Recovery from an Eating Disorder

How do you know when you’ve recovered from an eating disorder? The answer is not so simple. The challenge of determining whether someone no longer has an illness such as anorexia or bulimia was explored in a recent New York Times article, “In Fighting Anorexia, Recovery is Elusive” by Abby Ellin. Often — and certainly by insurance companies — recovery is measured simply in terms of a physical condition: restoration of normal-range body weight and, in the case of women, menstruation. But eating disorders are more than just physical symptoms; they’re also a complex mix of sufferers’ thoughts and behaviors. People with anorexia or bulimia can reach a normal body weight yet still have the traits of someone with the disorder: They remain preoccupied with what they eat, restrict certain foods, and have severe body image problems.

Can someone whose weight is stable but who retains these other thoughts and behaviors really be considered fully recovered? I don’t think so. In the wake of the article’s publication, some eating-disorder professionals have commented that they felt the story’s tone was overly negative, leading to the impression that recovery from eating disorders is not possible. Some described patients as reacting to the article with a feeling of hopelessness. Others found it reasonable to anticipate the possibility of a return of eating disorder symptoms during a time of high stress. They agree with the comments of a doctor quoted in the article, Daniel Le Grange, who says he tells patients, “This is your Achilles’ heel.”

I myself did not find the article especially discouraging. When people leave a treatment for any kind of disorder, they often want to believe that they are done with the problem. They feel that any kind of recurrence or a return to therapy is a mark of failure. I disagree. It’s realistic to understand that in times of stress, people tend to fall back on old habits and coping strategies. The depressed person may be vulnerable to a recurrence of depression; the anxious person to a recurrence of anxiety symptoms. Similarly, people with a history of an eating disorder may find themselves returning to their old practice of restricting their calorie intake. But this does nothing to discount the value of all the intervening time in which they lived without their eating disorder. Anticipating a return to old habits, and using it as a signal for intervention, can be helpful and protective.