As a therapist, I often encourage clients to think about the road to recovery as a dirt road that hasn't had any traffic in quite some time. Unlike a paved highway, it is not smooth or straight. There can be many turns and unexpected obstacles in the way. It is important -- not only for the client, but also for their families -- to understand that eating disorder recovery will not be over in a few weeks. It can be a difficult road and is one that can take a long time. Knowing this can help everyone involved have realistic expectations of the situation.
What does "recovery" really mean?
Unfortunately, there is no universally accepted definition of full recovery in eating disorders. Most professionals agree that simply no longer meeting full criteria for an eating disorder is not enough to be considered full recovery. For example, a person who has been struggling with anorexia nervosa may reach a normal weight but still be struggling with an intense fear of weight gain or still be having body-image distortions. While this person may no longer qualify for a diagnosis of anorexia nervosa, they are continuing to struggle with symptoms of an eating disorder.
Complicating this even more is the idea within society that it is normal to be concerned about weight, food, and appearance. Is full recovery not being concerned about these things at all? Unlike substance abuse recovery, where abstinence may be the goal, we all have to eat. Perhaps one way of thinking about recovery is not meeting criteria for an eating disorder, and struggling with these ubiquitous food and body image issues in a way that is within the norm of the general population.
Is full recovery possible?
Although there are professionals who may believe that full recovery from an eating disorder is not possible, research supports the idea that people can fully recover from an eating disorder. These differences are typically linked to a professional's theoretical orientation, his/her own experiences, and training.
Many people who use the 12-step model to treat eating disorders think of eating disorders through the model of addiction. Similar to concepts used for alcoholism or drug addictions, people struggling with eating disorders may be considered recovering or in recovery but never recovered. This may be a limitation in extending the addiction model of recovery to eating disorders.
One research study performed at the University of Missouri and the University of North Carolina at Chapel Hill in 2010 was able to show that full recovery is possible. They defined full recovery as no longer meeting criteria for an eating disorder, in addition to an absence of binge eating, compensatory behaviors (such as purging), and restrictive eating. They also defined full recovery as no longer struggling with aspects of eating disorders, such as a fear of weight gain or body image issues.
What does the course of recovery look like?
In the beginning stages of recovery, a person may deny that they have a problem, and even if they acknowledge the problem they may deny that the eating disorder is serious. Once a person begins to acknowledge that they have a problem, they may then begin to be able to distinguish what thoughts and behaviors are related to the eating disorder and what thought processes reflect their healthy self. A person can then begin fully engaging in recovery -- beginning to decrease eating disorder behaviors while building coping skills and ultimately building a healthier self. As recovery progresses, a person may have many of the symptoms under control but may still struggle with eating disordered thoughts or a desire to return to eating disorder behaviors. Full recovery occurs after this point when both symptoms and thought patterns associated with the eating disorder are gone.
How long does recovery take?
Full recovery can take many years to achieve, but the amount of time a person is in treatment varies widely based on the severity of their eating disorder, how long they have had an eating disorder, and their level of commitment to treatment. Early identification can help shorten the amount of time it takes to achieve a full recovery.
Does everyone recover?
Unfortunately, not all people struggling with eating disorders will recover fully. Some people will ultimately die from their eating disorder. Others will reach a partial recovery, and still others will struggle with their eating disorder and associated relapses for many years.
Bardone-Cone, A.M., Harney, M.B., Maldonado, C.R., Lawson, M.A., Robinson, D.P., Smith, R. & Tosh, A. (2010). Defining recovery from an eating disorder: Conceptualization, validation and examination of psychosocial functioning and psychiatric comorbidity. Behaviour Research and Therapy, 48(3) 194-202.
Costin, C. (2007). The eating disorder sourcebook (3rd Ed.). New York, NY: McGraw Hill.
Zerbe, K. (2008). Integrated treatment of eating disorders: Beyond the body betrayed. New York, NY: W.W. Norton & Company.