Inside Out: Portrait of an Eating Disorder

by Nadia Shivack

"Every day, meal by meal, millions of people suffer from eating disorders. I am one of them."

Nadia Shivack was fourteen years old when she met Ed, her eating disorder. Sometimes like an alien in her body, sometimes like a lover, Ed was unpredictable and exciting, but ultimately always dangerous and destructive.

At an inpatient unit unit of a hospital where she was taken for treatment, Nadia wrote and drew on napkins after meals in order to keep the food in and calm the outrageous voices in her head. These pictures, together with others drawn on notebook paper and a variety of other surfaces, tell an unflinchingly honest story of a woman's lifelong battle with anorexia and bulimia. Raw, brave, and brilliant, Nadia's journey takes readers to the intimate corners of these misunderstood diseases. You will never think about eating disorders in the same way again.

Genres: Graphic Novels, Nonfiction, Memoir, Mental Health, Mental Illness, Psychology, Teen

64 pages, Hardcover

First published July 24, 2007

About the author

Nadia Shivack was born in Flushing, New York, but grew up in Manhattan. She studied at the Fiorello H. LaGuardia High School of Music & Art and Performing Arts, the City College of New York, and Columbia University, where she focused on occupational therapy. She now lives in Tuscon, Arizona, where she makes jewelry, and draws and paints when she has the courage.

Nadia has just completed a program at Recovery Support Specialist Institute and plans to work in the area of mental health. She deeply believes this work will help her continue to define her own recovery and the awareness that she is far more than an eating disorder.

Nadia continues to recover with the help of her kitty, Lily, and her dog, Lucy.

Reviews

[Jon Nakapalau · Rating 4 out of 5]

'Ed' (a manifestation of an eating disorder) tells Nadia what she thinks she needs to hear...but 'Ed' should really be called 'Id'...something Nadia needs to discover quickly. Very clever book that takes a very realistic look at eating disorders; would recommend this book to a parent who is trying to understand how they can help a child that is suffering in this way.

[Adia · Rating 2 out of 5]

A book about the author's decades-long struggle with Bulimia, illustrated with crayon drawings done by Shivack during her recovery. Found the layout confusing and the hand-written portions occasionally illegible (which feels kind of wrong to critique, as she was battling illness and in the hospital while writing). The message may be important, but I didn't like the book.

[Frank McGirk · Rating 2 out of 5]

Wish this had been better. The kind of graphic novel that deserves to be in schools, etc...except it's just not that well done. The text around the drawings is dense and largely skippable, and I was never really drawn in to her problem, or felt that I understood.

[Brittany Becker · Rating 4 out of 5]

Summary:

"Day by day, meal by meal, millions of girls and women in the United States struggle with eating disorders." This is the opening statement in the book, Inside Out. The author, Nadia Shivack, explains that she is one of these struggling women. The author takes the readers through her life, which portrays her continuous struggle with eating disorders. She describes how either food or weight loss is on her mind and how it started taking over her life. She includes her thoughts and feelings throughout different stages in her life with the eating disorders and the effects it has on her body and mind. Will the author overcome these eating disorders, or will it always be a constant struggle for her?

Post-read:
I would recommend this book for teenagers, especially females. Even though this story is based on the author's real life experiences with eating disorders, it is told in a unique way that I've never seen before. She has sketches, thinking bubbles, and characters drawn on every page to express her feelings during each phase of her life. There are also statistics regarding eating disorders added on different pages throughout the book. The author knows how to keep the reader's attention, especially teenagers, with her interesting illustrations. This book takes a serious topic and makes it appeal to readers. At the end, she explains how to get help and ways to "trick the mind" in order to ignore the bad thoughts of food or weight loss. It was an easy read and a great way to learn about different eating disorders.

[Becky R. · Rating 2 out of 5]

This was a bit manic in the way it was put together and told. I realize that might have been the tone the author wanted to get across, to go along with the way they felt descending into this disorder. I suppose that my biggest hang up with the way it pulled together was the pictures. The narrative voice felt like an adult's voice, but the pictures were all children's drawings/sketches pretty much. The information then came in small text boxes that felt important, but just not with as much weight in comparison to the amount of room and frenetic energy that the children's pictures were taking up on the page.

Having had a close family member who has struggled with an eating disorder, I am very familiar with the depression, the mania, and the repulsion from others they experience. It is frightening, and I wasn't the one going through it. In some ways, you watch the person and feel as though you are helpless to get them to see their way out of their thinking. I will admit that my own experience watching a loved family member probably made me not enjoy the manic nature of this book, perhaps shaping the way I felt about seeing her inside view of the disease. Is there a more orderly way of expressing a debilitating disease? I don't know. I just know that I struggled with this graphic novel's representation of it. I can only speak from my reasons and the tone set from the points I found in it.

[Licha · Rating 2 out of 5]

I hate to give this two stars. I know it has an important message to pass on but I wasn't too fond of the illustrations or the text. The drawings looked like something a first grader would draw. I hate to be picky about it, but they are just not appealing to the eye and so it pulled me away from the story. The text was just as bad and hard to read at times. It was so jumbled and looked like the author had carried a crayon with her at all times. These drawings were all made on napkins and it was suggested to the author that she should make a book out of them. I'm glad they helped her through her eating disorder, but I wish she had cleaned these drawings up. The visual unfortunately made the impact of the book get lost somewhere within its pages.

[Grace · Rating 5 out of 5]

It has been a long time since I read this, but I remember liking this book very much. A unique and raw look at the life of a person with an eating disorder.

[Jennifer Wardrip · Rating 4 out of 5]

Reviewed by Me for TeensReadToo.com

In Nadia Shivack's heartbreaking true story, she tells the world about her life-long problem with eating disorders. Told with a mixture of text and pictures drawn by Ms. Shivack, her preoccupation with food began when her mother told her that not only did she not dress like a girl, but that she was also getting chunky. Her parents had their own problems - her father was overly critical and her mother, a Holocaust survivor, refused to let her three children leave the table until they had cleaned their plates, even though she herself only ate one small meal a day to survive.

When Nadia began swimming competitively in school, her swim coach would praise the girls who were slender and berate those who, in his opinion, needed to lose weight. She began to feel huge and unattractive, and started the cycle of abuse with restricting her diet and then binging on foods that were not allowed. It wasn't long before she met "Ed," her eating disorder - the evil alien being who took over her life.

Nadia's trouble with food was not restricted to her youth. Through high school, through college, through study programs and medication, she struggled with it her entire life. Even knowing the side effects - being unable to sleep, rotting gums from purging, being incapable of having effective relationships - it wasn't until Nadia was about to turn forty that she decided to try another treatment program.

Thankfully, Ms. Shivack did eventually overcome the horror of her eating disorder. Like many other diseases, however, she knows that this will be a lifelong struggle, something that she will always have to work at. By telling her story inside the pages of INSIDE OUT, she hopes that other people struggling with an eating disorder will realize just how serious it is, and that reaching out for help isn't a sign of weakness, but of strength.

Although I've never had an eating disorder, I truly felt empowered by reading INSIDE OUT. Nadia's story could be that of any number of young people in the world today, and I hope that they all are able to come to the same realization that she was - that letting food rule your life is never a good thing.

[Jennifer · Rating 4 out of 5]

This was an exceptional book, beautifully and creatively illustrated. The illustrations were wonderful, so insightful and interesting to contemplate. I love art therapy so naturally this is no surprise. The only drawback is that I wish the author would have gone even deeper into her feelings, aside from the eating disorder. She made it very clear her ED was driven by other feelings, besides food, which as a recovered ED sufferer I know this. There were other personal issues hinted at that I wish the author would have creatively explored more in depth. What drove her feelings? What pain haunted her, making her want to disappear besides the triggering moments in childhood? It just seemed like there was more lurking beneath the surface. I really enjoyed reading this book and especially value her contribution in regards to spreading awareness about ED and trying to reduce the shame, stigma, and isolation surrounding this illness. I love her strength, her courage, and her honesty about recovery and relapses and the not-so-picture-perfect-but-realistic attitude towards the end of the book about recovery and such. To anyone suffering and anyone wishing to get a deeper look at the mind numbing torture of ED, read this book. If you are just curious about creativity and one's emotions, I'd also read this. It was very intriguing to read and ponder. Wishing all the best...

[Yvonne Powderly · Rating 4 out of 5]

Nadia Shivack’s heartbreaking true story is about her lifelong battle with anorexia and bulimia. The book is unflinching honest; the raw, graphic drawings convey the depression, anxiety, despair, and self-loathing that characterized her life. It is hearth wrenching to read Nadia's words and see, through her drawings, the extent of her inner turmoil. Although we know the hard clinical facts about the aspects of eating disorders, this book make the emotional side hit.
Told with a mixture of text and pictures drawn by Nadia, her preoccupation with food began when in her troubled household when she was in her pre-teen years. She likens her daily routine as a teen to a perilous climb up a steep, jagged mountain. Her dizzying downward spiral is sobering indeed, as her bulimia takes over her life and she becomes suicidal. This is a very sobering account of a life out of control, desperate for control and help. It gives us a glimpse of the emotional and chaotic thinking endured by bulimics. Statistics about eating disorders are found throughout the book, which concludes with a list of resources.

[Chrissy · Rating 2 out of 5]

Okay, this one confused the HECK out of me because my library had it in the Juvenile section -- like in the low-to-the-ground shelves of picture books for very, very young readers.

I'm confused, because the size, shape, and format of the book SEEMS like it is attempting to appeal to those that are very young. But once I read this little story, I'm not sure I'd even necessarily recommend it for YA readers, let alone little tiny kids.

The art is interesting -- but it feels very dark and creepy, which may be appropriate for the subject of an eating disorder. I absolutely LOVED reading about eating disorders when I was a teen (still do, actually), but I wanted to hear more about people my age. This lady is in her 40's, I think, and it FEELS like she's even older. Would teens necessarily be interested in this story?

I just felt like this story was too disjointed, disconnected, dark, and uninspiring to really be shelved amongst my favorite books on eating disorders. I'm confused about her intended audience, and I'm actually confused about her purpose too. Is the point to educate me or to just depress me?

Not sure on this one.

[Jessica Adams Duzan · Rating 5 out of 5]

I picked this book up because I was working on a graphic novel display for our teens. I flipped through the pages and was immediately intrigued. This graphic novel is written and illustrated by a woman who has been stuggling with Bulima since she was very young. She says that she first remembers hiding candy in a drawer in her room when she was seven. Her mother was a Holocaust survivor so there was a great importance placed on food while she was growing up. She gets involved in swimming, and more emphasis is placed on being the correct weight and having the right body type. Nadia constantly struggles with the desire to eat and then purge. She has been in and out of several treatment hospitals, been on various meds, contemplated sucide and has had multiple relapses. Nadia discovered that drawing calms her after eating and is using this book to reach out to other young people, in hopes of letting them know that they are not alone with this mental illness. She also states that the book is motivation for her to make her own recovery.

"I must accept my past, not deny it, not discard it and learn to forgive myself."

[eli · Rating 5 out of 5]

I absolutely loved this book to pieces. I can barely even manage to express how much joy and sadness this brought to me.. this book is the story of the author, Nadia Shivack. The book is rather short, and mainly crayon looking drawings she drew on napkins and notebook paper while in treatment for her anorexia. The drawings are very abstract in a way, and truly show how it feels/how it is to have anorexia, among other things. There's just so many feelings within this book, I literally had to set it aside and stop reading at times out of pure emotion.. the book also features statistics and such, which is really neat, and I enjoyed reading. This book would be perfect for friends and family who have a loved one suffering, and for those suffering as well. It could be triggering for those suffering, however, as it's very truthful and the drawings are VERY emotional. This is now one of my favorite all time books, and I had only rented it from my school library. I am FOR SURE going to purchase a copy, it's amazing, and could be life-saving. It was for me.

[Mariah · Rating 3 out of 5]

This book has me tittering on whether or not I liked it. Coming from a background where I myself understand an eating disorder I can view it as she did, but I don't believe if my background was different that I would have a similar. It's shocking to me that "Seven million women and one million men suffer from eating disorders"(unmarked) every year because the book portrays the idea of solitary so well that this single fact is mind blowing. The art work also complements the underlying idea that even kids can suffer from this. I think she did a really great job showing how the beast swells inside each of us and is extremely difficult to tame.

I recommend this book to anyone who wants to see what people with eating disorders actually think like, those who can't seem to catch a break, and those who have recovered. Also, Winter girls is a great novel about eating disorders that is pretty eye opening as well.

[Jazzybabe125 · Rating 4 out of 5]

It was an outstanding book but sad at the same time. i loved this book because it truely opened my mind about what people with eating disorder go through it's not what i just thought "Oh they just make them self throw up to be skin" it's more then that it's actually something thats hard for them to go through because it's like a drug to them that they can't stop taking. i would strongly advice people to take their time out on a day to read this book even if your already reading a book to stop and read this one because it will have you in tears and would open your mind about people with eating disorders it would even make you want to help them and give a day to support them through out everything.

[Glenda · Rating 4 out of 5]

Nadia Shivack's "Inside Out: Portrait of an Eating Disorder" chronicles her struggle w/ bulimia from her teen years until her 40th birthday. The book is multigenre, utilizing elements of cartoons, such as speech bubbles; elements of infodoodles; elements of memoir; and embedded research. It's an excellent mentor text and is a book I've used w/ students to show them that the process of research writing can take many forms other than a traditional essay.

[Joanne · Rating 4 out of 5]

Some readers may look at the GN format of this book and think it is for younger readers.

It definitely gets into some of the challenges of eating disorders.

Definitely an accessible format for teens about an important topic.

[hhhhhhhhh · Rating 3 out of 5]

whoa, this was dark. the art really puts you inside the head of a woman torn apart by self-loathing.

[Emily · Rating 3 out of 5]

(Reluctant Readers, non-fiction)

Presented in picture book format, Inside Out deals with one woman’s life-long struggle with an eating disorder. Her drawings of the “E.D” (Eating Disorder) monster living inside of her are poignant. She shares exactly how she felt as she faced food and what would run through her mind as she struggled not to eat. My only complaint is that the author makes the struggle to get better seem a bit pointless. She explains how she has been to rehab multiple times since the book was published, but does not offer hope that she will eventually beat the disease.

There are many teens who deal with this disease in silence. Reading this book may help them come to terms with the fact that it is a disease. Most people need professional help to overcome it, and the book lists organizations and facilities that will help. Teens who suffer from this disease may relate to the “E.D” monster and perhaps use this book as a starting point for getting help. It can also bring awareness to family members and friends of the victim, letting them know what is going through the mind of their daughter, son, friend, etc, as the disease takes over.

How the disease is portrayed and explained is a valuable insight, I would find it difficult to promote this book on its own. Some of the ideas presented may be too advanced for younger readers, which is a shame because the picture book format may be more appealing to them. As I mentioned before, this author’s struggle seems hopeless. I would not want to promote this book without having another book that gives hope to those struggling with anorexia. Teens need to see this disease can be overcome. I would have to do more research to find a companion book that would help me promote Inside Out.

3Q, 2P, J/H

[Daniel Loendorf · Rating 3 out of 5]

This book was pretty decent. Inside Out is about the author Nadia who explains that she has an eating disorder. She explains that having an eating disorder is not as easy to get a rid of as many people say. When she was twelve she had a best friend named Amy and she was always on a diet. It made Nadia jealous. Nadia's eating disorder began when she joined a competitive swimming team. The eating disorder started because of the pressure from the athletic events. She had a problem with a thing called binge eating. To cure it she tried ipecac abuse which is taking a medicine to throw up. That can lead to irregular heartbeat, rapid heart rate, cardiac arrest, and sudden death as the book explains. She did not know what to do. She became less socialized and quit all of the things that she loved to do to just be alone. She did not find any help. She moved around and for a moment she slowly began to feel better. She skipped her senior year of high school and took an early admission to a city college. She found herself a tiny place, but then binge eating began again. She eventually moved to Albuquerque and she fell in love and bought a house, but the eating disorder never stopped. She went to seek help and she started to do better. She one day could not take it and she ran away and planned to commit suicide, but she was caught by one of the counselors and was brought to safety. After that she found a way to counter her eating disorder by drawing and taking her mind off of food. She uses this book to remind herself to never give up. I would rate this book a 7 out of 10 because it gives good information.

[R · Rating 2 out of 5]

This was a bit manic in the way it was put together and told. I realize that might have been the tone the author wanted to get across, to go along with the way they felt descending into this disorder. I suppose that my biggest hang up with the way it pulled together was the pictures. The narrative voice felt like an adult's voice, but the pictures were all children's drawings/sketches pretty much. The information then came in small text boxes that felt important, but just not with as much weight in comparison to the amount of room and frenetic energy that the children's pictures were taking up on the page.

Having had a close family member who has struggled with an eating disorder, I am very familiar with the depression, the mania, and the repulsion from others they experience. It is frightening, and I wasn't the one going through it. In some ways, you watch the person and feel as though you are helpless to get them to see their way out of their thinking. I will admit that my own experience watching a loved family member probably made me not enjoy the manic nature of this book, perhaps shaping the way I felt about seeing her inside view of the disease. Is there a more orderly way of expressing a debilitating disease? I don't know. I just know that I struggled with this graphic novel's representation of it. I can only speak from my reasons and the tone set from the points I found in it.

[Dawn Strake · Rating 3 out of 5]

After finishing this book, I had mixed feelings. I was unsure if I liked it even though I read it straight through and couldn't put it down. The storyline is of a girl named Nadia who deals with ED (her eating disorder) almost her entire life. The book starts by telling about her awareness of food when she was only six. The book shows her emotional struggle with food well into her forties. The struggle and feelings shown throughout this book are real. The empathy I felt for Nadia was painful. It broke my heart seeing someone struggle with her bulimia demon for so long. On the other hand, the pictures used in this book confused me, while also offering disturbing outlooks of what is inside Nadia's thoughts. The words within the pictures were too much for me to understand or follow, but I could comprehend the drawings to show the overall endless feeling of being so helpless. Every page I turned I wanted it to show me a hopeful, happy, woman, but it never came. I finished this book feeling hopeless. I enjoy reading about eating disorders, but the drawings took me back. I understand the author wanted to let us inside her head through her battle, but it wasn't always appealing to me in this format. If the author wanted her readers to see the dread and pain that comes along with this sickness, I think she makes her point. I myself saw her point, but finished the book unrelieved.

[Atlanta · Rating 3 out of 5]

My Rating: 3.75 stars

This book is a graphic novel memoir by Nadia Shivack that takes us through her journey with her eating disorder, not just physically, but mentally and emotionally as well.

This was a hard one for me to read. At just 64 pages, it's easy to get the idea that this will be a light read. It isn't so. I did finish this one in one day, but not in one sitting as I had originally intended. At times, it got so dark, that I had no choice but to put it down.

I am a person that has had an unhealthy relationship with food and my weight for all of my life. At times, I felt like I could really relate to Shivack. At others, I realized just how crazy things can get so easily, for anyone around you. I marveled, wondering how a person could let themselves reach that point, without pausing to take a moment and realize that anyone could be there. That could have been me.

This was a painful one to read. I would definitely say it should come with some trigger warnings for body dysmorphia, EDs, self-harm, and depression. This book got 3 stars from me because at times, I felt I didn't understand the imagery and there was little to no explanation. I view this as more of a journal belonging to a person with an eating disorder, not necessarily a portrait of an eating disorder.

[Hyun Mo · Rating 3 out of 5]

I was first attracted by the book due to its front cover and title, 'Inside Out'. What would the book be about?
However, as soon as I started reading, the images and pictures really grabbed me - in a negative way. I was disturbed by the pictures and illustrations, which filled the whole book as it was a graphic novel.
To shortly introduce the book, the general plot is about eating disorders, such as anorexia. The author, Nadia Shivack, is both the narrator and protagonist in the book, who experiences eating disorder problems at age fourteen. The disorganized illustrations carry on the plot, while some textual facts and informations are written on sides or bottoms of the pages.
In my point of view, I think the author's approach towards the subject was fresh and somewhat unconventional. The author tried to lay out the story in a familiar way by using her teenage experience as an example, while including the warnings and important messages she tried to portray.
However, the illustrations, as I mentioned before, undermined the effectiveness. The pictures and graphics used made me hard to concentrate and progress on reading.
Overall, I enjoyed reading the book as it dealt with a subject I wasn't acquainted with, but, there was put up with inconvenience.

[Dan · Rating 3 out of 5]

Nadia’s mother, a survivor of the Holocaust, only ate one meal a day and refused to talk about her past with her family. Her swim coach praised the thin girls on the team and criticized the ones who “needed to lose weight.” With these pressures, Nadia turned to her friend Ed (eating disorder) to take care of her. As the story progresses Nadia’s “friend,” bulimia, turns into an uncontrollable monster that brings her only loneliness and shame. The reader discovers Nadia’s journey towards recovery has been a lifelong one as even after writing this book she has been hospitalized several more times.

Nadia Shivack’s portrayal of her lifelong struggles with bulimia through drawings, narrative and the inclusion of factual information regarding eating disorders will draw readers in, especially reluctant readers as the book is short and powerful. As the power of photo editing bodies in magazines and commercials continue to send society false messages regarding beauty and health, many will relate to Nadia’s story and experiences. A great book for young people to know that they are not alone.

[Courtney Nicole · Rating 3 out of 5]

Nadia became deeply aware of food when she was only six years old. She remembers tense family meals, an overbearing father, a mother with strange eating habits, and a thin-is-beautiful environment. Her eating disorder would take full bloom at age fourteen. Sometimes Nadia feels her eating disorder is a safe haven; other times she knows it is killing her. This intense memoir is raw but honest, with fantastic art that expresses Nadia’s demons, her strengths, and her road to recovery from bulimia and anorexia.

This graphic novel is disturbing, riveting, and hopeful. Nadia’s illustrations and words show readers the relentless turmoil and mayhem that accompanies an eating disorder that has spun out of control. Nadia provides startling statistics on the prevalence of eating disorders, along with important resources on information and recovery. I think this is a valuable book to add to a young adult collection. It sheds light on a topic that is often kept in secret and shame, and gives people who are struggling with an eating disorder a place to relate.

[BCL Teen Librarians · Rating 3 out of 5]

"Day by day, meal by meal, millions of girls and women in the United States struggle with eating disorders. I am one of them."

Nadia grew up in a family where food was a commodity and self-control was the pinnacle of success. Nothing less that perfection would be accepted.

That's when Nadia met "Ed," her Eating Disorder. Ed helped her control life: he obsessively monitored her weight, created demanding exercise regimens, and taught her the exquisite joy of binging and purging to rid herself of the contamination of food... so why did she feel so out of control?

This is slender book is a story of hurt, loneliness, overwhelming odds, and ultimate recovery. Read this is if you need to be reminded that you can survive... and thrive.

--Courtney

[Raven · Rating 2 out of 5]

The story of Nadia's ongoing battle with ED (eating disorder) is presented with hand drawn pictures interspersed with statistics. The drawings convey the confusion, pain, anxiety, and other stark feelings she experienced. My one complaint is sometimes I had difficulty reading the words. I know you can get the gist but being able to read the words would have been nice since she did take the time to write them. I would have liked to see a better ending to the story but the reality is that many times with eating disorders there is an ongoing battle. I think the format was something different but I don't know if I felt overly excited by the book. I can see how it can be useful to others who are going through similar situations.

[Angela W · Rating 2 out of 5]

The only thing particularly good about this book is that it was short. This was the quickest overview into a woman's journey with an eating disorder that I have ever read. I didn't even really look at the pictures or read what they said because the print was too tiny and pushed together that it was hard to discern. It somewhat freaked me out that the author is past her forties and still dealing with her E.D. Sometimes you think that it's a disorder that only affects high school/college age people, but I'm not sure that weight obsession ever goes away. I thought I might be able to relate to her story, but the book was so short I was finished with it before I was even able to make connections.

[SadieReadsAgain · Rating 1 out of 5]

I was quite disappointed by this book on a few different levels. Firstly, I hadn’t realised it was a graphic novel of sorts when I ordered it, & as that really isn’t my thing at all I was quite put off by that. But that wasn’t the book’s fault!

Obviously I can’t really judge it on its graphic merits as I don’t have any real knowledge of that genre. But visually I didn’t find it too impressive. What I feel I can judge it on is the subject matter, having read a number of books in the same vein as this. And on that level...it just didn’t come up to par. Yes, it was personal & honest. But I just felt that the form it took didn’t leave much room for detail or much emotion.

Basically, this left me cold.