Enhancing long-term recovery

This is a subject I'm rather interested in: long-term recovery. Much of the research on recovery focuses on the acute phase of treatment--and, to some extent, rightly so. If you can't start getting better, than figuring out how to stay better is somewhat secondary. Except there are a lot of people who have crawled their way out of the hellhole of the eating disorder and are now focusing on staying well.

So what do we know about how to stay well from an eating disorder?

Answer: not a whole lot. Continuing nutrition, obviously. Management of co-occurring mental and physical disorders. Therapy as needed.

But these are all very vague things. Everyone is different, and so getting too prescribed in terms of treatment isn't super useful, either.

However, a group out of the University of Iowa and Harvard University followed women with AN or BN for 10 years, and found that "worse psychosocial function and overconcern with weight or shape demonstrated statistical significance in increasing the risk of relapse." The researchers found that approximately one-third of women whose eating disorders had gone into remission ultimately relapsed, and rates were the same regardless of initial diagnosis. And regardless of whether the person presented with the restricting subtype of anorexia, the binge/purge subtype of anorexia, or bulimia nervosa, most people relapsed into binge/purge behaviors.

Several interesting points:

  • the researchers defined remission as "having a period of 8 consecutive weeks in which no or minimal symptoms of the syndrome were present," which doesn't seem like a super long time to define something as ephemeral as 'recovery' or 'remission.' Then again, that also would seem to imply a relative freedom from body image issues and other ED thoughts, which is pretty indicative of significant progress towards recovery.
  • only ONE THIRD of the women presenting with a diagnosis of anorexia nervosa even achieved an eight week period of remission. If that doesn't signal the need for better treatments, I don't know what does.

The authors say that

Women with poor psychosocial function may be less equipped to cope with life stressors. Thus, stress coupled with poor coping may lead to a return of symptomatic behaviors...In addition, poor psychosocial function among recovered patients may contribute to the emergence of such stressors. Such a pattern may explain why interpersonal psychotherapy has demonstrated efficacy in the treatment of bulimia nervosa at follow-up.

As a solution, the authors say that "Thus, the combination of poor psychosocial function and increased concern about weight and shape may trigger the return of full eating disorders. Teaching patients to cope effectively with psychosocial stressors and to accept their bodies may help prevent relapse into eating disorders."

It's an older study (from 2005), but it does provide some useful information on an area that's not well-researched. If only the authors hadn't thrown that "food is something sufferers can control..." stuff into the last paragraph. Oh well.


Christine O'Brien said...

I have just began reading a few of your posts and am fascinated by some of the points you make. I have had 2 best friends suffer from eating disorders and it is a subject that although I have never personally gone through, is very close to my heart. I never thought about the long-term repercussions and/or recovery process. I am also very impressed with the layout and design of your blog and the amount of time you must have put into it. Kudos!

Kristina said...

First of all, I have to 'quibble' with the idea of "long-term recovery" at 8 weeks. Ha!
I do think it's a long road and a hard one, but I would like to believe that it isn't completely impossible (or less than probable, which is what the study seems to suggest).
I'm now far more 'recovered' than I've ever been in my life, and that sense of well-being extends to my personal life (relationships) and my professional life. I don't know, to be honest, what would happen if these fell apart, but I know that having the entire picture complete has helped me.

Carrie Arnold said...


Thank you very much for your kind words. I do appreciate them! And your friends are very lucky to have you supporting them.


I agree about the 8 weeks thing, too. And you're right- recovery encomapsses so much more than just the food aspect. It really begs the question: what is recovery, and how do we measure it?

K. said...

I just began my own blog a few days ago to help sort out my thoughts and ponder things in my life as I deal with IBS and recover from bulimia. I enjoyed reading your post- for me, recovery isn't something that can happen overnight. It is a long and gradual process. I look forward to reading more... and I hope you don't mind if I add you to my blogroll!

A:) said...

Let me guess -- they definition of recovery also included a weight over 85% of IBW. . . which means that those in the marginal weight range of 85-95% were also considered recovered. . .

8 weeks -- riiiiighhhttt -- if only

These studies have the right idea, but they piss me off


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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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