Eating disorder recovery
Recovery from an eating disorder is a long process which requires specialist, effective treatment, consistent support and time. It is important to recognise eating disorder recovery is achievable. Many people recover fully from anorexia or bulimia and feel their eating disorder is firmly part of their past. For others, some difficulties remain, but to a lesser extent than the original eating disorder.
In this article, we consider the key elements of sustained, long term eating disorder recovery. We consider some of the specific features of an anorexia recovery and bulimia recovery, together with work such as a relapse prevention plan which are essential for all forms of eating disorder recovery. We consider how long it may take to recover from an eating disorder, discussing the different stages involved and key elements of treatment.
Anorexia treatment and recovery
In anorexia treatment, the first stage will focus on stabilisation and weight restoration. If an individual is severely underweight, they will not have the cognitive capacity to undertake the psychological or educational work involved in anorexia treatment. The first phase of treatment must focus upon re-feeding and weight restoration, together with early motivational work.
More complex parts of treatment, such as body image work and psychological therapies, can only effectively commence when weight is restored, or close to being restored, so an individual is better able to think, process information and start to manage emotions. This second stage is where treatment can be challenging, for example work to help the individual accept their body at a normal weight and reduce body image distress. One to one therapy will seek to understand the different causes of an individual’s anorexia and how this understanding can be built into treatment and relapse prevention.
The third stage of anorexia treatment is focused on maintaining a healthy weight and developing a relapse prevention plan. A study by Berends et al (2016) shows that a personalised relapse prevention plan does reduce levels of relapse after anorexia treatment. With a personalised relapse prevention plan, they found 11 per cent of the participants experienced a full relapse, 19 per cent a partial relapse and 70 per cent did not relapse. This compares with reported general relapse rates of 35 to 41 per cent.
When we consider these statistics around eating disorders recovery, it is important to keep in mind other known parameters: the sooner an eating disorder is diagnosed and effective treatment commenced, the greater the prospects of a full, sustained recovery. Eating disorders relapse rates tend to be higher in adult populations than in child and adolescent patients (Carter et al, 2012).
Bulimia treatment and recovery
Unlike anorexia, which may require inpatient treatment, bulimia is almost always treated without hospital admission, in community services. Broadly, recovery from bulimia may occur more quickly than anorexia (programmes are typically 20 weeks, with therapy for one or two hours per week), using a Cognitive Behavioural Therapy approach. Treatment is based on building understanding of the triggers for the binge, purge cycle and developing healthier ways of managing difficult feelings.
It is perhaps surprising then, that some studies suggest similar relapse rates for bulimia as for anorexia (30 to 40 per cent, two years after treatment). However, there is ongoing debate about the definition of a relapse in bulimia. This is sometimes defined as two episodes of binge and purge within a month. Some experts argue this is too narrow and patterns would need to be repeated over three consecutive months to equate to a full relapse.
The importance of a relapse prevention plan
For all types of eating disorder recovery, a relapse prevention plan is essential. A relapse prevention plan will consider what are the particular risks and triggers for the individual and how might these be addressed. It will consider their personal support network and environment, for example, how to address risks if the individual is moving away to university. An effective relapse prevention plan needs to be highly personalised: for example, an individual may enjoy sport, but compulsive exercise may have become a symptom and maintaining factor in their eating disorder. Their relapse prevention plan would need to encompass how they can enjoy exercise in a safe and enjoyable way and recognise if their exercise pattern is becoming unhealthy and compulsive again.
A relapse prevention plan needs to consider what actions need to be taken if triggers are identified. This needs to recognise personal circumstances: for example, a teenager who has been treated for anorexia may avoid talking to parents about concerns because of fear they will worry they are becoming ill again; they may be tempted to hide any difficulties they are experiencing. However, it is important to plan who they will talk to and what they would do if they experience a recurrence of anorexic feelings or behaviours.
Recovering from an eating disorder
Studies suggest that the time of greatest relapse risk is four to 18 months after treatment. As a specialist unit for children and adolescents, at Schoen Clinic, we recognise that for our patients, once they are discharged, they enter the increased risk of relapse phase at the time when they may also be leaving home to go to university. What this means, for each individual, will vary according to their needs and risks, but in some cases, a gap year may be helpful, or certainly planning which recognises the relapse risk in this early phase after treatment.
There can also be a long period of time between treatment and recovery, with symptoms returning at a much later stage. For example, a person who developed and recovered from bulimia during their twenties In bulimia recovery, an individual may experience no symptoms for many years but find a stressful life event, such as the death of a partner or friends, triggers a return of the binge purge cycle.
Vigilance, therefore, is important, even at a stage when an individual may feel their eating disorder is a thing of the past. In common with the initial development of an eating disorder, anyone experiencing a relapse, or symptomatic feelings, should seek help as soon as possible so that support and treatment can be put in place.
Carter et al, (2012). A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res. 2012; 200:518–23.
Berends et al (2016) Berends et al. (2016) Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study BMC Psychiatry 16:316 DOI 10.1186/s12888-016-1019-y
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Schoen Clinic Newbridge offers highly specialised inpatient treatment for children and young people (8-18 years) and a specialised outpatient service for young people (12-25 years) experiencing eating disorders and their associated problems. Welcoming NHS and private patients.
Schoen Clinic Chelsea
Schoen Clinic Chelsea is a leading London outpatient clinic in the heart of Chelsea.
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Schoen Clinic York offers highly specialised inpatient treatment for adults (18 years +) with diagnosed eating disorders and their associated problems.
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