Judy Scheel Ph.D., L.C.S.W., CEDS

When Food Is Family

Eating Disorders

Crossing the Divide: Eating Disorder in Full Recovery

Is full recovery possible and, if so, are there specific contributors?

Posted Dec 04, 2018

The moment of knowing that the time is right for change; the decision to stop being symptomatic is, for some individuals, a gradual process of non-linear progression. For others, it is the one quick moment of recognition that,  “I am done,” or “I have had enough.”

Whatever the fast trajectory or protracted process, those who are able to find their way or commit to full recovery are rare.  Many stay tied to one form for another of symptomatic behavior, ritual or worry and dissatisfaction about body size, weight, and shape.  Research varies. General understanding has been than 50 percent of people with eating disorders recover, but the degree of recovery within that percentage is ambiguous.   More current research puts recovery prevalence higher for improvement, but stops short of making claims or having statistical proof regarding full recovery.  And, most see recovery on a spectrum so that full recovery is at one extreme end.   

What does full recovery look like? 

Full recovery means a return to normal eating and weight.  It also means that healthy cognition returns:  judgment, perceptions, reasoning about body size and shape become realistic as the body’s functions return to normal and the brain is fed.  The ability to do the psychological work can occur when cognitive processes are well and fully functioning.  

When the eating disorder has been used as a metaphor (“voice”) for psychological and relational unrest, conflict and pain, recovery means the resolution of these underlying conditions so that fulfillment and satisfaction are found outside of the eating disorder.  Often, this is a protracted and costly process.  

Family therapy dismantles the use of the eating disorder as a control, stronghold, or physical manifestation of emotional pain and anger for the sufferer.  Communication, acceptance of responsibility, understanding, respect, and empathy among all family members take the place of symptoms and familial fear and despair.  Resolution of eating disorder and often other relational issues is part of full recovery. 

Normal Caveats 

Clearly, our culture plays a role regarding standards of beauty and has an effect on perceptions of even the most secure and psychologically stable individuals.  It is difficult to always feel great when images of the ideal body flash constantly on one media forum or another.  Questioning one’s body within a culture steadfast in its attempt to devalue many people for body size and shape is bound to happen.  

Also, within the parameters of recovery is a grey zone where healthy eating and normal body size and weight are achieved and where underlying issues are mostly addressed.  What also remains in spectrum recovery,  however, are the worrisome thoughts about food, weight, and body, internal and relational struggles continue and the very real possibility of relapse exists.   

What compels and commits some people to move toward full recovery?  

Those who commit to full recovery, in my experience, have made a decision, consciously or unconsciously, that they are ready to let go and move forward.  Though many express fear about the future and often cannot conceptualize how life can be fulfilling, they often convey that they feel relief from the constant food rituals and obsessional thoughts.  When the sense of relief subsides, what comes next is often fraught with confusion and the road ahead often feels difficult and risky.  

Depression looks back at loss and sadness.  Anxiety projects forward about future fears.  My experience among those who have fully recovered is that they have acknowledged the impact of historic loss and future fear.  As a result, they are able to integrate sadness as an acceptable part of their life experience; they face the future with opportunity and enthusiasm versus fear. 

Though histories and difficult or traumatic life experiences remain woven in to the viscera of individuals with eating disorders, resiliency trumps for those who recover.  

I have wondered about resiliency.  Why do some with traumatic histories of abuse and/or neglect rise above and eradicate years of complex and ritualized eating disorder symptoms and behaviors? What enables them to do so?    

What underlies resiliency? 

I have seen how intellect, competitive natures, solid social and relational supports, belief in divine intervention for some or inexplicable 'will' for others, career opportunities, pregnancy, and the birth of children have all contributed to fueling, if not creating, resiliency.    

For those individuals with whom I have had the privilege to see achieve full recovery, it has been their capacity to accept sadness and loss, allow for fear, but maintain a “move forward anyway” mentality combined with good old fashioned competitiveness (“I can do it” mindset) that underlies their thinking and motivation.