How To Define Recovery From An Eating Disorder (May, 2015)
How will I know when I am “recovered” from an eating disorder? That’s a question I frequently hear from clients who have embarked on a long journey to achieve a healthy relationship with food and a positive body image. There are many factors that need to be considered before a patient is recovered or “disease free.” My colleague and friend, Dr. Edward P. Tyson, has written a wonderful article on the topic, recently published in The Renfrew Center Newsletter Perspectives. I am reprinting the article below with his permission. Dr. Tyson has specialized in the assessment and treatment of eating disorders for over 25 years.
For a patient to be recovered from an eating disorder, the following are essential considerations:
1. As a physician, I would answer this similarly to how I would declare someone “cancer-free”. That means no remnants of the disease exist in any aspect or are they likely to return and additional treatment is not considered worthwhile. The full treatment team has to agree that treatment for the eating disorder is no longer needed.
2. The patient must also agree that the eating disorder is no longer occupying any aspect of her or his life, be it physical, emotional, or social. This does not mean the patient cannot have other psychological or physical problems separate from the eating disorder.
3. Competent medical assessments must be done for much of the treatment phase, including at the end of treatment. This is probably the weakest link in most treatment teams as there are few physicians who are trained in medical care of eating disorders. But, it is still necessary to ensure safety and the status of “recovered”. I am not saying that just because I am a physician, but because the medical issues in eating disorders can be both dramatic and subtle any aspects that have the potential to rekindle the eating disorder need to be completely obliterated.
4. Incorporating exercise is a must as it is part of a healthy lifestyle. A recovered patient has learned to incorporate exercise and has done so in what the treatment team believes to be a balanced, appropriate manner. If the patient is a competitive or professional athlete, there is a consistent pattern that the increased demands of the sport have been met nutritionally, physically and emotionally.
5. There are no longer any precautions or restrictions in place, such as limited hours at work or school. Adaptation to those environments is complete.
6. The patient does not obsess about weight, food, exercise, or appearance and does not have distortions about “fat” on their body or about any aspect of their appearance. This, of course does not mean that they do not have fat or even a substantial amount of it. It is that they no longer have noticeable distortions about that fat or body appearance.
7. To be declared “disease free” or “eating disorder free”, the patient needs to be followed by the treatment team for approximately two years, during which time there has been no evidence of eating disorder behaviors or attitudes and the full demands of everyday life are being met. Having observed patients who remained well and eating disorder-free, two years represents a reasonable and appropriate period of time.
8. I do not include “being at “ideal” body weight.” That is because weight is such an individualized measure and no one can reliably predict exactly what weight is “ideal” for a given person (guess can be pretty reasonable, but this is about being recovered, not being better). Recovery is so much more than a measure of gravitational force.
Being recovered is much less about weight per se and more about what weigh now means to the sufferer. Other physical indicators are much more reliable, including vital signs and physical exam and these much indicate normalcy.
Finally, a patient must not be afraid of her or his own weight and must not refrain from getting weighed. S/he must be able to be weighted without trepidation and the number on the scale needs to be interpreted in an appropriate manner. For example, if a patient with an eating disorder also has congestive heart failure, an increase in weight may indicate excessive fluid buildup. The concern is not being too big or being overweight in the usual sense, but rather having a worsening medical issue.
9. For an illness as serious as an eating disorder to be eliminated from one’s existence, there needs there needs to be some powerful sense of gratitude, acceptance and perspective. When a patient declares to me, “The worst thing that ever happened to me is now the best thing that ever happened to me,” then I am highly confident that that person is unlikely to return to the eating disorder.
They stated, in so many words, that God had given them the eating disorder as a gift and without it they would never be in such a positive place as they are now. “As hard as it was, I hate to think of where I’d be if I had not gone through my treatment and recovery. I never want to go back to that life again.” In short, my patients recognize that it took an eating disorder to push them to face the issues they had to face to have a happy, full life.
I believe Dr. Tyson all the aspects that must be addressed and worked on through the minimum two year period. From my experience the client who is recovered in a two year period has a supportive family, and makes recovery the top priority in his/her life. Research shows those who do not prioritize take seven to ten years and the rest die.
Edward P. Tyson, MD has specialized in eating disorder treatment for over 25 years. He is the co-author of AED’s Medical Guide for Eating Disorders with a worldwide distribution of 100,000+ copies. He authored a chapter on medical assessment for “Eating Disorders-Bridging the Research-Practice Gap” and has developed legislation mandating insurance coverage for EDs in Texas. A member of AED’s (Academy of Eating Disorder) Advisory Board and Austin Foundation for Eating Disorders, Dr. Tyson also teaches medical, nursing students, graduates and undergraduates at the University of Texas.
References
1. Tyson, Edward. “Perspectives” A Professional Journal of the Renfrew Center Foundation, summer 2014, 10-11.
