Mirror, Mirror, on the Wall, Who’s the Sickest of Them All?

Mirror, Mirror, on the Wall, Who’s the Sickest of Them All?

There is a disturbing tendency amongst individuals with eating disorders to compare their illness to another’s. It’s the worst kind of competition of them all and sounds like this: “What’s your lowest weight? How many hospitalizations have you had? How many calories do you consume? How often do you work out and for how long?” The most pressing question in this game of who is the most sick: “What type of eating disorder do you have?” A long time ago someone, clearly very ill, created an extremely disturbing hierarchy of eating disorders that has forever been adopted, with anorexia being the elite disorder, bulimia falling in a distant second place, and binge eating disorder, well, the person that created this misguided ranking doesn’t even consider that an illness, it’s just cringe-worthy.

I’m not gonna lie, I’m a former game player, but I’m DONE and I’m requesting that you consider retiring from this futile waste of time. Let’s think about it: There’re two possible outcomes to this game — you either feel superior at the end when it’s evident in the eating disordered part of your brain that you’re “better than,” aka “sicker than” the person you are playing with, or you’re somehow “less than” your opponent, in which case you feel like shit and consider redoubling your efforts. I guess I’m just curious, IS THIS REALLY THE GAME YOU WANT TO WIN?? Honestly!? If it is, I want you to fully consider the end result; I promise it’s not good. No one cheers for you when you win this game, no victory dance, and certainly no celebratory party.

What’s ironic and speaks to how much the brain changes during the course of this illness, is that never once have I heard anyone with any other type of illness aspire to be the sickest. I guarantee you that my beloved mother-in-law, diagnosed with terminal brain cancer never once felt superior to the person receiving chemo sitting next to her who had a more favorable prognosis. They were just humans together, battling scary illnesses who shared a common bond.

Social media just makes this sad competition a million times more complex. I must say, I’m grateful social media didn’t exist when I had an eating disorder (or while dating, thank God!!). During therapy sessions my clients show me “triggering images” of friends they’ve made while in hospital-based or residential treatment programs who’ve relapsed. One image shared with me was of a patient with a feeding tube (due to complete refusal to eat) — in what f’ed up universe is this a badge of honor? Another post might reveal protruding bones or evidence of recent self-harm behaviors. Although I feel for my client who is triggered by these images, my heart literally hurts for the lost and incredibly ill soul that would post such pictures; clearly their brain is invaded by this severe illness.

Playing this game with me isn’t an option. My therapy clients know that I’ve recovered from an eating disorder. It’s not uncommon, once they are more comfortable with me, to ask questions stemming from a desire to play the “how sick were you” game. I simply ask, “Tell me how it will serve your recovery to have this information?” Long pause, followed by, “I don’t know that it would.” “Right, so if you wanted to ask me a question that would serve your recovery, what might you ask?” This creates a much juicer dialogue that I’m open to engaging in with them (despite some pretty antiquated rules about self-disclosure in the therapeutic relationship; but that’s another post entirely).

Now that we’ve established the unhealthy and destructive nature of this game and my heartfelt desire for you to disengage and bow out, I want to offer you some tools on how to change this pattern:

1. The first step is to catch yourself in the act. So maybe your mid-sentence and you stop and think, “Oh, shoot, the eating disorder slipped in and did its thing, I’m not going there.”

2. Retract the question once you’ve insightfully noticed comparing your eating disorder to another’s, and name it — ED Comparison.

3. Courageously call yourself out to the person you were comparing your ED with because I can assure you that you’ll be doing both yourself and your friend a favor as they’ve likely struggled with this same issue; it’s sort of the nature of the beast. It can be a “me too” moment and an opportunity to collectively agree to try again and have it be different.

4. Be so compassionate with yourself during this relearning process. It takes time to change our behaviors. And maybe, you could even set the intention before you enter into a situation that might elicit comparisons — “I choose to connect with my highest self, who knows that comparisons don’t serve my recovery.”

5. My favorite suggestion is for you to funnel that badass desire of yours to excel in this world into something that aligns with your values. Remember those misplaced dreams? Wrap them up in your arms and take action steps to reincorporate them in your life.

A note on the mistaken notion of an eating disorder hierarchy: Hour after clinical hour I see people diagnosed with every type of eating disorder in the book from people who struggle with compulsive over-eating, bulimia and anorexia. I promise that those of us in this battle (regardless of where we are in the journey) are far more alike than different; we are kindred spirits. We are/were engulfed by an illness that helped us alleviate the pain of our soul’s suffering. Let’s hold each other’s hands and hearts, literally or in spirit, and wish the person in your mind’s eye, or the person sitting next to you in the waiting room, or in group, well in their recovery.

May you find a recovery tribe where love and support is bountiful! May all beings be well.

Love + Light,


If you’re struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.

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