generate information that can be used as a reference for further research. This research is also expected to provide many benefits for the researchers themselves and readers because this study will obtain data about the characteristics of AN, the factors causing it, and how to treat an eating disorder of AN. So that it can provide information and increase knowledge about eating disorders, especially in anorexia nervosa.

Then, as a result of this research, researcher and readers will have a better understanding of how diet that lead to the eating disorder of anorexia nervosa and will be more aware of a diet that is followed, regardless of whether it is healthy or not. So that they can avoid a deviant diet from here.

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CHAPTER II

THEORETICAL FRAMEWORK

A. Psychological Approach

The researcher applied the psychological approaches in this study. The purpose is simply and solely to find out the psychological problems of the anorexia nervosa of Ellen that reflected in the film “To the Bone” by Marti Noxon. This approach attempts to work on literature based on the development of conflict. Psychological approach involve psychoanlytic theories to analyze characters in the film. According to Nyoman Kutha Ratna,

“Psikologi Sastra adalah analisis teks dengan mempertimbangkan relevansi dan peranan studi psikologis”.6 This means that, from the perspective of literary psychology, psychology plays an important role in the study of literary works from the perspectives of the author, character, and reader.

Internal conflicts in literary works can be studied by concentrating on character. In general it can be concluded that the relationship between literature and psychology, so closely that it merged and gave birth to a new science called "Literary Psychology". That is, by examining a literary work through a literary psychology approach, we have indirectly discussed psychology, because the literary world cannot be separated from the psychological values that may be implied in the literary work.

According to Wellek and Warren, there are two kinds of psychological analysis, namely psychological studies which are solely related to the author. The second study deals with inspiration, and other supernatural forces.7 Essentially, literary psychology is concerned with the second problem, namely, the discussion of psychological aspects of fictional characters in literary works. In general, the facets of humanity are the most

6Nyoman Kutha Ratna. Teori, Metode, dan Teknik Penelitian Sastra : dari Struktuturalisme hingga Postrukturalisme. (Yogyakarta : Pustaka pelajar. 2004) p. 350

7Wellek and Warren. Theory of Literature. ( New York: Harcout, Brace, and Company.

1976) p. 81

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important artifacts in literary psychology, since psychological aspects are only embedded and invested in humans as characters. With the explanation above, literary psychology research can be carried out in two ways, namely first, through understanding psychological theories then analyzing a literary work. Second, by first determining a literary work as the object of research, then determining the psychological theories that are considered relevant for conducting the analysis.

B. Anorexia Nervosa

Anorexia nervosa is defined as a loss of appetite which causes a person to become obsessed with body weight so as to maintain the lowest possible weight. Anorexia nervosa is also characterized by weight loss with self-starvation and lack of exercise, besides that sufferers also have a tremendous fear of gaining weight and use body weight and body shape as a way of self-evaluation. According to Pamela K. Keel, Anorexia nervosa (AN) can be characterized as a self-starvation syndrome. The major sign of the syndrome is emaciation caused by deliberate restriction of food intake. In addition, there is an intense fear of becoming fat or gaining weight, which the AN sufferer may describe explicitly or may express implicitly as behavior aimed at preventing weight gain.8 From the above understanding, it can be understood that the excessive diet carried out by sufferers of anorexia nervosa is done deliberately, because the patient is very worried about gaining weight or becoming obese.

Usually weight loss is accomplished primarily through reduction in total food intake. Although individuals may begin by excluding from their diet what they perceive to be highly caloric foods, most eventually end up with a very restricted diet that is sometimes limited to only a few foods.

Additional methods of weight loss include purging (i.e., self-induced vomiting or the misuse of laxatives or diuretics) and increased or excessive exercise. Individuals with this disorder intensely fear gaining weight or

8 Pamela K. Keel. Eating Disorder. (the 2nd. Ed.). (United States of America: Oxford University Press. 2017) p. 2

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becoming fat. This intense fear of becoming fat is usually not alleviated by the weight loss. In fact, concern about weight gain often increases even as actual weight continues to decrease.9

According to Diagnostic and Statistical Manual of Mental Disorders (DSM, published by the American Psychiatric Association) states that there are three types of eating disorder, first is anorexia nervosa, second is bulimia nervosa and and third is binge-eating disorder.10 Bulimia nervosa is a deviant eating behavior with the characteristics of consuming large amounts of food and then regurgitating it by force (purging) or using laxatives or diuretics, fasting or excessive exercise. Individuals with Bulimia Nervosa are typically ashamed of their eating problems and attempt to conceal their symptoms.

Meanwhile binge eating disorder is a state of consuming large amounts of food and cannot be controlled by the individual himself. Binge eating usually occurs in secrecy, or as inconspicuously as possible. The binge eating often continues until the individual is uncomfortably, or even painfully, full. Binge eating is typically triggered by dysphoric mood states, interpersonal stressors, intense hunger following dietary restraint, or feelings related to body weight, body shape, and food. Binge eating may transiently reduce dysphoria, but disparaging self-criticism and depressed mood often follow.

C. The Characteristic of Anorexia Nervosa

The physical signs and symptoms of anorexia nervosa are related to hunger. Anorexia nervosa also includes emotional and behavioral problems that involve on unrealistic perception of weight and excessive fear of gaining weight or being obese. Patients with anorexia nervosa have the main characteristics of refusing to maintain a normal body weight according to their age and height, a tremendous fear of being obese despite being

9 Pamela K. Keel. Eating Disorder. (the 2nd. Ed.). (United States of America: Oxford University Press. 2017) p. 2

10 Diagnostic and Statistical Manual for Mental Disorders Fourth Edition. (Washington, DC:

American Psychiatric Association. 2013) P. 540

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underweight and in women experiencing amenorhea (no menstruation for at least three months) due to decreased estrogen levels. Even so, people with anorexia nervosa deny that they have problems and avoid medical treatment which can lead to death.

The essential features of Anorexia Nervosa are that the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body. In addition, postmenarcheal females with this disorder are amenorrheic. (The term anorexia is a misnomer because loss of appetite is rare.)

1. The individual maintains a body weight

The individual maintains a body weight that is below a minimally normal level for age and height. When Anorexia Nervosa develops in an individual during childhood or early adolescence, there may be failure to make expected weight gains (i.e., while growing in height) instead of weight loss.

When the individual meets the threshold for being underweight. It suggests that the individual weigh less than 85% of that weight that is considered normal for that person's age and height (usually computed using one of several published versions of the Metropolitan Life Insurance tables or pediatric growth charts). An alternative and somewhat stricter guideline (used in the ICD-10 Diagnostic Criteria for Research) requires that the individual have a body mass index (BMI) (calculated as weight in kilograms/height in meters 2) equal to or below 17.5 kg/m2. These cutoffs are provided only as suggested guidelines for the clinician, since it is unreasonable to specify a single standard for minimally normal weight that applies to all individuals of a given age and height. In determining a minimally normal weight, the clinician should consider not only such guidelines but also the individual's body build and weight history.

Usually weight loss is accomplished primarily through reduction in total food intake. Although individuals may begin by excluding from

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their diet what they perceive to be highly caloric foods, Individuals usually pay close attention to every calorie in every meal. Following that, they choose low-calorie foods. Most eventually end up with a very restricted diet that is sometimes limited to only a few foods. Additional methods of weight loss include purging (i.e., self-induced vomiting or the misuse of laxatives or diuretics) and increased or excessive exercise.

2. Intensely afraid of gaining weight

Individuals with this disorder intensely fear gaining weight or becoming fat. This intense fear of becoming fat is usually not alleviated by the weight loss. In fact, concern about weight gain often increases even as actual weight continues to decrease. Emotional and behavioral signs and symptoms include frequently skipping meals or refusing to eat. Even though people with anorexia are very thin, they still have a fear of getting fat. They cannot accept that they are thin and need to gain weight rather than lose weight and usually they use loose clothes to cover their skinniness.

3. Exhibits a significant disturbance in the perception of the shape or size of his or her body

The experience and significance of body weight and shape are distorted in these individuals. Some individuals feel globally overweight.

Others realize that they are thin, but are still concerned that certain parts of their bodies, particularly the abdomen, buttocks, and thighs, are "too fat."

They may employ a wide variety of techniques to estimate their body size or weight, including excessive weighing, obsessive measuring of body parts, and persistently using a mirror to check for perceived areas of "fat."

The self-esteem of individuals with Anorexia Nervosa is highly dependent on their body shape and weight. Weight loss is viewed as an impressive achievement and a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control. Though some individuals with this disorder may acknowledge being thin, they typically deny the serious medical implications of their malnourished state.

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4. Postmenarcheal females with this disorder are amenorrheic.

In postmenarcheal females, amenorrhea (due to abnormally low levels of estrogen secretion that are due in turn to diminished pituitary secretion of follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) is an indicator of physiological dysfunction in Anorexia Nervosa.

Amenorrhea is usually a consequence of the weight loss but, in a minority of individuals, may actually precede it. In prepubertal females, menarche may be delayed by the illness. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)11

D. The Factors Causing of Anorexia Nervosa

Anorexia is a complex disease, the causes of which are not only one.

Anorexia can cause psychological effects that make a person not behave like other people normally. They can talk a lot about their weight and diet, do not eat in front of people, became sensitive easily, or do not even want to socialize with other people. In fact, most of women want to appear slim and thin. they think being slim will make them happy, successful and popular. A person with an eating disorder has problems with their body image. This means that they already have unsatisfactory thoughts in their bodies (the thoughts imprinted in their brains). They feel that their body is not ideal, fat everywhere, and ugly. Family factor, biological, and psychological can be factor in causing of anorexia nervosa.

According to Pamela in her Eating Disorders book, the factors causing of anorexia nervosa are divided into three, family factors, psychological factors, and biological factors.12

11 Diagnostic and Statistical Manual for Mental Disorders Fourth Edition. (Washington, DC: American Psychiatric Association. 2013) P. 544

12 Pamela K. Keel. Eating Disorder. (the 2nd. Ed.). (United States of America: Oxford University Press. 2017) p. 85-119

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1. Family factor

Eating disorders often begin during adolescence, when families and peers form one’s immediate social environment. Early hypotheses on the etiology of eating disorders focused almost exclusively on patients’

families. Families of individuals with eating disorders have more problems than do families of individuals without eating disorders, These involve general problems in interaction style and specific problems related to disordered eating attitudes and behaviors. Rearing environments in which child-initiated cues are not recognized or appropriately responded to may increase the pressure on children to conform to external demands. As a consequence, these individuals may be particularly vulnerable to messages concerning how they should behave and how they should look, which they may encounter from society wide influences such as the media or from family members or peers. The rearing environment also may contribute to difficulties identifying and differentiating among one’s internal drives and may reinforce the futility of attempting to do so. At the beginning of adolescence, the thin ideal may provide a road map for achieving social acceptance, particularly if family members and peers subscribe to attitudes that contribute to eating pathology.

In anorexia sufferers tend to come from overprotective families or families that are not harmonious where there is a lot of conflict and inconsistency. For this reason, people with anorexia feel the need to be in control of something, and that something is their weight. Families often have high, sometimes unrealistic and rigid expectations. Often, something stressful or upsetting becomes a trigger for initiating anorexic behavior.

Divorce is one of the problems in the family. Garoo states that short-term effect of divorce can hamper a child’s psychological and psychological growth which can have long-term impact such as behavioral and social problems, trouble with a relationship, prone to substance abuse, depression, and poor education and socioeconomic position.

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2. Psychological factor

Psychological factors in certain personality types appear to be more prone to developing anorexia nervosa. Anorexics tend to be perfectionists who have unrealistic expectations of how "should" they look and behave.

Many people with anorexia do not have a strong identity, and choose to sacrifice their identity in order to please others. Almost all people with anorexia lack self-respect. Many people with anorexia feel depressed and anxious, even though sufferers do not know whether this is the cause or effect of an eating disorder.

Personality has been defined as a stable way in which individuals perceive, react to, and interact with their environments that is influenced by both biology and experience. Temperament has been defined as a biologically based predisposition to experience certain emotional and behavioral responses. Temperament is the building block upon which personality develops. While acknowledging that considerable debate surrounds the definitions of temperament and personality. Tellegen (1982) described three personality dimensions: positive emotionality, negative emotionality, and constraint that have also been examined in relation to eating disorders. Positive emotionality is the tendency to enjoy and actively engage in work and social interactions. Low positive emotionality is characterized by high levels of introversion or a tendency to keep to oneself. Negative emotionality is the tendency to experience negative mood states (e.g., sadness, anxiety, and anger). Low negative emotionality is characterized by a tendency to be calm and unflappable. Constraint is the tendency to inhibit impulses and show caution, restraint, and conventionalism. Low constraint is characterized by a tendency to act impulsively.

3. Biological factor

Biological differences may represent risk factors that were present before the onset of eating disorders. However, just as eating disorders

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affect psychological function, they affect biological functions, and biological differences may reflect consequences of eating disorders.

Biological factors reveal that there is some evidence to suggest that anorexia nervosa is associated with abnormal neurotransmitter activity in parts of the brain that control pleasure and appetite. Neurotransmitters are chemicals that facilitate communication between brain cells (neurons).

Examples of neurotransmitters include serotonin (also called 5- hydroxytryptamine, 5-HT), norepinephrine, and dopamine. Food intake is associated with release of these three neurotransmitters in the hypothalamus. Activity of 5-HT in the medial hypothalamus decreases food intake, suggesting that 5-HT is important to that structure’s role in reducing appetite and weight. Activity of dopamine and norepinephrine in the hypothalamus inhibits function. Specifically, activity of dopamine and norepinephrine in the lateral hypothalamus decreases food intake, whereas dopamine and norepinephrine activity in the medial hypothalamus increases food intake. These neurotransmitters also involve other mental disorders, such as depression. According to Smith and Segal, there are some common symptoms of depression, such as feeling of hopelessness and helplessness, anger or irritability, loss of interest in daily activities, sleep changes, appetite or weight changes, self-loathing, concentration problems, unexplained aches and pains.

E. The Treatments of Anorexia Nervosa

Treatment of anorexia nervosa is generally carried out with a team appoarch, which includes doctors, mental health professionals, and dietirians or all of whom are experienced in eating disorders. Ongoing nutritional therapy and education are essential for sustainable recovery. Treatment of anorexia is challenging and difficult to do, because most people with this condition either deny they have a problem or are so afraid of being overweight that they may resist trying to help them gain normal weight. The purpose of treatment include restoring a person to a normal weight. Coping

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with emotional problem such as low self-estem, correcting distorted thinking patterns and developing long-term behavior changes.

Quoted from the book Practice Guideline for the Treatment of patients with eating disorders by Joel yager, et. al. there are 2 traetmens for anorexia nervosa:13

1. Nutritional rehabilitation

With regard to approaches to promoting weight gain, the evidence does not show that giving a patient a warming treatment or growth hormone injections significantly increases weight gain or decreases the length of hospitalization. For weight maintenance, Kaye et al. found that weight-restored patients with anorexia nervosa often require 200–400 calories more than sex-, age-, weight-, and height-matched control subjects to maintain weight. The energy wasting of malnourished anorexia nervosa patients results in higher than normal resting energy expenditure (REE;

measured in kilocalories perkilogram perday), resulting in resistance to weight gain. In malnourished anorexia nervosa patients, a high REE has been independently linked to anxiety level; abdominal pain and vomiting;

physical activity, including exercise, fidgeting, and other non-exercise- related energy expenditure; and cigarette smoking. Of note, REE measured as kilocalories per day is lower in patients with anorexia nervosa and returns to normal with refeeding. These different measurement and reporting techniques may be the source of some confusion among study results, and reports concerning REE must be read carefully to fully understand exactly what is being measured.

2. Psychosocial treatments

Although psychosocial interventions, including psychoeducation, individual therapy, family therapy, and (in some settings) group therapy, are considered to be the mainstay of effective treatment for anorexia nervosa. Instead, this perspective is derived primarily from considerable

13 Joel Yager, et. al. “Practice Guideline for the Treatment of Patients with Eating Disorder”. (America: APA. 2006). P. 75

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clinical experience and patient reports. In a review of 23 studies reporting surveys of people who have had an eating disorder to determine which treatments patients find helpful, support, understanding, and empathic relationships were rated as critically important, psychological approaches were rated as the most helpful, and medical interventions focused exclusively on weight were viewed as not helpful. Several types of psychosocial treatments that can help in healing anorexia nervosa:

a. Structured inpatient and partial hospitalization programs

Most inpatient programs use one of many behaviorally formulated interventions, individual and family psychotherapy, empathic nursing approaches, nutritional counseling, and several group therapies designed to improve the patient’s knowledge about and attitude toward eating, exercise, and body image. These behavioral programs implement a variety of strategies derived from social learning theory that include reinforcement and contingency management (e.g., em-pathic praise, exercise-related limits and rewards, bed rest, privileges linked to achieving weight goals and desired behaviors). Behavioral programs have been shown to produce good short-term therapeutic effects

b. Individual psychotherapy

Individual psychotherapy or interpersonal psychotherapy is a short-term psychological treatment that focuses on a person's relationship with other people. The main purpose of this therapy is to improve a person's relationships and social interactions to help reduce the stress they experience. During the acute phase of treatment, the efficacy of specific psychotherapeutic interventions for facilitating weight gain remains uncertain. A randomized controlled trial by McIntosh et al. of 56 acutely ill adult women with anorexia nervosa treated as outpatients showed that 20 weekly sessions of nonspecific clinical management (a manual-based therapy delivered by individuals knowledgeable about the treatment of eating disorders and consisting

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of advice, support, and education) were as effective as or more effective than 20 weekly sessions. Of the 56 women, 70% either did not complete treatment or made small or no gains; only about 10%

had a very good outcome and 20% improved considerably by the end of these treatments.

c. Family psychotherapy

In the process of healing anorexia through this family therapy process, usually all family members of an anorexia sufferers are called to see a psychologist. They will be instructed on their role in helping people with anorexia heal. Jenis terapi ini biasanya berlangsung sekitar 12 minggu, berfokus pada peningkatan hubungan antara anggota keluarga. Systematic studies of the Maudsley model of family therapy that are currently under way are receiving considerable interest. In these interventions, families are “put in charge” of their children’s eating. Lock et al. found that short-term family therapy was as helpful as longer-term family therapy and that, overall, adolescents with anorexia nervosa did well. The results suggested that those who had high levels of OCD symptoms or a nonintact family tended to need longer courses of more intense therapy. A multisite study of this approach is currently being conducted.

d. Support groups

Support groups are forums for counseling and sharing experiences with people with similar conditions or goals. Expert opinion suggests that benefits are likely to accrue from support groups; however, at present no data are available that systematically assess the contribution of support groups led by professionals or advocacy organizations that provide patients and their families with mutual support, advice, and education about eating disorders.

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F. Review on Previous Research

In this study, the researcher aims to avoid duplication of research, so before choosing this topic, the researcher finds a thesis that is related to the research. There are three previous related researches. The first analysis about anorexia has been analyzed before by English Literature student of Sanata Dharma University, named Amanda Destyanti in 2017. The analysis entitled Francesca's Anorexia Nervosa Unconscious Regression in Steven Levenkron's The Best Little Girl in the World. This analysis discuss about the descriptions of Francesca Louise who has an eating disorder of anorexia nervosa. This thesis used theory from Petter barry, Bressler and Hilde Bruch.

The result of this thesis is that anorexia nervosa suffered by Francesca was a defense mechanism for herself. In her sexual development, Francesca refused to become an associate degree adult. She still desires to depend upon his oldsters. The defense mechanism utilized by Francesca is regression.

Regression unconsciously carries childhood habits back into the present even when they are adults. Francesca is afraid to grow up and because that she unconsciously regresses himself to look like a child again. Being anorexic keeps her body from growing properly and makes her body look like a child.

There are two focuses of this research. The primary is to depict the most character of this novel and second is to indicate that the regression of Francesca's anorexia could be a defence mechanism.

The second thesis was entitled A Psychoanalysis of Anorexia Nervosa a Halse Anderson's Novel Wintergirls from a student at the University of North Sumatra in 2019 named Silvy Yosviana Meliala. The focus of the analysis is the main character of the novel who has suffered from anorexia nervosa. This thesis is only to know the causes of Anorexia Nervosa as portrayed in Laurie Halse Anderson's Novel Wintergirls and to know how the main character overcomes the anorexia nervosa. This thesis uses theory from DSM-IV and theory Hilde Bruch. The result of this study is that anorexia nervosa itself occurs due to disharmony in the relationship between parents.

The quarrel between father and mother had made the girl, Lia enter into a loss

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of appetite syndrome. The disharmony that led to the divorce made him very frustrated by experiencing anorexia nervosa syndrome or a loss of appetite.

The third related research study, researcher found in a journal article by Oyindrila Basu and Shiva Roman Pandey as Founder & CEO e-wellness Expert, MIMS Ardendale, Bangalore, India. Volume 2, Issue 2, 2007, ARC Journal of Addiction. Journal article paper entitled The Growing Tendency of Anorexia in TV/Film Celebrities – an Addictive Behaviour towards Eating Disorder. This jurnal is to analyse the growing problem of eating disorders especially among screen celebrities across the world. The study method used in this research is a descriptive survey of popular samples from India and the world. Then used theory Mitchell, Wales and Nielson, and DSM-IV. The findings eventually establish that Anorexia is getting prominent among TV and film celebrities as they are always conscious about their weight and appearances.

From the third related studies above discussed the eating disorder of anorexia nervosa. Of those studies had difference focuses, the first research focuses on the regression fransesca's anorexia nervosa as defense mechanism, the second research focuses on how the main character overcomes the anorexia nervosa and then the third is the growing problem of eating disorders among celebrities around the world.

The differences of this research from studies above is in this study was conducted to find out the characteristic of anorexia nervosa of Ellen, the factors causing and to know the treatment used in the To the Bone film. This thesis used theory from DSM-IV, Pamela K. Keel and Joel Yager et. al. After that most of them analyzing the novel as an object and one of them that analyze amoung celebrities in the world while the researcher focuses on film To the Bone film by Marti Noxon. Then the similarity from the third related studies with researcher is this study discusses the eating disorder toward anorexia nervosa and also uses qualitative method.

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CHAPTER III

METHOD OF RESEARCH

A. Design of Research

In writing this thesis, the researcher used a qualitative research with descriptive method. The data collected in the form of words as a descriptive explanation than a number. Where data was collected from word to word, paragraph to paragraph, and sentence to sentence, to get a conclusion. The purpose of this qualitative research is also not to find generalizations but to find an understanding of the meaning of the problem by collecting and analyzing data.

According to Habermas and Beck “qualitative research is of specific relevance to the study of social relations, due to the fact of the pluralization of life worlds. Key expressions for this pluralization are the ‘new obscurity’, the growing ‘individualitation of ways of living and biograpical patterns’, and the dissolution of ‘old’ social inequalities into the new diversity of milieus, subcultures, lifesyles, and ways of living”.14 That means, qualitative studies are of precise relevance with looking at social relationships, because of the truth of the pluralization of the world's lifestyle. Key expressions for this pluralization are the 'new obscurity', the 'individualitation of growing methods of occupancy and biographical patterns', and the dissolution of' old 'social inequalities into brand new ranges of millieus, subcultures, lifesyles, and methods of shelter. As well, according to Jane Richie, “qualitative research method is an attempt to present the social world, and its perspectives in the world in terms of concept, behaviour, perception and human problems studied”.15 From these understanding, it can be understood that qualitative research method functions to understand what phenomena

14 Uwe Flick, an introduction to qualitative research. ( London: SAGE Publication. 2009 ) p. 12

15 Lexy J, Moleong, Metodologi Penelitian Kualitatif. (Bandung: Pt. Remaja Rosdakarya.

2006) p. 6

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experienced by the study subject such as behavior, perception, motivation, action, and so on.

According to Nyoman Kutha Ratna: “Qualitative research provides attention to natural data, data in relation to the context of its existence.

These are the ways in which qualitative research was perceived as multi- research because research in turn involves a large number of relevant social phenomena. In the study of literary works, for example, will be the author, the social environment in which the author is located, including cultural elements.”16 Based on the quotation above, the qualitative research used in this research due to the qualitative method did not only involve the intrinsic aspect in literary work. But, it related with the extrinsic aspect in the literary itself. So, that is why, the qualitative method also said as multi method. Because, the relating of the intrinsic aspect and extrinsic aspect in the literary itself.

According to Nawawi, “Metode deskriptif dapat diartikan sebagai prosedur pemecahan masalah yang diselidiki dengan menggambarkan atau melukiskan keadaan subjek atau objek penelitian ( novel, drama, cerita pendek, puisi ) pada saat sekarang berdasarkan fakta – fakta yang tampak atau sebagaimana adanya”17. Descriptive method can be defined as problem solving in which the current state of the subject or research object (novel, drama, short story, poem) is investigated by drawing or depicting the state of the subject or research object (novel, drama, short story, poem) based on visible facts or unification. It indicates that a descriptive approach can be described as a problem-solving approach that involves characterizing the status of the subject or item under study.

Based on those statements, it can be concluded that qualitative research is analyzing about descriptive data that collected is in the form of the situation of the natural object. In this theory, qualitative research in research procedures which produce descriptive data as spoken words of

16Nyoman Kutha Ratna. Teori, Metode, dan Teknik Penelitian Sastra : dari Struktuturalisme hingga Postrukturalisme. (Yogyakarta : Pustaka pelajar. 2004) p.46-47

17 Siswantoro, Metode penelitian Sastra. Yogyakarta : Pustaka Pelajar, 2010.p.56.

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the person or behaviour be research. It easier for researcher to get the right data. Then the researcher believes that qualitative research method can obtain factual data and are trusted to be true, because research also can be judged valid or not based on the provisions of the use the research method and by using qualitative research the researcher has a nice answer about the question in analyzing the problem in To the Bone film.

B. Source of Data

The research aims to get data because the data is the important tool in the research. In this research, the data taken from the film itself that is To the Bone film by Marti Noxon.18 This film is distributed by Netflix and released on July 14, 2017 and began production in late March 2016 in Los Angeles. To the Bone film was directed and written by Marti Noxon and broadcast for the first time at the Sundance Film Festival competition on January 22, 2017.

This film is also included in the U.S Dramatic Competition film category.

Duration of this film is 107 minutes or 1 hour 47 minutes which managed to get a rating of 6.8/10 by IMDb.com.19

The researcher used the script20, dialogues, and picture on screen to analysis this study. Thus, The data of this research is pictures and some dialogues among main character and another characters which describes the presence of anorexia nervosa disorder, the factors causing and how the treatment is carried out in the film.

C. Technique of Data Collection

Technique of data collection is very important part in any form of research. In this research, the researcher used documentation technique in collecting the data. Moleong states there are three technique of collecting the data. They are observation, interview, and documentation technique.

18 https://www.netflix.com/title/80171659?s=a&trkid=13747225&t=wha (30 September 2020)

19 Restu Wahyuning. “Film – To The Bone (2017)”. Accesed from

https://www.tribunnewswiki,com/2020/04/07/film-to-the-bone-17 . ( 7 April 2020).

20 https://www.scripts.com/script-pdf/21989 . (28 May 2021)

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“Observation technique is that collecting the data which focus on observation an object with all human sense, Interview technique is the technique which focuses on collecting the data from respondents who are interviewed, While documentation technique means that the collected data are from internet, video, transcription and some books of copy.”21 So, for doing this research, the researcher choosed documentation technique in collecting the data, because the researcher used the film as the object. In collecting the data, the researcher did some steps that they are:

1. Download the film .

The researcher download film for the data from free website. The film was download from WWW.Netflix.com.

2. Watch the To the Bone film

The researcher watches the whole story from the beginning to the end to find out which characters in the film that have an eating disorder of anorexia nervosa and also watching repeatedly in order to get the data needed.

3. Reading the film script

Researcher read the film script to collect the data which is in the form of utterance in the script. The script of To the Bone film will be taking from the internet.

4. Marking on the dialogues

Marking on the words or sentences and all the important statements and information that point into anorexia, as well as afterwards, making a note of data.

5. Find the book and the other reference

The researcher found the book and the other references to get more data that relates about eating disorder of Anorexia Nervosa, and the psychoanalysis theory by web surfing.

21 Lexy J Moleong. Metodologi Penelitian Kualitatif. (Bandung: Pt. Remaja Rosdakarya.

2006) p. 112

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6. Selecting and categorizing the data to be analyzed

After that, the researcher then selected the data to decide for which are necessary to be analyzed.

D. Technique of Data Analysis

After carrying out the five steps of data collection above, the next step is to analyzing the data. The researcher have several techniques from the data analysis, in order to make this research more specific. In qualitative research, technique of data analysis is applied to answer the formulation problem. Data analysis technique that researcher used in this research is descriptive analysis technique. Which descriptive analysis seeks information and describes a phenomenon in detail. In this research the writer can get the data from expression, action or script in the film. So those are must be explain with the academic sentence because this is a scientific research. Bodgan &

Biklen reveals that “analysis involves working with data, organizing them, breaking them into manageable units, synthesizing them, searching for patterns, discovering what is important and what is to be learned and deciding what you will tell to others”.22 It means that, data analysis is a process of editing, coding or classifying and manipulating the data. Therefore by using data analysis, it was easier for the researcher in writing report.

After seeing the definition above, the researcher started to study the collected data step by step to be analyzed based on that procedure. The researcher had some steps in analyzing the data, in order to make this research more spesific, the steps are:

1. Watching “To the Bone” film repeatedly.

Researcher watched the film “To the Bone” repeatedly in order to get the data needed.

2. Classifying the data

The researcher classified the data which has taken into several parts of classification of data that will answer the formulation of the problem.

22 Bodgan and Biklen. Qualitative Research: An Introduction to Theory and Methods.

Allyn and Bacon, Inc: Boston London. 2006. P.157

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3. Analyzing

The researcher analyzed the context of the situation in the conversation of Ellen and other characters about anorexia nervosa in To the Bone film.

4. Making the conclusion

After the data have been analyzed, described and explained in the research, the researcher make the conclusion based on the analysis about the characteristic, the factors causing and the treatments of anorexia nervosa.

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CHAPTER IV ANALYSIS

A. The characteristics of anorexia nervosa experienced by Ellen that reflected in To the Bone film

According to the Diagnostic and Statistical Manual of Mental Disorder IV (DSM IV) there are four characteristic of anorexia nervosa are the individual refuses to maintain a minimally normal body weight, intensely afraid of gaining weight, exhibits a significant disturbance in the perception of the shape or size of his or her body and postmenarcheal females with this disorder are amenorrheic.

Based on the researcher analysis about the characteristic of anorexia nervosa experienced by Ellen in To the Bone film by Marti Noxon, it was found that Ellen as an anorexia nervosa sufferer has all the characteristic of anorexia as mentioned above, they are:

1. The individual maintains a body weight

The individual maintains a body weight that is below a minimally normal level for age and height. When Anorexia Nervosa develops in an individual during childhood or early adolescence, there may be failure to make expected weight gains (i.e., while growing in height) instead of weight loss. When the individual meets the threshold for being underweight. It suggests that the individual weigh less than 85% of that weight that is considered normal for that person's age and height. Usually weight loss is accomplished primarily through reduction in total food intake. Although individuals may begin by excluding from their diet what they perceive to be highly caloric foods, individuals usually pay close attention to every calorie in every meal. Following that, they choose low-calorie foods. Most eventually end up with a very restricted diet that is sometimes limited to only a few foods. Additional methods of weight loss include purging (i.e., self-induced vomiting or the misuse of laxatives or diuretics) and

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