The Best Worst
For some reason I feel like I should include this… Disclaimer: This whole post is based purely on observation and not remotely rooted in any kind of research. It is not really reflect my views on trauma, treatment for trauma/abuse, or the significance of abuse.
Tonight I stumbled upon a forum thread discussing Sex Rehab with Dr. Drew. I don’t know how I have missed it all of this time! Anyway, there are a lot of great things being said in the 30-page thread, but a couple of things caught my eye.
The first was this comment:
This is a danger in all group therapy of being the “best worst”. If you can’t be the best, best you can always be the “best worst”.
And then, this comment:
“If you need to see me in my addiction practice, there’s almost a 100% guarantee you suffered childhood neglect, physical abuse, or sexual trauma. It’s always there. Always.”
The second remark wasn’t really in response to the first, but I definitely think there is a connection between being the “best worst” and trauma. I don’t mean that people with a trauma history want to be the sickest patient, but instead the opposite – people who want to be the sickest also want to have the worst trauma.
I realize that this is a gross generalization, but it’s something that I always noticed in treatment. When I was inpatient, there were special groups for people with a trauma history. They were definitely necessary and no one WANTED to go to those groups, but for whatever reason having that trauma label made those patients’ struggles seem more valid. You could pull the trauma wild card when things started getting competitive.
Anyone who has been inpatient knows what I’m talking about. There are some patients that want to make sure you know that their eating disorder is the worst. With anorexia, it’s about who developed their eating disorder at the earliest age, ate the fewest calories, got to the lowest weight, or had the most hospitalization. With bulimia, I remember comparisons over who ate the most while bingeing, purged most frequently, spent the most money on a binge, had the most irregular labs (potassium in particular), and have purged in the weirdest places. I think the same thing happens with trauma. When the girl sitting next to you has some horrific childhood trauma (for instance… she grew up in a nudist cult where her mother divorced and one week later remarried a high school boy 5 years your junior, or something crazy like that), you can’t help but sit there and think “Wow, she REALLY had it bad. She has way more to deal with than me.”
There was actually a third comment that I liked:
Just because a patient admits to trauma does not mean that
- its true
- said trauma is the cause of adulthood problems
- the solution lies in dwelling over the past.
All three of these notions are commonly assumed.
I’m not sure where I stand on the issue of trauma treatment, so I’m not going to dive into that, but I just want to point out that not everyone with an eating disorder (or an addiction) has a history of abuse. Individuals can develop an eating disorder regardless of how great or awful their childhood was. Abuse/neglect is horrible and unfortunately many with eating disorders have this history. However… I wish trauma didn’t get tied up in the whole “best worst” competition.
First–I love your new look! It looks so nice! I completely agree with you on the “best worst”–it has always been an issue with groups/treatments I have been in and we have always talked about it in those settings. But, I really wonder if talking about it gives more attention to the topic and to those that want to be the “best worst”……
This is a really interesting post. I also especially like the 3rd comment. My therapist was talking to me yesterday about how she doesn’t think groups for people with anorexia are very beneficial because of the whole “best worst” phenomena. She was saying that, for an anorexic to be in a group, it’s been best, in her experience, for there to be a group of people with a mix of EDs (bulimia, BED…) and maybe just one anorexic. There are some eating disorder blogs, run by therapists, that are on the internet. I have found these very useful, in part because I can’t see the other participants. The idea of “virtual group therapy” in the case of anorexia is kind of interesting…
Interesting. Although I don’t think I’ve seen the best/worst competition in my current OP ED group, I would imagine that IP would be very different. To some extent there are always those people who I call “story toppers” but that tenancy has to be very disturbing and counter productive in a treatment setting whether it is related to trauma or ED.
I think the best/worst is most easily attributed to competitiveness, but I tend to believe its not necessarily just that. I wonder if the need to be the best or worst is related to emotional maturity and/or other diagnoses. I also potentially see the best/worst competition as a reaction to a lifetime of having one’s experiences dismissed by others.
Regardless of its root causes it has to be pretty counterproductive to treatment as a whole and I would hope and imagine that treatment teams try to limit it as much as they can (it must be nearly impossible to completely eliminate it in IP though).
Emily, I agree with what you said about it being attributed to more things than just competitiveness. I, too, have thought about the role of emotional maturity being a role in people feeling the need to be a “Story topper.” I used to get SO annoyed at “story toppers.’ I thought they were so immature, counterproductive, and full of themselves. Now (perhaps as I’ve matured), I have sympathy for them. Perhaps this is now because hearing their stories is not at all triggering to me because I feel proud to feel stable in my progress towards health. I don’t know what changed from seeing story toppers as annoying to seeing them in a sympathetic light, but I’m guessing I changed – not them. I’m guessing I grew up. I’m guessing I saw their story topper-ness as a symptom of someone who just needs people to care for them and show them they’re a valuable person regardless of their story….
imaginenamaste – Thanks, glad you like the new design! From my experience, the “best worst” thing isn’t really talked about in groups. Maybe that is for the best; I guess the depends on how it’s affecting other people in the group?
Laura – It’s interesting that your therapist recommends having on anorexic per group. I kind of agree… although I think it really matters on where someone is in their recovery. I’ve never seen these “virtual group therapy” blogs that you’ve mentioned – could you send me a link to one? You can email me if you don’t want to post – greythinking (at) gmail (dot) com.
I also love the phrase, “story topper.” Maybe I should change the title of this post…. Hmm. Anyway, I agree with your thoughts on emotional maturity and can relate to your experiencing these people differently throughout the progression of your treatment. I also think there might be something about recognizing the “story topper” pattern. The more women I meet with eating disorders, the more patterns I recognize.
Emily – I haven’t seen the issue too much in strictly outpatient groups, either. I always wondered what you do with people competing to be the sickest… it seems like they are usually moved to a higher level of care, though. Maybe that move helps them feel more validated with struggling or maybe it gives them the time/attention they need to deal with the ED.
Amen to that!
I see a LOT of young people who’ve come into my office, or I’ve supported or what have you… and sooo many want to be the best worst and it makes me want to cry! (plus knock their heads together)
Not everyone has had trauma and some have and while every trauma is valid… that doesn’t mean its the worst and oh my… I so often think fixing THAT need is more important then dealing with the trauma… almost like dealing with the trauma/ed etc continues that cycle in and of itself!
Anyway, I really like what you wrote and it also reflects my perceptions