Defining Recovery from Anorexia
What is recovery? How does someone know if they are recovered? There are many questions surrounding recovery from anorexia, and while I am not an expert, I want to provide some information on what anorexia recovery could entail.
It is important to note that there is no specific definition of recovery from anorexia. Different academic studies define recovery in various ways for their research purposes, but there is no medical or psychological criteria used to label someone as "recovered". I've seen individuals believe that they are truly recovered and that complete recovery is possible, while other individuals believe they will have to actively work towards maintaining recovery for the rest of their lives. I personally feel like I still have to work to make sure I never slip and start restricting or becoming addicted to exercise again, but maintaining recovery is much easier now than it was just a couple years ago.
Recovery can look different for everyone dealing with anorexia, but based on my personal history with anorexia and experience academically researching it, I believe there are two key components of recovery: physical recovery and psychological recovery.
Physical Recovery
Since significant weight loss is part of the criteria for an anorexia diagnosis, returning to a healthy weight is important in recovery. Many anorexia treatments involve substantially increasing the amount of calories a patient eats, as well as expanding the variety of types of food they eat. I've seen treatment plans that mandated the patient consume a certain number of calories every day or that dictated how many servings of grains, protein, fruit, etc. the patient must eat every day, to try to reduce the important of counting calories. Some recovery plans involve challenging the patient to eat specific foods or ingredients that they have come to fear. Reducing or eliminating exercise can also be part of a recovery plan in order to increase weight and decrease compensatory behaviors.
I worked with numerous nutritionists to create meal plans that would both increase my weight and reduce my fear of certain foods or food groups. I slowly started feeling okay about eating more and realizing that I needed to eat substantially more to have energy and survive. I realized that my life wouldn't be over if I ate Fruity Pebbles or breakfast or if I skipped my work out one day to hang out with my friends. When I was anorexic, I thought I had to constantly follow my regimen exactly in order to have the body I wanted, but recovering physically slowly helped me learn that I didn't have to be perfect to be healthy and like my body.
Anorexia can have a severe and potentially irreversible impact on one's physical health. Depending on how severe one's anorexia is, they may require hospitalization in order to obtain the necessary fluids and nutrients. I personally never got to that point, but it's important to note that all eating disorders are serious issues, no matter what your lowest weight or what treatment you require.
Psychological Recovery
However, while weight gain is necessary for recovery, it is not sufficient. It must be accompanied by a complete overhaul of the disordered thought processes and motivation.
When my parents started taking me to see therapists and nutritionists, I personally was not committed to recovery. I would do as little as I could to satisfy my therapist and nutritionist since I wanted to continue losing weight and listening to my eating disorder. When my nutritionist told me I had to gain a certain amount of weight before she would let me run again, I was determined to reach that weight, but then run enough to lose weight again. I would pretend to follow my meal plan, while secretly throwing food away and eating less than I was supposed to. I did not actively choose to recover until I realized I had to in order to be able to go away to college.
There wasn't one magical moment where I changed my thought processes and stopped listening to my eating disorder voice. I couldn't pinpoint which therapist helped me the most, or what tactic was the most effective, but slowly and surely I started listening to the eating disorder less. Certain foods or ingredients didn't seem as scary anymore, and counting calories no longer consumed all my waking hours. I realized that I wouldn't die if I had a cookie with high fructose corn syrup, and I realized I wouldn't gain 50 pounds if I skipped a workout.
In my experience, eating disorders are very self-reinforcing. The more weight you lose, the stronger the eating disorder voice in your head is because you want to keep losing weight. Recovery is so hard because you have to constantly challenge the disordered behaviors and cognitions that you have grown used to. I had to constantly tell myself that I deserved food each and every day, no matter how much I ate the previous day. I had to remember that even if I was at a healthy weight, my mind was still quite disordered and I had to actively work towards recovery every single time I interacted with food or exercise. Although I now consider myself recovered, I still have to choose recovery each and every day. While there are many days where I feel fat or I feel like I should eat less, I'm careful to never revert back to my disordered behaviors.
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Click here to learn more about different types of treatment that address physical and psychological effects of anorexia.