67 Anorexia Nervosa
Name: Trevor Reznik
Source: The Machinist (movie, 2004)
Background Information
Trevor Renik is a middle aged male of Euro-Asian decent. Trevor is a blue-collar worker. Trevor works for a company, National Machine, as a welder. Trevor’s work environment is not a positive or friendly one. Trevor’s age and family history are not known through the film. Trevor Reznik is not a healthy individual: he smokes cigarettes, he does not sleep, he does not eat at all, and consumes large amount of caffeine. Trevor states he does not drink frequently, but is seen drinking throughout the film. Trevor is not seen eating once throughout the film, nor does he engage in any physical exercise.
Trevor is socially withdrawn and does not have any close friends or family members. The interactions with women in the beginning of the film indicate that Trevor is lonely. Trevor’s interactions with women show he does not have healthy relationships with women. One is with a prostitute, Stevie, whom he is a patron of throughout the film. Another woman is a waitress, Maria, whom Trevor believes he interacts with, but is actually one of Trevor’s hallucinations. Realistically, Trevor never interacted with his waitress, whom was unrecognizable to Trevor when he is not hallucinating. Trevor’s work environment is a constant stressor. Trevor’s boss informs Trevor he “is on his shit list”. Trevor is confronted by his bosses and asked for a Urinary Analysis because they believe he “looks like shit” thus he must be on drugs. Co-workers invite him to play poker and Trevor declines, upon doing so a co-worker responds “What’s wrong with you, you used to be alright” while another co-worker says “You were never alright, but you used to hang”. Trevor creates a hazardous situation at work while in an induced fatigue hallucination resulting in a co-worker losing his hand due to Trevor’s actions. Trevor’s co-workers are hostile and aggressive towards him after the work-related accident, thus Trevor experiences persecutory delusions and referential delusions. Trevor experiences many life-stressors throughout the film such as injuring others, himself, losing his job, losing relationships, and legal issues.
Trevor is consumed by his own delusions and hallucinations, which are induced from a hit-and-run. Trevor allows his memory to torment himself and has poor coping skills. Trevor’s coping technique of thought repression to handle the hit-and-run make him feel enormous amounts of guilt. The implicit guilt Trevor experiences is explicitly seen throughout the film by his sticky notes in his home. Trevor’s hit-and-run provoked the negative image of self to control all aspects of his life. Trevor has no desired goals or outcomes from his life, except to answer sticky notes he leaves himself. “Who are you?” is a sticky note Trevor leaves himself to remind him to seek for whom he really is. Trevor’s weaknesses are his inability to interact socially and distinguish what is actually reality. Trevor is paranoid from his hallucinations and delusions and he frequently feels as if people are following him. Trevor thoughtfully analyzes situations to “expose” plots against him, while doing so he throws himself in front of a moving car in order to get information from the police. Upon doing so, the police inform him he is committing a felony and so he runs through underground tunnels to evade pursuit. Trevor finally realizes who he is by the end of the film: he is an individual that killed a little boy by committing a hit-and-run. After realizing who he is, a “killer”, Trevor turns himself into the police for the hit-and-run. The individual who he hallucinated throughout the film was himself as Ivan and Maria, the victim’s mother. Trevor is able to sleep once he turns himself into the police.
Description of the Problem
The opening scene is Trevor standing in front of a mirror looking at his self then replies, “shit”, in disgust while looking at his reflection. Trevor holds a negative image of himself. In this scene, Trevor’s shirt is off and his underweight body is revealed. Trevor displays physical symptoms of Anorexia Nervosa such as his body weight, sunken eyes, and puffy cheeks.
Individuals who interact with an individual suffering from Anorexia Nervosa display concern for their health. This is displayed as Trevor is asked “Are you alright?” throughout the film, indicating others do not perceive him as being in an okay state. Others ask Trevor if he uses drugs throughout the film. The prostitute and waitress try to feed Trevor food in many scenes. The women say, “If you were any thinner, you wouldn’t exist”.
Trevor’s actions of not eating and properly nourishing his body are common for individuals suffering from Anorexia Nervosa, specifically the restrictive type. Trevor orders pie at a diner he goes to but he is never seen eating the pie. Fatigue is a common sign of Anorexia Nervosa due to malnourishment. Trevor reports to always be tired, cannot sleep, nor has slept in the past year. Trevor’s sexual relations are not atypical of one with Anorexia Nervosa since he is the prostitute’s “best costumer”.
Trevor socially withdraws, which is a symptom associated with Anorexia Nervosa. Trevor loses touch with reality and those whom interact with him call him crazy and psycho. The persecutory delusions and referential delusions may be a side effect from long-term malnutrition and dehydration. Trevor believes his coworkers are plotting against him and ends up losing his job when he behaves erratically by physically attacking his co-workers. The physical attack results in Trevor becoming short in breath, another common symptom displayed with the disorder.
Diagnosis
One possible diagnosis for Trevor Reznik from the DSM IV-TR would be Anorexia Nervosa, Restrictive Type, (307.1). Trevor experiences many social and economical stressors as well, including a hostile work environment, negative co-worker interactions, social interaction non-existent, job loss, committing a hit-and-run, and a loss of relationships.
Criterion that are met for Anorexia Nervosa include:
A. Refusal to maintain body weight at or above a minimally normal weight for age and height.
Trevor was substantially under 85% of the body weight he should have maintained.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body shape on self-evaluation, or denial of the seriousness of the current low body weight.
Trevor was disturbed by his body image as indicated with his response to his reflection. Trevor denied the seriousness of his underweight body. He does not seem aware of his diet, weight, or health thus, in denial of his personal health.
Difficulties diagnosing Trevor Reznik include: lack of knowledge about family history, lack of personal history, lack of medical history, and lack of self-report from him.
Accuracy of Portrayal
Trevor Reznik’s suffering from Anorexia Nervosa is not very apparent due to his inattentiveness about his body weight. Therefore, Anorexia Nervosa may be mislabeled in this film. Trevor never explicitly states or indicates he has a fear of gaining weight, which is typical for those whom suffer from Anorexia Nervosa. Trevor’s lack of concern with his body weight is not an accurate portrayal of an individual who suffers from Anorexia Nervosa.
If an individual watching the film knows what signs and symptoms to be aware of when assessing an individual who suffers from Anorexia Nervosa, then they may be able to diagnose Trevor Reznik as having the disorder. An individual who is aware of common symptoms and signs of Anorexia Nervosa may be able to decipher Trevor’s disorder as an accurate portrayal. A stressor, murdering a little boy, may have been the on-set for Anorexia Nervosa and, as such, the film does accurately depict the course typical of individuals with Anorexia Nervosa. This includes Trevor not eating, acknowledging his poor health, and holding a negative image of self. Trevor never ate food during the film. Trevor’s physical symptoms were very apparent but others in the film attributed this to drug use. Trevor’s fatigue, delusions, and hallucinations may be symptoms due to severe malnourishment and dehydration. Individuals who watch the film would be able to understand how one who suffers from Anorexia Nervosa lives with constant paranoia of his self-image and induced on-set of Anorexia Nervosa that may have caused the delusions and hallucinations from inadequate diet. The film is accurate because people suffering from Anorexia Nervosa do not acknowledge the pervasiveness of their disorder. Trevor never acknowledges that his poor health is due to his lifestyle.
Treatment
Treating Trevor Reznik would require him to acknowledge having the disorder, Anorexia Nervosa. The patient’s willingness and acceptance of the disorder are essential for treatment to a progressive lifestyle to changing behavior. Treatment would focus on two main goals: 1) Trevor must gain weight and nourish his body with an adequate diet and 2) address Trevor’s psychological and environmental stressors. An empirically supported treatment widely used is family and group therapy. Trevor lacks a support system such as family and friends who are usually the people who initiated treatment for individuals suffering from the disorder. Typically, family and friends monitor diet and exercise for individuals suffering from Anorexia Nervosa. The lack of a social support Trevor receives makes treatment difficult. Trevor would have more success in self-help groups since he lacks a family for family therapy. The self-help group meetings would allow Trevor the opportunity to interact with others suffering from Anorexia Nervosa. The self-help group meetings would enlighten Trevor about Anorexia Nervosa tremendously. In order for self-help treatments to be successful Trevor must attend the meetings regularly and change his behavior through the acquisition of new knowledge. The self-help groups may be the social support Trevor needs to overcome Anorexia Nervosa. Trevor must change his attitude, behaviors, diet, and physically exercise to live a healthy lifestyle. If Trevor avoids situations and environments that are mental triggers for his disorder he will overcome the disorder with successful treatment. Trevor’s successful treatment seems unlikely and he seems vulnerable to enduring a chronic episode that will ultimately end in his body’s expiration.