[Valid Atom 1.0] Life With Cake: Eating Disorder Blog: Dis-Ease or Disease?

Sunday, March 18, 2012

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???

3 comments:

Jenn Lynne said...

I can totally relate to this. I have days that I believe that maybe, just maybe there is hope for "full recovery" in my life. Times where I'll go a few days in a row without feeling guilt after eating, not having urges to act on behaviors, days that I don't spend excessive time staring in the mirror, picking apart every inch of my body. These are wonderful moments. These moments give me hope. But then they're always ruined by something that turns my thinking into a negative place. I'm in a place now that I don't act on those thoughts, but I feel so horrible about myself. This is just another manifestation of my black and white thinking though, all or nothing. In my mind, I either will recover or I will not.
I like that you say at the end "Even if one can't be "fully recovered" and are in recovery, is that really such a bad thing??? " This really got me thinking...I get so upset with the concept of "full recovery." But what does it matter if I really do achieve full recovery?!? The important thing is that for today, I choose to remain in recovery, choosing to not engage in behaviors, to honor my body, and respect myself and others. Afterall, I'm proud to be in recovery today. I've worked hard to get here!

Amber said...

So excited to see Renfrew mentioned in your post!! That's where I spent last year and it saved my life. As someone recovering from bulimia, you give me hope that one day my healthy voice will consistently be louder than my bulimic voice. So glad I found your blog - it's going on my blogroll! I'm supporting my transformation with my own blog at www.exceptionaltransformations.com. Thank you!

Anonymous said...

I do think that kind of long term existence is "really such a bad thing." For a blog that I presume is intended to promote hope, that is a) devastating and b) a really flip and glib thing to say (the last sentence). For someone trying to recover and who had many moments of hopelessness and doubt as to whether to just give up because of a fear that full recovery will never happen, this post was immensely damaging. In fact, since reading this several days ago, I have endured a rapid and really frightening downward spiral, both symptom-wise (because why even try if a life a struggle to deal with my weight is all there is), but moreso emotional. I struggle to maintain hope in my fight with ED, anxiety and depression, and this post has completely drained me of any hope I may have had left.