So tired of the widely-held view that anorexia (AN) is more serious than other #eatingdisorders (EDs). In my experience it's not - bulimia (BN) has been far more difficult even though anorexia nearly killed me too. BUT- we need to drop these comparisons entirely. This is why-> 1/

The idea that AN is more serious psychological & physical prob is propped up by stats such as "anorexia is most fatal psychiatric condition." But data is shoddy. Recording causes of death is flawed, e.g. EDs of any kind often don't get noted as contributing factor in suicides 2/

Considering AN is the cast minority of EDs (c8%) it prob shows up on death certs because of the obvious physical symptoms. But BN & BED also significantly reduce length of life w metabolic & other changes we don't adequately understand, & have direct issues impacting mortality 3/

E.g. low potassium is seen in BN, in my experience my 30+ emergency admissions for potassium & cardiac issues have been at a normal weight. I've had a stomach tear which was thankfully small but if much bigger would have been a fatal rupture. All come w risks to life & health 4/

And the point about suicide & self-harm is important, & may differ across diagnoses & individual experience. In my case, AN was protective - against feeling. Numbing. BN been characterised by far more volitile, dysregulated & dangerous emotions & far more suicide attempts. 5/

Let alone the cost, having spent over £100,000 on food for bulimia, getting into debt, riskily engaging in sex work and theft to maintain the ED which put my life at risk in more than one instance. We don't talk about these factors, and they are complex. 6/

But, this is just my experience. The whole point is that we should NOT be comparing diagnoses wholesale, saying one is more serious than the other. Nobody has same experience as another, same presentation. All need to be heard. All are serious & could get more so without help 7/

YET, the way in which different diagnoses are treated and responded to does reflect this, it perpetuates hierarchy. Continual denial of support to people on basis of BMI reinforces AN as more severe. Most ED services (especially inpatient) are in fact anorexia services 8/

& getting treatment for bulimia has been so so much harder than for AN. What about BED? Are people with binge eating even seen in most ED services? Is any psychological help offered for them at the GP? 9/

So you have to wonder then why people may write off their own problems as not important and become engulfed in shame and private pain when systems tell them they are not severe enough or that their needs don't warrant support. Shame on us for tolerating such systems. 10/

People say eating disorders are competitive. Well, the really problematic competitiveness is the competition for help and support when it is so rationed that we have to decide on an arbitrary basis who is the most severe/in need. 11/

Too often this happens on outdated, non-evidence-based hierarchy which also perpetuates the idea that the *most* significant risks are physical ones & not psychological ones. Well I am floored with how flawed that as a modern understanding of how EDs are a synthesis of issues 12/

The biggest barrier is resources. Yes, money, cash, staff who need to be paid and trained. It is so unsexy and so easy to switch off calls for more money, isn't it? How unrealistic, greedy, pie-in-the-sky. Well, people are dying and living miserable lives. 13/

Until we seriously inject resources *on the scale needed - not just "more"* into #eatingdisorders treatment then we will continue to let people down & reinforce an inherently discriminatory competition for severity which drives us all down the pan. We can't wait much longer. END