What Does Recovery Mean?
The question of what constitutes recovery from an eating disorder is one that has been debated in many places by many people. Providers, families, and clients often have different perspectives, and there is a wide spectrum of beliefs within each of these groups. A key reason for this is that eating disorders have distinct physical and psychological manifestations.
The physical manifestations of eating disorders are usually what drive people to the highest level of care. That is because these manifestations often carry an immediate risk to one’s physical health and require intensive clinical support. Recovery from physical manifestations is very important, but it does not constitute full recovery.
There is a word that is commonly used in healthcare settings—particularly for illnesses like cancer—that may be more appropriate for describing the physical and weight aspects of eating disorder recovery. This word is “remission.” When a person is out of physical risk and has stopped engaging in eating disorder behaviors, they’re in remission. But neither I nor most other people would think that’s in any way sufficient to be recovered.
In general, eating disorder recovery includes five stages. Physical stability and weight restoration precede psychological improvement. Once a client’s physical health and weight stability are restored, they work toward psychological improvement to the point where their eating disorder is not the dominant feature of their mental and emotional experience.
Clearly the latter stage is difficult to define since the criteria are so subjective. But when most people say they have recovered from an eating disorder, they do in fact focus on the behavioral and psychological aspects of the illness. They talk about normalized eating and healthier attitudes toward food and body. For this reason, I tend to think that the word “recovery” really does refer to the behavioral and psychological aspects of the illness.
People who are recovered are able to eat out, to enjoy food with friends and family, to eat a varied diet, and to not have thoughts about food and body interfere with their daily functioning. They experience a full range of emotional states that are not food- or body-based, and they do not allow body concerns to define their sense of wellbeing. People in recovery are able to transition from any food and body issues to other areas of their life in a smooth, easy way.
Recovery, therefore, is highly subjective and difficult to measure. This fits with most psychiatric diagnoses, including depression, anxiety, and PTSD. People with multiple other psychiatric diagnoses look to quality of life and freedom from their disorder to consider themselves recovered.
For many people, recovery will remain a process throughout their entire life. For some, it will be something they think about frequently; for others, they may think about it very infrequently. For most, the traits that are associated with risk for an eating disorder, perfectionism, persistence, attention to detail, impulsivity, high-noticing, and the like, will continue to be an integral part of who we are, but the eating disorder behaviors once hijacked by these traits can resolve. We are none of us without pain and managing our experience in the world as humans continues on. It is too high an expectation that everything about our relationships with food and body will somehow disappear and no longer be of import once we have suffered from these disorders.
Recovery does not mean a perfect relationship with food and body. Recovery means the ability to accept ourselves and make peace with food and our bodies so that our lives are rich with experiences, opportunities, and connection.
ABOUT THE AUTHOR
Mark Warren, M.D.
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.