Eating disorder recovery is a complex process that typically requires each client to progress through five stages. To have a diagnosis of an eating disorder implies that an individual’s life will experience significant, disruptive changes and a need for treatment over a period of time. Treatment for eating disorders usually improves and speeds recovery, however, someone who carries an eating disorder diagnosis should expect there to be a significant amount of time and several stages as they move towards recovery.
It is important to reiterate that these stages are general and each individual’s experience will be unique, but there are some common experiences and needs we see across individuals recovering from eating disorders.
The first stage of recovery is the stabilization of physical health, to the degree necessary. During this stage and the second stage, residential treatment or intensive day programming may be recommended in order to improve health and medical stability or to interrupt eating disorder behaviors that pose a high risk to health.
Following, and sometimes concurrent with, the stabilization of physical health, the second stage is the cessation of eating disorder behaviors and weight restoration. It is important to know that weight restoration is thought of in terms of restoring health and weight stability, not just in weight increase or decrease. Clearly, the cessation of eating disorder behaviors and weight restoration will have different meanings based on the specific eating disorder diagnosis.
For those individuals who have had a weight pattern that has moved in multiple directions, it can be difficult to identify what a healthy, peaceful weight may be for the individual. The first step in this process of understanding is to try to gain some level of weight stability so that the process of behavior cessation can occur.
The question of where someone’s weight “should” be is complex and requires multiple factors to be carefully considered by the multidisciplinary team, client, and family. It will likely take a significant amount of time, possibly years before one knows where one’s weight will end up once eating disorder behaviors have ceased. Given the complexities with weight, in this stage, we are primarily looking for an individual to be at a weight that will allow for progress into the next stage of recovery, the cessation of eating disorder thoughts and feelings.
This third stage of recovery, the cessation of eating disorder thoughts and feelings, may extend for a significant amount of time. As a general rule, the longer one has suffered from an eating disorder, the longer this stage of recovery may take. During this, intensive outpatient care or outpatient care is often recommended. Care in this stage is focused on continued health improvement. Individuals will work on skill development for the management of thought patterns and urges related to eating disorder behaviors, while also developing a supportive community.
The fourth stage of recovery is the prevention of relapse. Anyone who has been recovered from an eating disorder carries an awareness that they have had a serious illness. Like all serious illnesses, it is crucial to take steps to be protected against the illness returning. Outpatient care is often recommended during this time as well as the further development of skills and support systems needed to remain healthy.
The fifth and final stage of recovery is the appreciation of the recovered state. This stage includes the awareness of the strength and fragility of one’s recovered state and the ongoing development of a community to protect, support, and help in continuing to live a meaningful life.
While a person’s progression through the stages of recovery may be unique, the general stages are similar. Across eating disorder diagnoses, from OSFED (Other Specified Feeding and Eating Disorders) to ARFID (Avoidant Restrictive Food Intake Disorder) to Anorexia Nervosa (AN) to Bulimia Nervosa (BN), to Binge Eating Disorder (BED), there will be variations within the stages and not all individuals will spend time in each stage
If an individual relapses or goes back in the stages, it is crucial that the individual gets out of the relapse as quickly as possible. This may mean stepping up to a higher level of care quickly in order to get out of relapse. This part is complicated because, in general, once a person has been to treatment and can feel themselves being pulled back to their eating disorder, the initial impulse may not be to step up to a higher level of care. However, lower levels of care may not be as effective at treating the behavioral aspects of eating disorders, particularly in relapse situations.
We would like to think that full recovery from an eating disorder is possible for everyone. However, we do know that many people who wait to start treatment tend to struggle more in recovery. Research indicates that the shorter the amount of time an individual has been ill often corresponds with the amount of time it takes the individual to get through the stages of recovery. Despite this, there is no reason to not be hopeful, regardless of when an individual seeks treatment. Eating disorder research has only recently started to delve into questions related to patients who have been ill for long periods of time and what their specific needs are, but that research is growing and we are hopeful for the future. We believe that full recovery from an eating disorder is possible—many of our staff know recovery is possible from their personal experience with an eating disorder—and we believe in you.
Mark Warren is the chief medical officer of The Emily Program. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the national Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.
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