How Long Does it Take to get Better from an Eating Disorder?

The course of an eating disorder from the innocent urge to lose weight to real freedom from the illness is a long road. Each transition between stages of the disease through steps of recovery is a battle. From recognizing the problem, finding good treatment, fully committing to the hard work of getting better and making the personal changes needed for recovery, the path is fraught with hazards and challenges. Unfortunately, the eating disorder treatment community still paints a rosy, unrealistic vision of recovery all too often. Any program that implies that in a few months someone can be mostly recovered is not being truthful. Normal eating patterns can be restored in that period of time, but normal eating and weight only encompass part of a full recovery. It's important to know ahead of time what the path looks like and what each part of treatment entails.

There is frequently a long lag time between the onset of symptoms and entering into treatment. The strong personal attachment to the symptoms, such as the elation of starving or the powerful desire to lose weight, does not lend itself to seeing these desires as anything but natural. An illness is the furthest thing from someone's mind early in an eating disorder. For people with Anorexia, it's as if they have found nirvana: a way to ward off hunger and feel superhuman while miraculously shedding many, many pounds. Years, or a lifetime, can go by before someone recognizes the enormous consequences of this illness. When binging and/or purging are symptoms, shame and guilt serve as significant barriers. Each binge feels like a personal failure, rather than the sign of an illness, and leaves people caught in a struggle between willpower and self-hatred. Seeking help feels like a failure, not acknowledgement of a disease that needs treatment. In fact, on average it takes seven years for someone with Bulimia Nervosa to enter therapy. The time to treatment is shorter with Anorexia due to concern over weight loss, but the intervention is usually based on medical necessity, not any desire of the patient to get better.
The focus of initial treatment is to normalize eating patterns and weight. Clinicians know that a patient needs to resume normal eating to think clearly and reverse any long term medical consequences of the eating disorder. What is frequently not stated early in treatment is that normal eating and weight does NOT mean full recovery. Too many family members, friends and even clinicians equate normal weight with full recovery. My experience is that this false belief is actually counterproductive and prolongs the length of illness. The patient, still struggling with eating daily and the internal turmoil associated with recovery, feels left alone and quickly realizes that only relapsing will cure the loneliness and rally the support again. In fact, a person in recovery needs much more support after eating and weight returns to normal. The eating disorder serves as a very effective coping mechanism, and without it, every patient feels much more afraid and alone and needs extra support to get well.
What makes this second part of recovery, after some improvement in eating behaviors, so challenging is the profound personal transformation that must occur for someone to get better. It's clear from psychiatric research that there is a genetic predisposition to getting sick with an eating disorder. Certain core personality traits predispose someone from the start, but then environmental factors including family dynamics, early exposure to dieting and body obsession and emotional isolation contribute greatly. At some point early in personal development, the eating disorder becomes a central part of that person's identity. As I have stated many times in this blog, the eating disorder starts to feel like much more than an illness; it becomes who you are. Soon after weight restoration and regular meals, the person realizes that the food behaviors only encompass a part of the eating disorder. The thought processes behind the illness, mostly the contradictory sense of superiority about mastering food combined with self-punishment driving every personal decision, have to change drastically in order to get better. This profound realization is always daunting at first. Committing to this transformation means both sustained attention to every meal and snack and the internal psychological work to fashion a new way of seeing oneself in the world.  This is clearly a lot to commit to, but with any perspective to see the true nature of these illnesses, committing becomes the only option.
This part of the work of recovery occurs largely as an outpatient in a gradual, fluctuating process over many years. There are periods of significant progress punctuated by stretches that are difficult. Some days or weeks may include stable eating and the personal freedom of living more fully and others days can feel like falling back into the eating disorder again. Maintaining steady treatment, learning how to be resilient and accepting the psychological goals of recovery are all significant challenges yet are also necessary hurdles to recover and be well. When family, friends and clinicians can learn about the nature of eating disorder recovery, the patient will believe she has true, reliable support through this difficult time. It behooves all parties involved to face the reality of the illness and the time of recovery so that the patient suffering has everyone on her side. The goal in eating disorder treatment is not managing a chronic illness. The goal is to get well. 


  1. Thank you very much for this post. I am in recovery from an eating disorder. After quite a few months of being on the upswing and things slowly getting better (minus a few minor slips here and there), recently I have found myself back pretty tightly in the grips of the disorder. Before the last few days I was ashamed that seek out extra help or share with family, friends and even my outpatient treatment team how much I have been struggling. I felt that with all of the support that I have had, especially in the begining and the knowledge I have gained since entering treatment, that I should be "over this" by now and shouldn't be where I find myself. Although my friends, family and treatment team has been super encouraging the past few days and have reminded me that this is normal, I still have felt like a failure. This post helped me a lot. It allowed me to take a deep breath and partially realize that this is going to be a long journey.

  2. The history of my eating disorder, anorexia, has been long, too long. After approximately six months in residential treatment I am home, trying to navigate this precarious transition of recovery. In my heart I know there is no room for relapse. This time, recovery must last, no room for relapse.

    However, there are still set backs, more then I had planned for, while riding that pink cloud of arriving home. Yes, I am maintaining my goal weight, which does not by any means show what a literal minefield each day in the recovery process can be. While in residential treatment, weight was restored, a meal plan was set in place, and I considered that the most complex journey was finished. I was sure I had all the skills I needed. I had learned to respond vs. react, to choose relationships over my anorexia, the importance of soul over body. Using these concepts out of the treatment bubble and, applying them to the complexities of daily living is overwhelming and, often disheartening.

    Yes, I have days when normal eating feels appropriate; it is intuitive, liberating and, even joyful. The world of recovery feels congruent, filling me with pride. Devoid of anorexia to numb my emotions, the minefield is fraught with explosions, seemingly everywhere I turn. It feels as if, with each step I take, I need to look right, then left, not at all conscious of where the next booby trap shall be. In these moments, a meal plan goes by the out the window. The eating disorder beliefs kick back into gear. The slippery slope of relapse is at the same time, fearsome and inviting. When faced with emotional chaos that the anorexia numbed, powerful feelings of anger, sadness, disenchant, seem overpowering. Support from therapy is helpful. Yet, no longer in twenty-four hour care, the journey is lonesome and terrifying.

    A treatment team does make a huge difference. Yet, unstable family dynamics lack of family empathy and support makes going back into the arms of a deadly eating disorder appealing.
    Getting well from an eating disorder is unquestionably not a linear process. There is no quick fix.

  3. I have been following some of your blog posts after being released from treatment for my eating disorder. I live in Milwaukee, WI.
    I was wondering if and how one who is in recovery can figure out timing of when the body will regulate and balance itself out? I am really struggling with going from 80 pounds to 136 pounds in a couple months. I had placed my trust in the experts to bring my weight up slowly so it wasn't such a shock to my system (physically as well as mentally). I am ticked that they allowing me to put on 50 pounds in 2.5 months.
    I am at my heaviest EVER, by a good 15+ pounds.
    Now, my body is really fatigued and has been having problems carrying this weight. Along with that, I struggle with accepting my appearance.
    I have been seeing my dietician I had during outpatient treatment but am in the process of changing to a different one that came recommended by a friend who has overcome her eating disorder. This new dietician says that my weight management by the treatment team was very aggressive and says that my diet established by the treatment team is excessive. I kept trying to maintain hope with my current dietician, that she had me in her best interests but I am failing to see that...and that isn't my ED mind telling me that. Its my rational mind.
    I had been seeing my current dietician once very two weeks. I also seek psych therapy once a week.
    I am in a better mental state of mind than I was weeks ago, yet I still struggle. I think part of what's keeping me grounded and optimistic is the fact that I have been in recovery for a little over four months. I had heard that the body begins to regulate itself as soon as six months. I am getting closer!
    I am a 5'3" 135 pound 39 year young female (will be 40 on July 1). I had began down the ED path by restricting, then restricting and exercise, then it became exercise and binging/purging and finally went to just binging/purging EVERYTHING that went into my body. This spanned for 15+ years with roughly the last two years being binge/purge.
    I have always been active, whether it was playing team sports (volleyball, basketball and softball) in grade school, high school, taking up running in college and continuing to run since college and adding triathlons into the mix the last 11 years. I have done 12 Boston Marathons and 9 Ironmans. To be not active has been challenging. Not to mention all the health issues that have come along with getting healthy: carpal tunnel syndrome, ulcerative colitis flare ups, edema of the legs, issues with my knees. I have had edema in the past and understand that I would have exo-cellular fluid with the re-feeding process.
    Though I know that I'm not healthy at 100 pounds or less, but I almost feel like I was healthier being "unhealthy". I do know that I couldn't maintain the ED as the outcome was grim and would result in death.
    I am just continuing to search for peace of mind and knowing that I can go back to being the athletic, fun, healthy person I once was that could eat food without associating consequences/fears.
    I accept and honor the notion of not excessively exercising as I have found the appreciation of friends and family...who used to take a backseat to my exercising.
    I hope you don't mind me reaching out to you in an email.
    Thank you for your time!