You decide that you want to recover from anorexia nervosa. You seek out treatment providers, whether at a treatment center or by finding individuals to form a treatment team. The brochure says, "73% of our patients recover from anorexia." Another suggests that 87% recover. Assuming that recovery is your most important goal, which do you choose? It's not a simple question, because there is little agreement on what recovery actually is.
Dr. James Lock, instrumental in developing the Maudsley method for recovery from anorexia and other eating disorders, presented issues and questions on recovery at the 2008 International Conference on Eating Disorders (ICED) in Seattle. Here are some of the thoughts that arose from the discussion:
Variations in the Definition of Anorexia Recovery
The simplest way to define recovery from anorexia is not meeting the criteria for the disorder, defined in the Diagnostic and Statistical Manual for Mental Disorders, 4th ed. To have a diagnosis of anorexia, a person must be less than 85% of her or his ideal body weight and must have a fear of gaining weight, distorted body image and an interrupted menstrual cycle (for women of appropriate age).
As Lock pointed out, though, there are significant limitations to this approach. If you enter treatment and gain enough weight for your menstrual cycle to start, for example, but you still fear weight gain and you're actually still less than 85% of your ideal body weight, what does it mean? Technically, you don't qualify for the diagnosis of active anorexia nervosa, but are you recovered? I would argue that you're not, in part because you'd still qualify for a diagnosis of eating disorder not otherwise specified (EDNOS).
Why Definitions of Anorexia Recovery Matter
How we define eating disorder treatment shapes the way the clinical community interacts with eating disorders and those who have them. Lock focused on four areas:
- Who gets treated? Like it or not, insurance companies often make this decision. Once a person does not qualify for a diagnosis, an insurance company does not want to pay for further treatment for that issue.
- What gets treated? If there are peripheral issues that result from an eating disorder, they could be seen as secondary within the treatment process. For example, if your relationships have been destroyed because you've isolated yourself in an effort to support an eating problem, you may be defined as "recovered" well before your social world has recovered.
- How do we assess incoming clients? If a person can be defined as "recovered" from a disorder, it may affect what treatments are available for that person. I wonder whether this would be particularly true in clinical settings in which funding is tied to certain diagnoses.
- How do we evaluate response to treatment? Some define treatment effectiveness as relief of symptoms, and that may be a fair definition. But is health really just the absence of illness? If health is more than that, is treatment successful when it only relieves specific symptoms?
Separating Recovery from Diagnosis
At ICED, one step in the right direction that was considered, is the possibility of employing the terms "recovery" and "remission" differently. For example, remission could refer to the absence of symptoms or to having only a subset of the symptoms required for a diagnosis. Recovery might then describe a more complete elimination of the disorder -- having no remaining symptoms.
Have Your Own Definition of Recovery From Anorexia
It's important to discuss the definition of recovery from anorexia, particularly for professionals in the field, and ICED set the stage for a great discussion. Recovery, though, is in some ways in the eyes of the person who is struggling in the first place. Has treatment produced the desired result? Has it created a sense of well-being that is comprehensive enough to give relief?
For this reason, it's important when entering treatment to talk about what you think recovery will include. Of course, those with anorexia often set goals that aren't strong enough: gaining ten pounds is not likely to improve life in a lasting way. Treatment providers thus should be able to work with you to modify your expectations as needed to create mutual agreement. Treatment may have its limitations, but it's your life, and ultimately, it's your choice to define recovery as is best for you.
Source:
Lock J. "Definitions of Recovery in Research." Oral presentation. International Conference on Eating Disorders, May 17, 2008.
