Most people with eating disorders, especially in the beginning, resist treatment and behavior change. They cling to the illusion that if they just lose enough weight, they will feel good about themselves, improve their lives, and enjoy self-confidence and success.
After a while, however, they begin to understand that the supposed benefits of thinness are only an illusion that will never bring them happiness. Starving, stuffing, purging, and other self-destructive behaviors will never lead to peace and a meaningful life. When people get to this point ,and when they begin to look for better ways to build meaningful lives, recovery becomes a real possibility.
Unfortunately, even then there are obstacles to progress. Between 20 and 30 percent of people who enter treatment drop out too soon and relapse. Even those who stick with it can have lapses and slips, leaving them discouraged and demoralized. Wanting a quick and easy solution to their problems, they too often give up when they find that recovery can take many months, even years, of hard work before they are free of their destructive behaviors and have resolved the underlying issues that led them to starving and stuffing in the first place.
- Is recovery possible?
Yes, eating disorders are treatable, and lots of people recover from them. Recovery, however, as noted above, is a difficult process that can take seven to ten years or even longer. Some people do better than others and make faster progress. The folks who do best, work with physicians and counselors who help them resolve both the medical and psychological issues that contribute to, or result from, disordered eating. (Int J Eat Disord 1997; 22:339 and Eating Disorders, 2000; 8:189)
About 80 percent of people with eating disorders who seek treatment either recover completely or make significant progress. Sadly, the rest remain chronic sufferers or die.
- What is recovery?
Recovery is much more than the abandonment of starving and stuffing. At minimum it includes the following:
- Maintenance of normal or near-normal weight
- In women, regular menstrual periods (not triggered by medication)
- A varied diet of normal foods (not just low-cal, non-fat, non-sugar items)
- Elimination or major reduction of irrational food fears
- Age appropriate relationships with family members
- Awareness of cultural demands for unrealistic thinness
- One or more mutually satisfying friendships with healthy, normal people. Such friendships involve mutual give-and-take and a minimum of caretaking and "parenting" behavior.
- Age-appropriate interest and participation in romantic relationships
- Strong repertoire of problem-solving skills
- Fun activities that have nothing to do with food, weight, or appearance
- Understanding of the process of choices and consequences
- Person has a sense of self, plus goals and a realistic plan for achieving them. Is moving towards building a meaningful, fulfilling, and satisfying life.
- Person has also learned to be kind to self and others, forsaking perfectionism and confronting flaws and disorder with grace and understanding. Person refuses to drive her/himself with criticism and demands for unrealistic performance.
- What is the best treatment for an eating disorder?
Because many factors contribute to the development of an eating disorder, and since every person's situation is different, the "best treatment" must be custom tailored for each individual. The process begins with an evaluation by a physician or counselor. Recommendations include any or all of the following. In general, the more components included in the treatment plan, the faster the person makes progress.
- Hospitalization to prevent death, suicide, and medical crisis.
- Weight restoration to improve health, mood, and cognitive functioning. Note: An anorexic's fear of weight gain, especially forced weight gain in hospital, is a huge obstacle to treatment and recovery. Nevertheless, it is clear that the closer to normal weight is at the end of treatment, the better the chances of complete recovery. In study after study, low body weight is strongly correlated with treatment failure and relapse.
- Medication to relieve depression and anxiety
- Dental work to repair damage and minimize future problems
- Individual counseling to develop healthy ways of taking control of one's life. Cognitive behavioral therapy (CBT) has proved effective in treating bulimia and binge eating disorder. The counseling of choice for anorexia is determined by individual and family circumstances.
- Group counseling to learn how to manage relationships effectively
- Family counseling to change old patterns and create healthier new ones
- Nutrition counseling to debunk food myths and design healthy meals
- Support groups to break down isolation and alienation. However, support groups by themselves are not sufficient treatment for an eating disorder. To be effective, they must be integrated into a comprehensive treatment plan.
- How long does it take to recover?
A few people who refuse professional treatment do eventually recover, but it may take several years, even decades. Most make little or no progress without help. Up to 20 percent do not survive.
People who do get into treatment, and stick with it, in general do much better. About half recover completely. Another 25 percent make significant progress. Unfortunately, the last 25 percent remain chronic sufferers, even with treatment, and a few die from consequences of their disordered behaviors.
With treatment, a few people recover in a year or less. For the vast majority, though, treatment and the recovery process take three to seven years, and in some cases even longer. Recovery takes however long it takes. For most people, changing entrenched food behaviors and resolving the issues that underlie them is a formidable challenge, perhaps the greatest challenge they will ever face.
Usually treatment is more intensive at the beginning: several therapy sessions a week and perhaps even hospitalization. As progress is made, sessions are scheduled less frequently until, at the end, there may be only two or three a year.
Relapses, especially in the beginning, are to be expected. The person learns to cope with life without depending on food and weight manipulation but then encounters a problem. The new coping skills are overwhelmed, and the person, feeling frantic, resorts to old familiar patterns: e.g., binge eating, starving, or purging. A common scenario involves a person receiving some treatment, leaving, being successful for a while, relapsing, and then returning to treatment. The cycle may be repeated several times before recovery is stable. There should be no shame in these lapses. They are learning experiences that point out where more work needs to be done.
An outcome study at Rogers Memorial Hospital in Wisconsin indicates that in the case of anorexia nervosa, the longer the person remains in a hospital program, and the closer his/her weight is to normal at discharge, the greater the chances of long-term, stable recovery. If you want a copy of the study, call 1.800.767.4411, extension 309.
- Where to find help
Finding a counselor, physician, and treatment team that you trust, and with whom you can work effectively, is an important part of the recovery process. Here are some tips to get you started.
- If you are in crisis, go to a hospital emergency room or call a crisis hotline. Find the number in the yellow pages under "Crisis Intervention."
- If you are not in crisis, ask your family doctor for an evaluation and referral. Don't let embarrassment stop you from telling the physician all the details. Doctors, nurses, and counselors have heard the eating disorder story many times before.
- You can also ask people you trust, and who have been in your situation, for the names of physicians and counselors they found helpful.
- If you are a student, check with the school counseling center. Services may be low cost or free.
- If your income is limited, or if your insurance will not cover treatment for eating disorders, look for community service agencies in the "Counselors" section of the yellow pages. The organizations listed there may not provide formal eating disorders programs, but they do offer basic assistance to people who have few other options.
- If you believe your insurance company is declining payment of a legitimate claim for eating disorders treatment, you may want to speak with an attorney. Sometimes insurance companies are open to negotiation, but unless you know how to do this, we recommend you let an attorney handle it for you. These discussions do not always lead to payment of claims, but some families have had success with them.
- Questions to ask a potential counselor
Your therapist or counselor will, in a sense, be your employee. You, or your insurance company, are paying him or her, so you might as well shop around for a good fit. If you want to work with someone who is warm and understanding, don't pick a person who works primarily in a corporate setting in problem-solving mode. Likewise, if you are ready for an action plan, you may not want a counselor who spends a lot of time examining feelings and emotions. The following are just some of the questions you can ask your potential "employee."
- What is your treatment approach?
- What can I expect to happen during sessions?
- How much experience have you had working with people who have EDs?
- What are your training, education, and licenses?
- How long do you think treatment will take?
- How often will we meet?
- If I think I need to, can I call you between sessions?
- What are your thoughts about using medications in the treatment of eating disorders?
- Could I be put in a hospital against my will? (This is a common fear. Get the facts at the beginning so you will know what to expect.)
- How much do sessions cost? Do you take insurance? What if my insurance will not cover all the costs of treatment?
- If I don't think I'm improving fast enough, I may feel like either you or I am failing. What can I do if that happens? (Be sure to ask this one. Don't just drop out if you get discouraged. Overcoming "stuckness" in treatment is a major victory.)
Best wishes as you continue your journey to health and happiness. You deserve a lot of credit for what you have already accomplished. ANRED is cheering you on.
Please Note: ANRED information is not a substitute for medical or psychological evaluation and treatment. For help with the physical and emotional problems associated with eating disorders, talk to your physician and a mental health professional.
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