It is that time of year again. Time for Resolutions and lists for the New Year. Tricky for a person with an eating disorder since Resolutions and lists can feel like a bucket full of expectations, ‘shoulds,’ guilt, self-recrimination and ultimately self-defeat. If recovery from an eating disorder is on your New Year’s Resolution list then trust that recovery is possible with time, hard work, honesty and commitment. It does not just happen and not the kind of thing that is usually achieved quickly.
Can someone really fully recover from an eating disorder? What can recovery mean? What does recovery in a family look like?
Recovery is different for each person. Growing up and living in a culture obsessed with body image makes it very difficult to challenge and change some of the beliefs inherited from our culture. Since culture provides the context for an eating disorder, recovery means facing the circumstances and issues in life (content) that contributed to the development of the eating disorder so that weathering the cultural ‘body image’ storm in the future is possible.
What is Recovery?
Let’s start with the data. Without treatment, up to 20 percent of people with serious eating disorders die (Kaminker 1998). This tragedy is made all the more painful given the recovery rate of those who do seek treatment. Eating disorders are one of the most lethal psychological illnesses. Anorexia has the highest incident of premature death of any psychiatric illness (Sullivan 1995). This is why it is paramount that the person with the disorder and family members seek therapy and the assistance of a physician, nutritionist, and other medical and psychiatric professionals as necessary. Medical stabilization permits psychological repair since a person who is not adequately fed or who is medically compromised cannot accurately address the psychological, biological predisposing factors and relational issues accompanying or underlying the eating disorder.
Though recovery statistics differ, the good news is that between 60 and 80 percent of people who get treatment for their eating disorders recover. That means their weight remains stable and appropriate for their height, age, body shape and size, and gender. They consume a diet of normal foods, and do not feel compelled to eat only chemically altered sugar-substitutes or low-calorie, low-fat, or non-fat foods. They are able to build and maintain both friendships and romantic relationships. They go on to higher education, professional degrees, and careers. Although I am hesitant to use the term, you might say they live a “normal life.”
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That said, it’s important to realize that recovery looks different for everyone. Recovery is a process, typically building over time. It unfolds in response to psychological awakenings, experienced emotions, communication, relational repairs, and behavioral changes. Sometimes it begins with independent insights or revelations. Sometimes the “aha” moment is triggered by the actions or reactions of a family member. In treating many people with eating disorders over the years, I have found that recovery and the exact circumstances that spurred the recovery seldom are the same.
Does Full Recovery Exist?
In some cases, people make what you might call a “complete recovery.” Their eating behaviors resolve and they do not have any triggers or trigger foods that tempt them to resume their behavior. However, this happens in a minority of cases. Many variables need to be aligned and there is not a script someone can follow to get to full recovery. I can tell you that in my experience, commitment to full recovery, despite the often tempting and seductive cultural messages regularly bombarding one’s senses, is difficult. Making the decision to eat normally every day takes emotional courage in its inherent vulnerability. Deep self-love, trust, and the desire to live freely are the fuel of recovery.
Other recovery scenarios are more likely, and these scenarios do not mean recovery is any less successful. For example, some who recover may cease vomiting, but cannot keep any trigger foods in their house for the rest of their life. Others may cease vomiting but, under certain conditions or during emotionally charged situations, avoid foods that will likely trigger a binge-purge episode. Are these people recovered? I say yes, absolutely!
How Does Recovery Unfold?
Recovery is not black and white. It doesn’t mean simply shutting down the eating disorder. Recovery means knowing what you need in life to go forward and to maintain your capacity to fully experience life and relationships. The benchmarks for recovery are having a healthy relationship with food, connecting with other people in healthy relationships, knowing your limitations, and honoring your feelings. Believing that there is some “perfect” form of recovery generally does more harm than good.
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Eating disorders represent, among many things, a belief that perfectionism is the only acceptable outcome in life. Recovery, then, represents the awareness that perfectionism is merely a protection against feelings of vulnerability — typically and unfortunately referred to by people with eating disorders as “weaknesses.” Just as it’s essential to learn how to integrate and even celebrate both positive and negative emotional experiences, it is also essential to come to terms with the necessary compromises that make a “recovered life” possible. In time, these compromises will no longer feel like defeats, but rather bring a sense of well-being and joy.
Perhaps if something is needed to be a New Year’s Resolution for eating disorder sufferers seeking recovery, I would say, patience and honesty; two incredibly useful qualities for the sufferer to strive for and invaluable to the therapist who needs all the facts to be the most helpful and competent in the recovery process.
