Overcoming an eating disorder can take tremendous work and substantial time, so when do the patient and family know that the effort has been successful? What does recovery from an eating disorder look like?
Unlike with some medical conditions, there is no definitive test that will determine if a patient has recovered from an eating disorder. Instead, the goal of treatment is to allow the patient to live without feeling the need to resort to previous unhealthy behaviors. A patient does not reach recovery by reaching a certain weight, number of days in treatment or even a particular number of days without the self-destructive behavior.
A patient is considered to be in recovery when certain treatment goals are met and he or she is living in a healthy way without the eating disorder behavior. This does not mean, however, that the person no longer has any thoughts about the behavior or no longer experiences the urge to act on them. A patient in recovery may still contend with such thoughts but has developed coping skills to avoid the behavior itself.
Each patient’s care team will define recovery differently, according to that person’s unique challenges and goals, personal history with his or her eating disorder, presence of other psychiatric or medical conditions, but the National Eating Disorders Association lists these common criteria:
- Self Direction – The individual decides for his/herself to seek recovery and actively searches for it.
- Individualized and Person-Centered – The way to recovery that an individual chooses will be unique to that person’s strengths, needs, experiences, and cultural backgrounds.
- Empowerment – The individual has the ability to speak for him/herself about what he/she needs, wants, and aspires. The person has control over their own future.
- Integrative care – Recovery covers all aspects of a person’s life. Areas include mind, body, spirit, and community. This can include: housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addiction treatment, spirituality, creativity, social networks, community participation, and family supports. Families, providers, organizations, systems happen in a consistent step-by-step basis. There is continual growth, occasional setbacks, and learning from experience. Recovery begins when a person realizes positive change is possible. This helps the individual move on to fully participate in the recovery process.
- Strengths-based – Recovery focuses on building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. Building on such strengths gives the person the ability to engage in new relationships and interact with others in supportive, trust-based relationships.
- Peer Support – Support through sharing experiences, knowledge, and skills with others going through recovery can help the individual as well as others by giving each other a sense of belonging, supportive relationships, a sense of value, and community.
- Respect – Acceptance by the community, society, and systems, as well as appreciation of the individual – including protection of rights, elimination of discrimination and stigma – is a necessary step for recovery to take place. Regaining self-acceptance and personal belief in one’s self are also necessary. Respect means that the individual will be included and fully participate in all parts of his/her life.
- Responsibility – Taking personal responsibility towards taking care of oneself and attaining goals is necessary for recovery. Individuals have to try to understand their experiences and recognize coping and healing methods to promote their own well-being.
- Hope – The message of a better future – that people can overcome hardships that occur must be internalized. It is the motivation for recovery. It can be inspired by peers, families, friends, providers and others.
Patients and family must be careful not to rush into declaring recovery. Celebrating milestones can be an effective way of supporting someone under treatment for an eating disorder, but even a major milestone is not recovery.
Leaving a treatment program often is cause for joy and satisfaction because the patient has progressed in learning to control the eating disorder. Yet completing the program marks only the beginning to the long road of recovery.
Successfully addressing an eating disorder is a lengthy process that easily takes months or years, so be careful not to confuse celebration-worthy milestones with recovery.
Recovery also is not permanent. As with many addictive behaviors, like alcohol and drug abuse, people who recover from eating disorders can relapse even after months or years of stability.
In one study of patients with anorexia, nearly 30 percent of patients had relapses following hospital discharge, but most patients studied went on to recovery.
That is why most eating disorder patients are encouraged to continue working with a self-help group or private therapist after achieving recovery and leaving treatment. Outpatient treatment also can be appropriate for some recovering patients after leaving inpatient care.
The patient may be set up with a recovery team made up of different types of professionals including psychiatrists, dietitians and psychotherapists who can provide support. It is important for the patient to work with that ream regularly, even when everything seems fine. Remember also that recovery can be a fragile thing. The patient and family of someone recovering from an eating disorder must be prepared for setbacks. Even for a patient well into recovery, some situations and settings can trigger an eating disorder. The holiday season, with all its abundant food and various stress-inducing activities, is probably the most challenging situation for someone recovering from an eating disorder.
Acknowledging that the situation will be difficult can help, making it easier to address the challenge head on with support from family and friends. A patient in recovery should be able to draw on the coping skills learned during treatment to successfully navigate the situation.
Recovery from an eating disorder will include everyday challenges because, unlike substance abuse, food cannot be avoided. Someone recovering from an eating disorder will have to learn to cope with being in the presence of food and the temptation to give in to unhealthy behavior.
While those situations cannot be avoided, a person in recovery will have the skills necessary for coping. Family members, in particular, should be aware of their potential influence on a recovering eating disorders patient. Casual references to the patient’s appearance, eating habits, or previous experiences with the disorder can trigger unhealthy habits, particularly if they come from someone with outsized influence on the patient, like a parent.
Recovery is not a single point in time that can be reached and then looked back upon. It is more like a plateau that can be reached by climbing, and then the job is to stay there. There will always be factors at work trying to push the patient back down, and unfortunately experience shows that many patients in recovery do not stay there for long. It is not uncommon for an eating disorder patient to return to treatment after a time in recovery.
It is important, therefore, to remind those in recovery that slipping down the mountain does not mean recovery is lost. The same hard work will get the patient back in control of their illness again.
For more on recovery from eating disorders, see www.nationaleatingdisorders.org/recovery.