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

1. its true
2. said trauma is the cause of adulthood problems
3. 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.

Lately, I’ve been reading Dr. Drew’s latest book, “The Mirror Effect.” It addresses celebrity narcissism and the extreme behavior that goes along with it. Dr. Drew does a great job at highlighting what has become typical tabloid material – multiple stints in rehab, sex tapes, drug use, eating disorders, etc. – and explaining the self-destructive pathology behind it.

Dr. Drew references troubling celebrity behavior over and over throughout the book. As I read, I found that most responses to this self-destructiveness fit in one of three categories (depending on one’s own background):

3 responses to troubling celebrity behavior:

1. Dr. Drew (empathetic / sympathetic)
2. “Regular” society (intrigued)
3. Relaters (Individuals with their own psychopathology)

The Dr. Drew Response

“As a group, however, [celebrities] often behaved in ways that unnerved and puzzled me.”

“…their behavior makes my heart ache for them.”

I’m coining this the Dr. Drew Response since I can’t think of any other word to better describes the reaction. His heart aches! He sees someone being self-destructive and he cares and feels their pain. It’s sympathy + knowledge + understanding + insight.

“Regular” society

“…this kind of behavior is portrayed as tragically glamorous, dramatically alluring, and, most alarmingly, normal and expected.”

A lot of people are interested in the self-destructive behavior of celebrities. It is a little bit of an obsession: Is Nicole Richie losing weight? Is Lindsay using? Is Amy Winehouse still alive? People want to know. The troubling behavior is intriguing and the press does a great job at, in essence, kicking celebrities when they’re down.

Relaters

“Witnessing such behavior also tends to provoke our own narcissistic impulses, causing us to feel envy, and tempting us to act like the celebrities we admire.”

“But for anyone who has experienced childhood trauma – the fundamental source of pathological narcissism – surrendering to such impulses can lead even mildly narcissistic people to spiral out of control with devastating results.”

Individuals with their own psychopathology or traumatic histories can be tempted (or even feel envious) by the self-destructive behavior of celebrities. There’s something triggering about it that makes these people want to engage in the same self-destructive behavior.

So there we go: In this world we have Dr. Drews, Regulars, and Relaters. I think that your response can change depending on the situation, and that it applies to anyone struggling – not just celebrities.

For example, I think about this girl who went to my college and was very obviously struggling with an eating disorder. “Regular” people would gossip about how sick she was. You’d hear the “I see her at the gym every single morning” and “I heard she eats a plate of broccoli for dinner” comments. Yes, it’s wrong and mean, but unfortunately that’s reality (at least on college campuses). Now, I was a Relater (struggling with an ED myself), so this girl kind of triggered me. I didn’t want to be that sick, but seeing her around campus would almost encourage my eating disorder; tempt me to cut corners, lose just 5 lb., eat a plate of broccoli for dinner, etc. That drove me CRAZY. I didn’t want to be a Relater – I wanted to be a Dr. Drew. I wanted to just empathize with her, wish she would get help, recognize how miserable she probably felt, and know how tough things were for her right now.

This is still a goal of mine: That Dr. Drew Response.

1. Full recovery is possible (to the point of being “cured”)
2. EDs are symptoms of a deep-seeded childhood trauma or toxic environment
3. Treatment should not be forced upon those who don’t feel ready to recover
4. Weight gain goals should be 100% of ideal body weight
5. Meal plans and/or monitored exchange/calorie counting is necessary
6. Without working through the underlying psychological causes of the eating disorder, one cannot completely recover
7. Anorexia, Bulimia, and Binge Eating Disorder are all on one disordered eating continuum
8. Society is largely to blame for eating disorders
9. Spontaneous recovery is possible (without professional treatment)
10. The AN diagnosis should not be dependent on weight or menses