What does recovery look like?

After nearly two years of focused work, with a fair share of bumps along the way, Helena has at last reached what her physician considers a healthy weight for her frame. She is eating nutrition-rich meals and hasn’t resorted to her trusty elliptical machine to ward off anxiety about donuts or job layoffs in more than a year. She has reconnected with the friends who, two years ago, told her that they felt disconnected from her, that they just couldn’t “get in.” Tonight they’re heading out to karaoke, an activity Helena used to adore because she could show off her powerful chops.

Would you call Helena recovered? In recovery? Partially recovered? Still in the grips of an eating disorder?

Think about that for a moment.

Now, would the label you assign change if I told you that Helena still counts calories almost every day? What if she only occasionally read nutrition labels – a former obsession – and only to check the amount of calcium and protein in her food? What if she still hates the way her legs look and cries regularly about not measuring up to her friends? What if instead she doesn’t hate the way that she looks, but is cautiously proud of her body – harboring fear, however mild, that her weight could shoot up? What if her food and weight obsessions were gone, but her perfectionism had translated into other areas of her life – like her work as a financial analyst?

Now what would call Helena? Fully recovered? Partially? In recovery? Nowhere close? If your label changed, think about why. On what did you base you assessment?

Assigning labels to the odyssey that is recovery is a challenge faced by clinical researchers, clinicians treating these individuals, and perhaps most significantly, individuals themselves. At the Academy for Eating Disorders international conference recently, I had the opportunity to hear Anna Bardone-Cone, Ph.D speak about her work in defining recovery.

Dr. Bardone-Cone recognized just how disparate definitions of recovery are across the literature on eating disorders. Looking at how various researchers defined recovery, we see that some do by the simple (though admittedly not so simple) restoration of weight, some by the absence of symptoms (e.g. restricting or binging), and some by more complex rubrics incorporating a person’s thoughts or attitudes. The problem is that when researchers are comparing treatments and other factors based on recovery that is defined differently, we really cannot compare at all.

There are other implications of a lack of consistent recovery definition as well. For one, individuals who struggle want to know what recovery will look like. While every single person’s journey will look different, it provides guidance and hope for individuals to understand just what they are working towards. It’s important, too, for individuals to know that recovery – full recovery, as I define it – is not simply about having a regular period (for females) or stopping their binge eating.

I am someone who believes that the idea of full recovery is real and can be attained by anyone with the right resources. These resources include a commitment to the process and a team of personal and professional support.

So what does full recovery look like? Like I said, the details might look different for different individuals, but I believe that recovery involves three main areas: physical, behavioral, and emotional. What this means is that those in full recovery are physically healthy and medically stable, are not using eating disorder behaviors, and they have developed a healthier attitude toward things like shape, weight, and food.

Does this mean that a person in recovery never bemoans the size of her thighs? Dr. Bardone-Cone says no, and astutely remarked in our workshop that we can’t expect those recovering from eating disorders to be super-people, free from the worries and concerns that are part of normal development and living in our society. We do of course hope that they have the skills to combat those thoughts when they arise, however. Occasional thoughts and concerns don’t mean a person isn’t recovered, just like occasional aches don’t mean that a person who had the flu once still has it.

Others prefer to use the terminology that is often used in circles of those who struggle with substance abuse and addictions and to refer to themselves forever as “in recovery.” Often the idea behind this semantic difference is that one will be aware and mindful of the possibility of returning to old habits in the face of stressors (as a person with a history of alcoholism might always need to be aware of the temptation to drink).  Personally, I respect any perspective on recovery that feels genuine and helpful to a person in maintaining health and happiness.

However you lay it out, the fact is that there is tremendous hope out there for those struggling with eating disorders, and for those who have struggled in the past. Despite recent press that paints a picture of recovery of elusive, it’s not at all. It’s difficult, sure. But it’s also attainable. If you’re still wondering about what recovery might look like, Aimee Liu’s new book, Restoring Our Bodies, Reclaiming Our Lives, is a fantastic resource full of first-person accounts of the recovery process.

Do you believe that full recovery is possible?

{Image Credit :: loswl}