Tuesday, May 24, 2011

More on Recovery..

If you didn't get a chance to read my first post regarding recovery, scroll down or click here to take a look! It is a post that is full of encouraging and thought provoking quotes about recovery. I still have a few more recovery oriented posts that I would like to share with you all, and today's post comes courtesy of Johanna Marie McShane, licensed psychologist, author of Why She Feels Fat, and all around awesome lady. When I asked her what she thought about 'full recovery', here is how she responded- below. 

Is there such thing as FULL recovery from an eating disorder?

The answer to the question of whether full recovery from eating disorders is possible depends on two primary things. The first is: how is recovery being defined? The second is: what is the nature of the eating disorder the question is being asked about?

Recovery is often defined in a variety of ways, depending on the viewpoint of the clinicians involved. For example, some people would consider recovery to be achieving and maintaining stable medical health and weight restoration; others would define it as resolution of eating disorder behaviors/symptoms; still others think of recovery as the change in rigid thought and belief patterns inherent in the disorder; while some clinicians see full recovery as meeting all the above criteria.

Characteristics of an eating disorder play a big part in the prognosis for “full” recovery. How long someone has been ill, how severe and frequent the symptoms/behaviors are and have been, the presence of other illnesses, all affect treatment and recovery. In general, the longer the course of the disorder the more difficult it is to treat, as is true for the more serious and frequent eating disorder behaviors and the presence of additional illnesses. However, this is not always the case.

My own view is that the answer to the question, is full recovery from and eating disorder possible, is “it depends” and “it is possible.” I don’t mean this negatively or pessimistically, simply pragmatically.  

It depends on all the variables, and on how we define recovery. Here are two people we can use as examples: the first is a 16 year old girl who developed an eating disorder three months ago- she compulsively exercises and restricts her food intake. The second is a 26 year old young woman who developed bulimia about ten years ago- she binges and purges 40 to 50 times a day (these are both real people who I have worked with).

Recovery might look quite different for these two women, right? For the teenager we might have different goals for recovery- perhaps full elimination of her symptoms and behaviors. For the 26 year old our overall goals might include stabilizing her health and reducing the binging and purging to the extent that she can have a quality of life that’s fulfilling for her.

In fact, this is exactly what happened in both these cases. With some intensive and relatively brief treatment the teenager’s behaviors were reduced to zero and she went on with her life, much like if she’d suffered from a bacterial infection and it was then successfully eliminated. The 26 year old worked tirelessly (and not wholly linearly) in treatment for several years, including a few months in a residential treatment program. She was able to reduce her bingeing and purging to about once a day and she remained medically stable. When she left treatment she had been stable for over a year, with the bingeing and purging frequency at about 3 or 4 times a week. She had a full time job, friends, and a repaired and fulfilling relationship with her family.

Are these people “fully” recovered?  It’s an interesting question. What might be a more valuable thing to consider is the quality of life each achieved and sustained, rather than whether they meet certain or all criteria for “full recovery.”

And perhaps the most valuable thing would be to ask each how she felt about her recovery. Since I know both these women I can tell you what each said at the time they left treatment. The teenager felt “wholly recovered,” almost as if the disorder had been a “dream” and hadn’t really existed. She was relieved to finish treatment and not need to go to appointments anymore. The 26 year old felt a type of gratitude possessed by someone who has worked extremely hard to get herself out of a situation that almost killed her several times. She knew she still had symptoms, and in fact, that she still met the “criteria for bulimia nervosa” (in terms of frequency of bingeing and purging). Compared to where she’d spent the previous 10 years and where she thought she was going to have to stay for the rest of her life with this illness, she felt pretty darn recovered.

Food for thought, indeed.. Would love to hear any of your comments, questions, or feedback! You can also check out Johanna's blog by following this link. Keep checking back for more recovery posts this week!

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