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???

Eating Disorder Transitional Living...Bridging the Gap

In an article published on May 7th, the Kansas City Star announced the opening of Thalia House, a transitional living house for women recovering from eating disorders. Given that I grew up in KC, and also the place where my eating disorder came alive, I am so excited for Thalia House's presence in the area.

When I lived in Kansas City, I had two stints at Baptist Memorial Hospital, in the eating disorder unit. The first was a 30-day stint, and the second was a 60-day stint. While I learned many tools and did not binge, purge, or starve while in the hospital, I relapsed within a couple days of discharge. The reason was not because I didn't know what I needed to do. It wasn't because I was a horrible person. It was because eating disorders are a BEAST. To go from 24-hour care to being thrown back in your old environment equates to relapse, in many cases.

What I needed was a step-down, or transitional, program. Of course, a place like Thalia House did not exist at that time. Even the few 12-Step OA meetings in the area did not really address anorexia and bulimia.

When I finally went to Sierra Tucson, a 28-day program in Arizona, they shed light on the need of the continuation of treatment. From there, I went to Turning Point of Tampa for 3 months, which was a step-down from Tucson. At Turning Point, I learned accountability for my actions and practiced being abstinent. Even after my discharge from Turning Point, I had some relapses. Eating disorders are tough. But, I practiced new behaviors, and my recovery time grew.

The person struggling with an eating disorder, family members, and even professionals often lack the knowledge or discount the power of the disease. Anyone who thinks that if you just eat X, Y, and Z three times a day then the eating disorder will go away is sorely mistaken. We don't want to admit it, face it, deal with it. But recovery requires a lot of work and SUPPORT. In this case, Ignorance is NOT Bliss.

While "sober" living houses have been around forever, primarily located near treatment centers, it's nice to see that eating disorder group homes popping up in more places. It is so needed! The ED epidemic continues to grow, and I'm guessing ED transitional living will grow, too. 'Hope so!