When Worse Is Better: The Unfortunate Hierarchy of Eating Disorders

Woman on scale covering faceImagine a life where you are continually tormented by an inner dialogue that screams of your worthlessness, your hideous appearance, and your pitiful, meaningless existence. Imagine a life where you mange your day solely around food, either by avoiding it, getting rid of it, or consuming as much of it as you can. Imagine spending your birthday in a psychiatric ward, perhaps too sick and too weak to even stand up on your own. And now imagine that there is a very strong part of you that wants to be worse. This is the horrible trap of an eating disorder.

One of the most difficult aspects of eating disorder treatment is the mind-boggling fact that those suffering would often do almost anything to cling to their disease. As much as part of them wants to be happy and healthy and free from the constant torture, there is another part, often referred to as “the eating disorder self”, that convinces the sufferer that they will be nothing without it. When your eating disorder becomes your identity, medicals markers used to gauge its severity, such as amenorrhea (absence of menses in women), or the body mass index scale, are looked upon as levels of achievement. When you’re trapped in this mindset, worse really does seem better.

Throughout the years that I struggled with anorexia, I used the presence of my period as a way to prove to myself that I was still safe, that I still had weight to lose. Some individuals will stop menstruating fairly quickly after substantial weight loss, others, myself included, can maintain dangerously low weights yet continue to menstruate. I remember my therapist and my doctor both diagnosing me with anorexia nervosa, but I had seen and memorized what the Diagnostic and Statistical Manual of Mental Disorders said about anorexia. I had to lose my period to be “officially” classified. The diagnosis went in my charts nonetheless. Yet, I had this strange longing to fit the bill, to really be able to call myself anorexic, because it meant that at least I was doing something right. If I failed at everything else in life, at least I would master my eating disorder. I would be the best anorexic I could be.

I  wanted to be the thinnest in the room, the sickest, and many times over I did hold that title. It became my prize, my sense of accomplishment. I became quite accustomed to the label “skinny, blonde girl.” Anorexia became my identity and when recovery (and the inevitable weight gain) threatened that, I would panic and slip right back into the disordered behaviors. Who would I be without it? I needed this disease to survive, or so my eating disorder constantly told me.

It is a very sick way of thinking, I know, but I also know that I was not alone in thinking. I have spent a great deal of time among other eating disordered individuals, and there is a definite cognitive pattern when it comes to symptoms and diagnostic labels. In short, it seems the worse you are, the better you feel. I can’t count how many times I’ve heard people with bulimia wish they had the “control” of their treatment peers with anorexia, and those who compulsively overeat long for the ability to easily purge like those with bulimia. There is an unfortunate perceived hierarchy among patients, with the “purity” and “cleanliness” of anorexia appearing to outrank the “hedonistic” behaviors of bulimia or compulsive eating.  But in reality, they are all equally serious, and all deadly. Whether you’re starving or stuffing or purging, your eating disorder is a distraction, a desperate attempt to control the un-controllable.

Eating disorders, in general, are very control-focused. Whether it’s an attempt to control anxiety, or anger, or relationships, they trigger and feed off of the  competitive and perfectionist personality traits that many sufferers share. I thought that if more control equaled more medical complications, so be it. But the crux of the matter is that sufferers inevitably reach a point, often quite quickly, where the lotus of control shifts completely out of their hands, and into the hands of the eating disorder.

It’s too hard to battle an eating disorder alone. Reaching out is the first step in successful recovery. Share your secret with a trusted friend or family member. Even that act of sharing a secret can often relieve some of the pain. Seek professional help. There are people who have been in your shoes and are willing to guide you out of the darkness. Hope is real. Recovery is real.

© Copyright 2011 by By Josie Tuttle, MA, therapist in Beverly Hills, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 13 comments
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  • maurice

    maurice

    July 11th, 2011 at 11:40 PM

    I’ve seen a cousin suffer with eating disorder-anorexia to be precise, and it’s very painful to see someone grapple with something like that.it was like her entire life only consisted of her eating disorder and things related to it.there was nothing mch in her life besides the disorder.I hope and pray everyday for her recovery.

  • Hubert

    Hubert

    July 12th, 2011 at 4:33 AM

    this is so SICK

  • L.Hall

    L.Hall

    July 12th, 2011 at 10:44 AM

    I still think that throwing out the scale and listening to someone other than yourself that you trust and respect would help greatly with eating disorders. They will give you an honest opinion on your physique. As far as I can tell every part of an anorexic’s problem simply comes down to the mindset of thinking you’re fat.

  • Letitia Saunders

    Letitia Saunders

    July 12th, 2011 at 12:48 PM

    @L.Hall: Your comment took my breath away. It’s not that simple at all! See, this is why anorexics and bulimics get little sympathy. There’s this superficial level of “understanding” about eating disorders everywhere. You’re wrong.

    Anorexia’s a very deep-rooted problem and those with an eating disorder are unlikely to listen to anyone who says anything contrary to their own core beliefs about themselves.

    If it was that easy, they could all be cured in a day or two with some smooth talking. You don’t just snap them out of it with a few well-chosen words! Good grief.

    Treatments can span months, if not years before they get better and some never will recover sadly. Educate yourself before talking next time please. It’s about control, not food.

  • Morgan Dade

    Morgan Dade

    July 12th, 2011 at 10:40 PM

    Unfortunately we will never live in a perfect world with perfect human beings. Much of the suffering we can got through in life is self-inflicted, including eating disorders. Sorry to say it but it’s true.

    Just like alcoholism, you’re calling the shots (no pun intended), nobody else, about what does and does not go into your body.

  • Ian Strong

    Ian Strong

    July 12th, 2011 at 11:00 PM

    I wonder if the fact that periods-the single most annoying part of womanhood-stop when you hit a certain weight is possibly part of the reason women become anorexic. The reality of menstruation, despite it being a natural function in a healthy body, disgusts some women (especially younger women). Perhaps for that group a way to stop them would be taken on board with open arms.

  • Marilyn

    Marilyn

    July 13th, 2011 at 4:38 AM

    One of the toughest things about eating disorders is that we ALL have such an obsession with weight and food, chances are that when we first see a girl losing weight we do not think that something is wrong but that she must be doing something right! By the time most of us can see past the fact the fact that she is skinny anymore but maybe scary skinny it is too late to get her any help. We have all already reinforced everything that she has been thinking by telling her how good she looks the whole time she is doing this to herself.

  • Becky D.

    Becky D.

    July 14th, 2011 at 1:42 AM

    @IanStrong – Hmmm, I guess that could be the case but I feel it would be a very tiny portion of the anorexic population. No-one becomes anorexic intentionally, do they? One root cause of anorexia is feeling a lack of control over one’s life, so they try and control their bodies. Being able to control their bodies gives them control over their lives you see or at least that’s how they view it.

    Unfortunately anorexics cannot see that it’s not worth the suffering they have to endure and also the subsequent health problems that anorexia brings on.

  • Kelsey Finch

    Kelsey Finch

    July 14th, 2011 at 8:41 PM

    There’s a girl I know with bulimia that told me about her condition, and I gave her a lot of support to improve her mood. I learned a lot from her. She was a wreck to put it nicely, and had much to deal with. I’ve not heard from her for a while but I’m sure she’s doing better. At least that’s what I like to think.

    When the opportunity comes up, reach out and offer support to those with eating disorders. It may be rejected but at least you tried. If you don’t try you’ll never know.

  • Josie Tuttle, MA

    Josie Tuttle, MA

    August 26th, 2011 at 5:06 PM

    Thanks, all, your contributions! Love to see discussion around eating disorders. They need to be talked about more!

    @maurice – It’s so true what you said about anorexia becoming your cousin’s whole life. EDs are extremely pervasive disorders can truly take over one’s life.

    @Hubert – Yes, it’s sick because people with an eating disorder are very ill. But approaching someone as simply a “sick” individual is too pathologizing and is counter-productive to recovery.

    @L.Hall – People with anorexia do indeed have a very distorted perception of their body but this is in no way the root of the problem – it is a symptom.

    @Letitia Saunders – It is so sad but true what you said about eating disorders getting little sympathy. Unfortunately, too few people truly understand the underlying psychological issues and see only a vanity issue.

    @Morgan Dade – Recovery is series of decisions, yes, but also requires a tremendous amount of support and understanding, among other things. I won’t ever place blame on someone who develops a disease like anorexia or alcoholism, but I do acknowledge their responsibility in getting better, if that is their wish.

    @Ian Strong – This may be true for some of the eating disorder population, especially with girls diagnosed around puberty. EDs serve as a way of delaying growth, and with that, responsibility. But remember, there are just as many women developing anorexia years later, including after menopause. And don’t forget, men develop anorexia too.

    @Marilyn – You’re so right. In fact, I just wrote my lastest article around the fact that disordered eating is normal eating! https://www.goodtherapy.org/blog/thin-line-diet-eating-disorder/

    @Becky D. – Yes, I know at least when I was in the throes of anorexia, I didn’t care so much about the consequences. It wasn’t so much that I couldn’t see them, but the disease makes everything pale in comparison to the goals of losing weight, being in control, etc. Horribly difficult to treat because of this.

    @Kelsey Finch – giving your friend lots of support and educating yourself about eating disorders are exactly the right thing to do :) I hope she is doing better as well.

  • Bree Kalb, LCSW

    Bree Kalb, LCSW

    June 5th, 2012 at 7:08 PM

    I applaud your honesty and directness describing your own history of an ED. Thanks for writing this.

  • Sarah

    Sarah

    November 17th, 2017 at 10:15 AM

    My friend is suffering and I’m the only one he’s told any advice on how I could help him?

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    November 17th, 2017 at 1:21 PM

    Dear Sarah,

    It sounds like you are concerned about your friend’s well-being and feel unsure of what you can do to help. This article about helping someone you care about might be one place to start: https://www.goodtherapy.org/how-to-help.html

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