A common question when starting recovery is how long does treatment last. That question is hard to answer exactly, but the answer must reflect the reality: it takes quite a long time to recover.
This reality is important for patients, clinicians and loved ones to understand because one underlying tenet of treatment is patience. Slips and struggles cannot turn into a reason for the patient, her family or the therapist to blame her for the illness or the length of time needed for recovery. Everyone needs to understand that this process includes many ups and downs, struggles and successes.
Since people can fully recover from these illnesses, it's perplexing to many why recovery takes so long. Changing eating patterns from disordered eating to normal eating seems like it ought to be very straightforward, yet realistic progress could not be more complex.
The biological underpinnings of the recovery process are useful to better understand why.
Some human behaviors, like those of animals, are largely innate and do not require much conscious attention, such as breathing, sleeping, walking or eating. Although we often use our abilities to attend to these actions, our more primitive brain functions will take over and force us to perform these tasks if we choose not to.
Our brains are hardwired for these specific actions because they are necessary for survival. The gift of conscious awareness and attention can only go so far before our animal instincts force us to continue these tasks. Eating falls into that category.
Most eating disorder patients who have restricted long-term reach a point where their hunger reaches starvation level and their minds don't let them starve anymore. As upsetting as this is, our bodies are programmed to live. But, as I have written many times in this blog, eating in and of itself doesn't equal recovery.
Similarly, our brains appear to develop powerful eating behaviors that become ingrained in our daily life. There is a large variety of these behaviors: grazing, substantial meals through the day, constant food obsessions and disordered patterns. However, once those patterns are set, they become deeply entrenched in our daily routine. Since food behaviors appear to be well-protected, primitive behaviors, these patterns become locked into very fixed circuits in the brain.
Changing those fixed circuits takes a lot of time, practice and attention. Eating like we did when we were children is not akin to riding a bicycle after years of not doing so. Relearning how to eat is a long, arduous process in which every step is not intuitive and demands attention and focus. Over time, the mind can learn a new way of handling food thoughts and behaviors, and the new patterns gradually become unconscious and automatic. Those behaviors do change, but the transformation of any unconscious process takes quite a bit of time.