Dis-Ease or Disease?

At least two times a week, my clients at Renfrew will inquire about whether an eating disorder is a disease, like in alcoholism, or if this is a disorder one can fully recover from and never have to think about again. Looking into their eyes, eyes that reflect a desperate desire to know that they can fully recover, I want to tell all of them that full recovery is possible for everyone. However, that is not my immediate answer.

First, I have to define how I'm defining "fully recovered." I think of recovered as no longer relating to having an eating disorder, not using eating disorder symptoms as maladaptive coping mechanisms, not being plagued by the ED voice, not concerned with weight/body image issues, not struggling with wanting to use symptoms, and not engaging in symptom use. Now I know there are others to add to this list, but you get the picture.

I believe that some will fully recovery while others will be in recovery for the rest of their lives. I think are a variety of variables that determine whether one will have a period of dis-ease with an eating disorder, or will have a disease that will have to be managed for the rest of one's life. Some variables could be developmental stage, age of onset, age of first intervention, number of years in ED before entering treatment, ability to restore weight, chronicity, level of support structure, family history of mental illness, co-occurring disorders, trauma, external antecedents, inability to alter worldview and belief system, etc. And there are so many more. I think the closest answer to the truth is that we don't really have much evidenced based knowledge what makes someone fully recover. I think of it similarly to having siblings who grow up where their parents are alcoholics--one sibling becomes an alcoholic later in life, and the other is, seemingly, without pathology. Why is that?

If eating disorders were reduced to issues of weight restoration and symptom management, my guess is that it would be much easier to have evidence based predictors of full recovery. But, as we know, the food and juxtaposed behaviors are merely a symptom. Can we predict that the prognosis for a 14 year-old who goes into treatment after a 6-month period of anorexia nervosa with no co-morbidity will be better than the 25 year-old anorexic with a history of trauma and substance abuse? Probably--but not absolutely.

I think that many can fully recover from an eating disorder. I just don't how realistic it is to claim that everyone can fully recover. In the last decade, I have had hundreds of interactions with women (not adolescents) who feel that they will be in recovery for the rest of their lives. It doesn't mean that they are imprisoned by an eating disorder and are actively using symptoms. It simply means there is some level of daily maintenance to sustain long-term recovery. Even if one can't be "fully recovered" and are in recovery, is that really such a bad thing???