Eating Disorder Recovery
The Eating Disorders (ED) field has not yet come to a consensus as to what defines ED recovery. This is in contrast to medical disorders, where there is a clear goal (e.g., remission of cancer), or other psychological disorders, where recovery is defined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria (e.g., remission of depression). DSM 5 criteria for EDs does not include remission, so there is no “gold standard” definition. In addition, many cognitions, behaviors, traits, and impairment aspects of EDs are not captured in the DSM 5 criteria, so it is hard to measure recovery when these may not have been assessed initially.
When there is a lack of conceptual clarity on recovery, this leads to a lack of consistent measurements of recovery, various research designs encompassing different definitions of recovery, and contradictory interpretations of the results of such research on recovery.
Suggestions for recovery definitions from the research literature thus far have included:
- Number of years with no DSM 5 ED symptoms (typically at least 1 year, or more).
- Restoration of body weight to a standardized minimum threshold (typically BMI, or IBW).
- Absence of ED behaviors (typically assessed by self, family members, professional team).
- Absence of ED cognitions (typically assessed by self).
- Improvement in quality of life (typically assessed by self, family members, professional team).
Part of the difficulty with these definitions is that each aspect in and of itself is a moving part. Recovery from EDs is not linear, with all aspects continuing to improve together over time. Indeed, many people initially recover from the physical symptoms of EDs, but may still have the psychological symptoms of the EDs linger for years.
There are some people who accept “recovered enough,” in that they recognize that they still have some ED symptoms, but they feel that they have improved overall, and the remaining symptoms are manageable. There are others who believe that “full recovery” is possible, though. While this instills hope, the definition is still ambiguous, and therefore, the goal.
Clinicians such as Carolyn Costin have proposed their own definitions of recovery, which focus less on quantifiable measures (e.g., number of years, standardized body weights), and more on conceptual freedom from ED symptoms (e.g., not worrying about food, enjoying relationships). These types of definitions of recovery are therefore more subjective vs. objective, with the recovered individual being the ultimate authority and judge as to their degree of recovery.
Usually, researchers/clinicians are the ones who are empowered to define the disorders, and therefore, the recoveries. The ED field would do well to listen to individuals describe their own experiences with the illnesses, as well as what recovery means for them. In this way, we may be able to move closer to a consensus definition that actually reflects the lives of those with EDs.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
De Vos, J.A., LaMarre, A., Radstaak, M., Bijkerk, C.A., Bohlmeijer, E.T., Westerhof, G.J. Identifying fundamental criterial for eating disorder recovery: a systematic review and qualitative meta-analysis. Journal of Eating Disorders (2017) 5:34.
Carolyn Costin Recovery Definition:
“Being recovered is when a person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale. When you are recovered you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.”
Heather Hower Personal Recovery Experience:
I had Anorexia Nervosa for 23 years, and I have been in recovery since 2012. When I woke up on the day of my "new reality," I knew that I could not continue on the path of listening to "ED (Eating Disorder)," as it had been a roller coaster of restriction, over-exercise, and emotional turmoil with those who loved me. The "essential me" knew that I needed to save myself (from ED). Working with my doctor, therapist, and nutritionist (my professional "support bench"), I learned how to hydrate and fuel my body, growing to trust it would tell me when I was hungry and full, and that it would make up for my mistakes. I had a lot of momentum in my recovery at first, and then I realized that I needed to maintain a pace that was sustainable (life is a marathon, not a sprint). There were times that I felt like I was on the cusp of giving up, but I pushed through, and the reward was that I became healthier and happier. I am in recovery for my loved ones (especially my husband), but most importantly I am in recovery for ME. There are many benefits to living without ED, but the driving one for me is a sense of sanity (it is priceless). I am seeking a balance; not too little or too much of anything, and when I am there, I am in my "sweet spot." Throughout recovery I have been further discovering my identity, the things that make me happy; I am really excited about moving away from ED, and focusing on the "essential me."
About the Author: Heather
Heather, MSW, LICSW, QCSW, ACSW has served on the Board of the National Eating Disorders Association (NEDA) since 2013, and collaborates with her NEDA colleagues on Eating Disorder research studies, papers, and presentations. Through her position at Brown University Department of Psychiatry and Human Behavior, she has also been collaborating with her local Rhode Island Hospital/Hasbro Children’s Hospital Eating Disorders Partial Hospital, Outpatient, and Home-Based clinical programs since 2013. Heather had Anorexia Nervosa for 23 years, and has been recovered since 2012.