The Strange Hierarchy of Eating Disorders

It seems like this is something people just know, despite no one talking openly about it. When I was in the throes of bulimia, I knew this to be true. When I had my first job working at an inpatient unit for eating disorders, I also knew and saw this to be true.

Here’s the strange, twisted hierarchy:

• Anorexia

• Bulimia

• Binge Eating 

Sickly enough, anorexia is what people aspire to. It represents strength, discipline, and purity. Bulimia is next. It’s seen as weak, lack of discipline, too much wanting, and dirty but the compensation characteristic remains a redeeming quality. Binge Eating is last in the hierarchy and is seen as the ultimate failure.

To be clear, I don’t believe this hierarchy, it is just an observation I have noticed within the eating disorder world. I wanted to name it since it doesn’t seem like many have.  I also want to explore it in this blog post.

Why This Hierarchy?

Two words: Diet Culture. Seems so obvious after I say it, right? Then, it seems so sad. Diet culture even invalidates people with eating disorders that don’t match the thin ideal. Diet culture tells us thin is better and we should always be trying to get thinner. Sure, sometimes it’s under the guise of health, but we all know if we didn’t lose weight by doing the thing diet culture tells us to do- we wouldn’t be doing it, despite the health benefits.

Anorexia:

When you look at the hierarchy of eating disorders through the diet culture lens, it makes sense that anorexia has been deemed to be at the top.  The myth that only thin people can have anorexia is alive and well. Remember though, the system is rigged because you can only have anorexia if you meet the following criteria according to the DSM V:

A.    Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected). 

If you are of “normal” or god forbid “higher” weight then you simply cannot have anorexia, except you totally can.

Diet culture also moralizes food and weight. So, if you are thin, you are seen as pure and clean. If you eat whole, unprocessed food, you are perceived as morally superior. If you exercise every day, despite your hurt knee and aching back, you are described as disciplined and strong willed. In many ways anorexia is the ultimate example of following diet culture rules.

Bulimia

Going along with diet culture’s preaching- of course bulimia is worse, or less desirable, than anorexia. There is the belief that people with bulimia are “normal weight.” Even worse, some people might have heard, “throwing up doesn’t even help you lose weight- you digest most of the calories anyway.” Reading between the lines, the message is that bulimia is an ineffective way to lose weight and if you had the discipline to lose weight you wouldn’t need to purge.  

Bulimia is also seen as weak willed- if you had more willpower, you’d be able to resist the urge to eat. Even worse, bulimia is seen as gluttonous (a comment on morality)- not only can you not restrict, but you have no control around food and “overindulge.”

Diet culture really demonizes this. According to diet culture, at least with bulimia the person is trying to compensate for the binge by over exercising, using laxatives, vomiting, etc. so that is the “redeemable quality.”

There’s no discussion about how the body’s healthy response to restriction is to seek out food with a vengeance. This very natural survival strategy is moralized by diet culture as being undisciplined. Furthermore, when the body is in a starvation state it seeks out food that has ready to use carbohydrates like cakes, cookies, bread- which is the opposite of “clean, pure, whole food.”

Binge Eating Disorder

If diet culture thinks bulimia is bad- then forget about Binge Eating Disorder. BED is seen as everything that bulimia is, but without the purging. So many of my clients with this disorder experience so much shame, which causes them to often suffer alone with this. The diet culture stereotype of someone with BED is that they are lazy, unmotivated, weak, and sad. I’ve even heard people comment that if a person is in a larger body, they must have BED.

Diet culture, and many medical providers, want to support individuals with BED by helping them lose weight in a “sustainable way.” The belief is that if a person with BED follows a “realistic” calorie deficient meal plan with daily exercise they will regain motivation, self-esteem, and control. Easy fix, right? Except for the small detail that this type of approach is shaming and only reinforces a person’s core belief that they are not good enough as is and must lose weight to have worth. Oh, and also- it supports the completely unsupported belief that weight loss is possible, sustainable, and necessary.

 The Hierarchy and Healing

This twisted hierarchy that is born out of diet culture is a major barrier to people seeking and achieving recovery. It creates the idea that only certain people are worthy of treatment and if you aren’t thin enough, you aren’t even deserving of a diagnosis, let alone help. Diet culture is so sneaky and clever it even invades eating disorder providers and treatment centers.

If you’re reading this blog, please know this hierarchy is total bullshit. All eating disorders wreak havoc in a person’s life and causes multiple layers of suffering and pain. Every person is deserving of quality care and treatment and body size should never even enter the equation. As more and more people join the anti-diet movement and adopt a HAES perspective, this hierarchy will be dismantled.

Unfortunately, that still isn’t the world we are living in, despite some things being better, but please know you are enough, you are worthy, you are deserving,

Are you ready to make a change and find food freedom? Reach out for your free consultation. I’m accepting new clients and would love to help you!