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Requiem for a Dream and Anoxeria Nervoa

Updated on January 24, 2012

In the movie Requiem for a Dream, Sarah Goldfarb, is an elderly widow who becomes completely consumed by her fantasy of appearing as a contestant on a television show. This fantasy is fueled by a deep desire to wear a red dress, which consequently leads to a haunting series of events. Food addiction, diet pills, anorexia nervosa, and substance dependencies set the stage for a film about four individuals, each suffering from their own addiction.

From the start of the film Sarah is portrayed as a loving mother, who will do anything for her son, Harry. Unfortunately, Harry has a methamphetamine dependency disorder, that impacts his ability to be there for is mother when she needs him. Sarah lives a very solitary life, spending a large majority of her time watching television. In the beginning of the film she receives a phone call which tells her that she has won a prize to appear as a contestant on a television game show – this later turns out to be a hoax. Nonetheless, she’s delighted and immediately begins to fantasize of appearing on television in her red dress. The red dress has sentimental value to Sarah. It reminds her of a time long ago, when her husband, Seymour was alive, and a time when Harry was not addicted to drugs. Unfortunately Sara has gained weight, and can no longer fit it. As a result, Sarah goes on a diet, which ultimately fails, thus causing her to take diet pills. Sarah eventually becomes addicted to the pills, which in turn paves the way for anorexia nervosa. In the end, Sarah’s fantasy of appearing on television reaches a climax when she experiences delusions, and hallucinations in which she believes she is on television. She ultimately has a nervous breakdown, and is admitted to a hospital. While at the hospital Sara is treated for anorexia nervosa and undergoes numerous treatments – including electroconvulsive therapy (ECT). After the ECT therapy, Sarah is portrayed at a feeble minded individual who no longer remembers her friends – content with spending the rest of her life in hospital care. It was tragic.

Overview of Anorexia Nervosa

Anorexia nervosa is an eating disorder that involves limiting the amount of food an individual consumes. This behavior of restricting food intake is known as restricting-type anorexia nervosa. Most individuals with this type of disorder may have an intense fear of weight gain, even when they are underweight. As anorexia nervosa progresses, individuals eventually show very little variability in their diet. They become increasingly cautious of the types of food they eat and some individuals tend to develop a “preoccupation” with food. It is this preoccupation that creates an “overevaluation of the control of eating, weight and shape” in individuals suffering from anorexia nervosa. Also, it appears that individuals suffering with anorexia nervosa have an incongruent or misperception of their body weight. This behavior is made evident through an anorexia nervosa assessment. During this assessment individuals look at a picture of themselves through an adjustable lens. The individuals are instructed to adjust the lens until their picture matches their actual body size. In one study, more than half of the subjects with anorexia nervosa were found to overestimate their body size. This is due to the way individuals with anorexia nervosa perceive themselves. In this case, perception not only includes the physical aspects of their body, also the cognitive perceptions one has of them (i.e. how I think I look). I believe this is largely dependent upon one’s self-esteem.

Additionally, anorexia nervosa is considerably more prevalent in females, than in males with 90 to 95 percent of all cases occurring in females. Several studies report that girls are more concerned about their body and their weight than boys. I believe this study illustrates the impact that society and cultural norms have on an individuals risk for developing anorexia nervosa. In other words, I believe society imparts certain expectations for females, than for males. This subsequently has an effect on the way they view themselves.

What Causes Anorexia Nervosa?

Many factors are involved in the development of anorexia nervosa. These factors include societal and cultural norms, home family environment, and individual self-perception. Some experts have suggested that conflicts within a family may contribute to the development of anorexia nervosa. Interestingly, in an examination of anorexia nervosa risk factors, it was discovered that individuals with anorexia nervosa generally have extremely low self-esteem, which appears to be one of the key motivators behind their drive for to lose weight.

Sara Goldfarb appears to suffer from some degradation of self esteem. This is evident in a scene in the film where she expresses her reasons for taking the diet pills, and for wanting to wear her red dress, and to appear on television to her son Harry. In the scene below Sarah and her friends is stilling outside their apartment building (a daily event), and Harry pulls up in a Taxicab.

…you drove up in a cab, you see who had the sun seat? You notice your mother in the special spot getting the sun? You know who everybody talks to? You know who’s somebody now? Who’s no longer just a widow in a little apartment who lives alone? I’m somebody now, Harry. Everyone like me. Soon millions of people will see me and like me. I’ll tell them about you and your father. I’ll tell them how your father likes the red dress and how good he was to us. Remember?

Clearly, Sarah’s remarks indicate her need to feel accepted not only by her peers, but also millions of people who she does not know. This strain, this anxiety, this depression, and low self-esteem are the primary cause of her anorexia nervosa.

DSM-IV Diagnostic Criteria for Anorexia Nervosa

The DSM-IV criteria for diagnosing a person with anorexia nervosa are listed below.

· Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.

· Intense fear of gaining weight or becoming fat, even though underweight.

· 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.

· Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration. (Cleveland Clinic, 2009)

Also, anorexia nervosa has two subtypes: restrictive eating and binge eating alternating with restrictive eating at different periods of the illness, they are: restricting type and binge-eating / purging type.

Sarah Goldfarb demonstrates behaviors to meet the criteria for anorexia nervosa, except for Amenorrhea. Based upon event in the movie, I am unable to determine if she experienced this condition. I will give brief examples of her behaviors to illustrate the DSM-IV criteria for anorexia nervosa below.

· Weight loss: throughout the film Sarah gradually replaces her food consumption with diet pills. This lead to significant loss of body weight; however, the percentage loss was never revealed.

· Fear of gaining weight: throughout the film Sarah is portrayed as developing a phobia of her refrigerator. One scene in particular Sarah hallucinates that the refrigerator is speaking to her, and violently lunging at her saying “feed me”. I believe this is analogist with her fear of gaining weight. Or possibly, not losing weight.

· Denial of the seriousness: as previously stated, Sarah (when confronted by her son), on the seriousness of taking the diet pills, and of her weight loss, denied that it was serious.

Although, her behaviors may not match the DSM-IV criteria exactly, I believe the director’s intention was to demonstrate semi-anorexia behaviors while continuing to make a Hollywood type file production.


This film has an interesting way of portraying the affects of eating disorders. Granted, this is not a true illustration of anorexia, but it gives a glimpse into the mind of someone suffering from it. At times the filmmaker over-exaggerated the symptoms concerning the disorder. For example, the scenes with the moving and talking refrigerator were a bit much, as were the scenes where Sarah hallucinated about appearing on television. With that said, this was not my first time watching this movie – in fact I have seen it numerous times. However, after learning about eating disorders, I feel as though I’m watching the movie for the first time. I never quit observed or noticed the underlying reason for Sarah’s issues, and I never quite interpreted the impact of them (other than the obvious). Now, with my new knowledge, I have a newly found appreciation for not only the movie, but for the seriousness of eating disorders – specifically anorexia nervosa. Eating disorders will continue to grow in our society and our culture until we ultimately change our perspective (holistically) on what we value as a society. Until then, it’s just a dream – or a requiem for people impacted by it. Along the way you’re given false hope that indeed things are getting better; but then things take a sharp turn and you see through the illusion. And then you realize this film is true to its title: there never was any chance– it was all a dream, and this is only a requiem for the already dead.

Click here for more reviews of Requiem for a Dream (Director's Cut).


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      7 years ago

      I don't think it was an eating disorder. Unless you're following the notion of "95% of women have eating disorders" perspective because of the unhealthy views about weight. Sara began as a woman who wanted to drop enough weight to fit into a dress. I don't think her attempts qualify as anorexia. She gets on the diet pills, and gets addicted to the FEELINGS it gives her, not the weight loss. She ups her dose w/o Dr. consent, and she destroys herself with the pills. I would believe she had depression prior to the pill taking, I base this on the never leaving apt, being a "tv junkie", and that conversation she had with Harry. I think she became addicted to the pills because she was self medication her depression. She stumbled upon the pills due to desire to lose weight to fit into a dress.


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