By Katrina Dever.
A question I am often asked by my clients and their families is – can a person ever truly and fully recovery from an eating disorder? I am also struck by the fact that many of my clients tell me that they have never known anyone who has recovered from an eating disorder. So part of my aim in writing this is to give hope to those with an eating disorder. I want to explore what being recovered looks like and how you can move towards your own full recovery in your own life.
To begin with I have had a family member and previous clients who have truly and fully recovered or are well on their way to being fully recovered from their eating disorders. Recovering from an eating disorder is different for everyone. Recovery is often a slow process and it can take several years to become fully recovered. Eating disorders are complex and the process of recovery is multilayered. Therefore some people continue to live with mild symptoms, and a smaller portion of people live with chronic symptoms7. In general recovering from an eating disorder involves overcoming complex physical, mental and emotional barriers in order to restore normal healthy eating habits and healthy thoughts and behaviours. The process of recovery can cover a range of areas such as eating and food behaviours, physical activity and exercise, attitudes and beliefs towards food and weight, body evaluation, psychological recovery, emotion regulation, social relations and addressing comorbid mental health issues5.
Being recovered is often referred to as being symptom free whereby the person is no longer meeting diagnostic criteria for a specific type of eating disorder (i.e., Anorexia Nervosa, Bulimia Nervosa, Binge eating Disorder). However like many other health professionals in the eating disorder field I believe full recovery is more than just being symptom free. It is about also about living a full and meaningful life. Feeling what is going on for you and not running away from the pain. Knowing that you can face the challenges that life presents and not turning to the eating disorder to cope. Recovery means accepting your body size for it natural size.
Carlyon Costin, a renowned therapist who has recovered from her own eating disorder views recovery as the following:
- “Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul (healthy self) to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviours to deal with, distract from, or cope with other problems” 1
I also wanted to share a few quotes from I clients I have worked with in regards to their views on recovery.
- “Going out into the world and making healthy-self decisions that reflect my values and goals” Anonymous.
- “Knowing who I am, knowing what brought me to the eating disorder such as my sensitivity, perfectionistic traits, and struggles in my life and knowing what keeps the eating disorder away. That is, knowing I am worth more than my physical appearance, and it is just one part of me. For me, it is accepting my imperfections and not letting my fear stop me from trying” K.G.
- “Choosing life rather than the ED” Anonymous.
As you have been reading about others views and experiences of being recovered – I am wondering what is your definition of recovery? What has your experience been so far? Is it to manage your symptoms, to be symptoms free, live your life in line with your values, have acceptance of your body’s natural size and shape, or being able to eat to your appetite? Spend a moment and write down what your thoughts are. You may want to explore this with a therapist, family member or friend.
Moving towards recovery….
Evidence has shown there are several areas that help someone move towards becoming recovered from their eating disorder 2-8. The following recommendations below are starting points to explore and incorporate into your life.
Increase your motivation: It is normal for someone to experience wavering levels of motivation. Often people feel torn between the eating disorder and their healthy self. However as they progress through recovery people start to make choices that are in line with the values and begin to see the benefits of living their life without the eating disorder. A helpful staring point is to list the pros and cons of changing or considering what the emotional and cost of the ED have been and what you are getting back from the ED.
Develop a strong support network: Have a team of experienced professionals in your treatment program. Your treatment team are there to support and guide you to through the enviable bumpy road of recovery. If you have found yourself isolating from friends and family – reconnect! Consider how could you reconnect and what would be one small change you could make this week.
Strengthen your healthy self: We often talk about having two parts of you – the “ED self” and the “healthy self”. When you hear the internal voices in your mind telling “you are fat and you can’t eat”, these voices come from your ED self. The ED self has its own set of rules, behaviours, feelings that are separate from your healthy self. Your healthy self is your core, the part of you that was there before the ED came along. Your healthy-self understands that you are struggling and does not criticise you. You will notice your healthy self-appear when you are able to provide reassurance and comfort to other who are struggling. One way to move towards full recovery is to strengthen your healthy self by challenging your critical ED thinking. This can be hard when you first start but with practice it will get easier and more automatic. Write down several of your ED thoughts and try writing back to each thought from your healthy self. It can be helpful if you get stuck to ask yourself how you would respond to if someone said an ED thought to you.
An example may be:
ED self – Today was tough, I just want to eat the whole chocolate cake. Nothing makes me feel as good as binging.
Healthy Self – Today was hard. I got through the day and I deserve to do something to help me relax, like yoga or a hot bath and have a piece of cake too. Eating the whole cake will feel good, or numb my feelings while I am eating it, but afterwards I will feel guilty, more stressed and worried about my eating and weight.
Develop healthy coping alternatives: Make a list of healthy coping strategies you can use when you have been triggered and or have strong ED thoughts/urges. Some examples are: Journaling, reaching out for support, creating a playlist of relaxing music and deep breathing.
Understand and express your feelings and emotions: Rather than numbing, avoiding or distracting with food, acknowledge and feel your emotions. Next time you have an urge or want to engage in an eating disorder behaviour journal about what you are feeling.
Develop self-compassion: Be kind to yourself. Treat yourself as you would treat someone you love when they are struggling. Beating yourself up just leaves you feeling worse about yourself.
Acknowledgment that recovery is not a linear process: It is expected that there will be slip-up along the way. This is normal, obtaining full recovery is a process of many ups and downs. Try viewing slip-ups as an opportunity to learn more about yourself. Explore what led to the slip up, put a plan in place to deal with it. This could be maintaining a pattern of regular eating, doing the opposite to what the ED wants, reaching out to your family and friends for support, being self-compassionate, being aware of unrealistic expectations you may be placing on yourself and try to get back on track as soon as you can. Remember, just because you had a slip-up does not mean you are not working towards recovery.
Develop greater meaning and purpose in your life: Recovering from an eating disorders goes beyond just eliminating your eating disorders behaviours, it is also about finding meaning and purpose in your life. Journal about what your values; what is important to you in the bigger picture. Write a letter to your future self in 2 years. One might reflect on what you hope for yourself and advice you would give your future self?
I hope this has helped you think about your own recovery and given you some ideas on how to continue to move towards full recovery.
1Costin, C. (2007). 100 Questions and Answers About Eating Disorders. Jones & Bartlett Learning: USA.
2Costin, C. & Grabb, G. W. (2012). 8 keys to recovering from an eating disorder: Effective strategies from therapeutic practice and personal experience. W.W. Norton & Company Inc: NY, USA.
3Fairburn. C. G. (2008). Cognitive behaviour therapy and eating disorders. The Guilford Press: NY, USA
4Kelly, A. C., Carter, J. C., & Borairi, S. (2013). Are improvements in shame and self-compassion early in eating disorders treatment associated with better patient outcomes? International Journal of Eating Disorders, 41, 54-64. doi: 10.1002/eat.22196. Epub 2013 Oct 1.
5Noordenbos, G. (2011). Which criteria for recovery are relevant according to eating disorder patients and therapist? Eating Disorder, 19, 441-151. doi: 10.1080/10640266.2011.618738.
6Rieger, E. (2008). Abnormal Psychology: Leading research perspectives. McGraw Hill: NSW.
7The National Eating Disorders Collaboration (2010). Eating Disorders Prevention, Treatment & Management: An Evidence Review. Retrieved from http://www.nedc.com.au/nedc-publications.
8The National Eating Disorders Collaboration. Understanding recovery. Retrieved from http://www.nedc.com.au/recovery