'The Crown' Took on Princess Diana's Bulimia — and Got It Really Right

Trigger warning: details of eating disorders.

I was introduced to bulimia on an episode of MTV's True Life. Though MTV wasn't allowed in my conservative household, my parents weren't home, and parental controls didn't exist on the decades-old TV in our living room. Ten-year-old me watched "True Life: I Have an Eating Disorder" with the schadenfreude of a self-righteous goody-two-shoes who would never succumb to something so weak. So gross. (You can probably guess where this is going.)

Ten years later, when I was a college sophomore spiraling into a wormhole of undiagnosed anxiety and depression, images from that episode flashed into my mind as I purged for the first time. Somehow, I had become one of the 4.7 women who will suffer from bulimia in their lifetimes. That's not what I told myself, of course. My internal monologue played on a loop: "This is a one time thing. I don't have a problem. Unlike those girls, I can control myself."

With the premiere of season four of Netflix's The Crown, bulimia has once again bubbled up into the national (and international) pop culture conversation, as it probably will again at some time in the near or distant future. The show's graphic depiction of Princess Diana's battle with the disease — an intentional choice by the show's creators, and of Emma Corrin, who plays Diana — has been criticized as much as it's been heralded, with some insinuating that the display was over-the-top. That showing Diana, cast in the blue light of the open fridge, spooning dessert after dessert by the heaping spoonful into her mouth with barely enough time to breathe between bites, was insensitive. That depicting her hanging over the toilet, the posture of both shame and relief — a clean slate — after she's forced two fingers to the back of her throat, is unsympathetic to her legacy.

For others, though, it was an honest portrayal of a disease that is often glossed over or made light of in pop culture (the camera cuts to a bathroom, the audience hears retching, the heroine emerges from the stall wiping her mouth with the back of her sleeve and then stares at her puffy face in the bathroom mirror; the show moves on). It is the kind of representation, and, in a way, validation, of a very real, very all-encompassing disease that does not come and go around mealtimes, but affects every aspect of your life, every choice you make.

"Many viewers have called the show's portrayal of the disease heartbreaking and sad to watch, however simply alluding to the eating disorder would have been downplaying the seriousness of the disease," Kristin Wilson, MA, LPC, Vice President of Clinical Outreach at Newport Institute, tells InStyle, "which can undermine the fact that it affects every aspect of millions of people's lives."

Though, for a time, I blamed MTV's True Life for "introducing" me to the concept of binging and purging, with hindsight I recognized that the show was not at the root of my disease. The habit of starving myself, and then binging, which I had mastered in high school, would have taken on this new dimension regardless of what I had watched that day. Despite the serious tone of True Life, it was my own fault for not taking the disease seriously, or understanding what it really was: a mental illness.

Here, Wilson explains what The Crown got right about its depiction of bulimia, as well as the lasting impact of Diana's decision to speak about her battle.

InStyle: How accurate is The Crown's portrayal of Princess Diana's bulimia?

Kristin Wilson, MA, LPC: The show's depiction of bulimia is very detailed and graphic and was revealed by the actors and show's crew to be a deliberate choice. They wanted to show an accurate portrayal of Princess Diana's battle with bulimia as well as raise overall awareness to the signs and symptoms of the disorder.

The show follows Princess Diana's battle with bulimia over the course of several years and does try to depict the disease accurately. It also sets the stage for the potential reasons that drive the eating disorder by showing Princess Di's rocky marriage, complicated relationship with the royal family, and nonstop scrutiny from the media.

What are the biggest misconceptions about bulimia?

One of the biggest misconceptions about bulimia is that those who are struggling with it will be very thin or underweight. Research shows that most individuals with bulimia are of typical weight or even overweight.

Another misconception is that you can easily identify someone with bulimia. Bulimia thrives in secrecy, therefore making it very difficult to diagnose or recognize.

People may also believe that bulimia is about food. Although individuals with bulimia may find comfort and/or enjoyment in food during a binging episode, this will often lead to feelings of self-disgust, powerlessness, and shame. Bulimia is highly linked to past trauma, depression, anxiety, low self-esteem, and other mental health issues.

What are the most common issues with the portrayal of the disease in pop culture?

Showing eating disorder behaviors like binging and purging on-screen can be very triggering for someone suffering from an eating disorder or in recovery. It needs to be done very sensitively without glamorizing or normalizing the disease.

Additionally, depictions of bulimia in popular culture can lead to comparisons from sufferers to who they see on-screen, i.e. the actor is skinny and I'm not, so even if I binge and purge, I must not really have a problem.

Even though there can be issues with portraying the disease, having a public figure bring attention to it, like Diana did, can be impactful. Diana spoke openly about her long struggle with bulimia which led to an effect called the "Diana Effect," where there was a sudden spike in the number of reported cases of bulimia, as people sought out treatment for the disease.

The show includes a trigger warning for its graphic depictions. Is that enough?

It is not advisable for anyone suffering from an eating disorder or in recovery to watch a show that portrays eating disorders like bulimia or anorexia, as they can be very triggering.

If someone does watch and feels triggered by the show, they should turn it off immediately and instead do something to create a safer emotional space; like taking a walk, meditating, or reading a book. Also, talking about how you are feeling with a trusted friend, family member, or therapist, can help you work through any emotional responses, instead of suffering in silence.

There has been criticism of the show's portrayal of the disease. Does it do more harm or good, in your opinion, to show the extent of Di's battle?

The scenes are difficult, shocking, and uncomfortable to watch for viewers, however accurately portraying a disease on a popular television show can help destigmatize mental health issues, like bulimia, and lead to more open, widespread discussions surrounding eating disorders and mental health.

If you are struggling with an eating disorder and are in need of crisis support, you can contact the NEDA Hotline at 1-800-931-2237.