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

When first contacting me for treatment, people often ask how long it will take to get better. I hesitate before answering the question. There is never an easy answer because this question involves several layers of meaning.

First is the underlying fear that no one gets better from an eating disorder. This is a lay myth that reveals an ignorance of these illnesses and is patently untrue. Some people do remain chronically ill but many people do get better, and it’s essential that everyone entering treatment knows that full recovery is a realistic goal.

The second implication is the antithesis of the first: the desire to magically rid themselves of the eating disorder quickly, once and for all. Sadly, this is not how people get better. The eating disorder is comprised of ingrained eating patterns and well-worn thoughts about food and weight. It takes time to tease apart, analyze and change these elements of the eating disorder. Recovery is hard work that takes time, but well worth it.

Third is the fear of fully engaging in recovery. Whether conscious or not, the person is aware that fundamental aspects of their life needs to change in order to get better. This means embarking on an intense therapeutic relationship and significant changes in their life in order to escape the eating disorder. No matter how miserable an eating disorder can be, this level of change is daunting.

Last, this question infers a significant cost. Adequate treatment is a commitment of time, energy and money. Attempting true recovery means diverting a large portion of these crucial elements of life to a difficult process, one that can work but is not guaranteed to work. It takes courage to truly take the step towards getting well and give so much of oneself to the task.

So the answer to this simple question is fraught. I can’t say five or ten sessions. I can’t say it’s necessary to meet weekly, biweekly or monthly. I can’t say six months or a year. The answer is that I never know and can only tell once the treatment starts. The answer is rarely satisfactory, and the goal is just to get started with treatment.

How to Fight the Positive Feelings about an Eating Disorder

Unlike most psychiatric disorders, eating disorders become a comfort and source of pride to many people. Patients feel sick and miserable when trapped in their eating disorder yet often feel a sense of accomplishment from the idea of mastery of food and weight or pleasure in how they eat. Moreover, they often get a sense of relief and comfort from their symptoms that can be hard to replace.

A strong emotional attachment to an illness is unusual. It’s to be expected that almost always people want to get better from their illness. The ambivalence and identification with eating disorders makes them unique among mental illnesses.

Successful treatment cannot solely focus on managing symptoms and finding new ways to cope with stresses in life. Creating new eating patterns and countering the thoughts of an eating disorder also remain central. However, even these goals may only lead to temporary recovery. Something else needs to create enough motivation to fight against an illness so wrapped up in one’s pleasure and identity.

The last piece of recovery is finding an anchor in the real world. Specifically, someone with an eating disorder needs to identify at least as strongly and maybe more strongly with a desire or goal in their life outside the illness. This goal needs to be impossible to achieve while the eating disorder is dominant.

The conflict between this goal and the eating disorder forces the person to choose between life and the illness. Instead of arguing with a therapist about getting better, the conflict is now internal.

The external goal can be having a family, maintaining an intimate relationship, being physically well enough to achieve a goal or raising children. The goal must be of supreme importance to the person and driven solely by their own needs.

No therapist can help a person find these goals; however, a therapist can identify and reinforce that this goal really is important. The eating disorder thoughts can be so demoralizing and render the patient helpless, but support to remember the goals are achievable will make this conflict feel very real.

The other aspects of recovery are still just as important. However, internalizing the conflict by having real goals in life that cannot exist with the eating disorder opens the door to fill recovery.

The Risks and Benefits is Increased Communication for Eating Disorder Recovery

The relentless thought process of an eating disorder dominates the mind of someone who is sick all day and night. Recovery aims to replace these thoughts with healthier thoughts about eating a normal mean plan and overall health and well-being.

However, one or two sessions per week is much less powerful than the endless stream of eating disorder thoughts that lives with someone day and night. Contact in between sessions helps balance the playing field in the recovery process.

Technology has opened up many new ways for therapists and nutritionists to contact a patient during the week. Email, texts and various recovery apps allow for regular check-ins that can stem the tide of eating disorder thoughts and allow treatment to have a more pervasive effect blocking worsening symptoms.

The regular contact through the week goes against the grain of all mental health treatment. With consistent, daily contact—a mainstay of eating disorder recovery—the therapeutic relationship can blend into what also feels like a personal relationship. The clear boundaries imposed by regular time slots and contact only in the office are much less defined with all forms of messaging.

Many patients with eating disorders have some confusion around boundaries and relationships. Sometimes this issue stems from complicated family relationships, and for others it is due to the lack of experience of social contact due to the isolation caused by the illness.

The inherent confusion around the therapeutic relationship, an essential component of successful treatment, can easily be misinterpreted by clinicians and laypeople unfamiliar with eating disorders treatment as inappropriate.

Eating disorder clinicians are employing other means to try to protect the privacy and treatment from those who might jump to conclusions that the therapeutic relationship crosses boundaries. HIPAA summaries in the email signature, encrypted text and email apps or formulaic recovery apps are increasingly used in therapy. However, some clinicians are even shying away from communication in between sessions to avoid any confusion, even if it harms recovery.

If eating disorder treatment fit into the traditional therapy approach, there would be no need for alternate forms of care. Instead, standard approaches fail miserably.

For many reasons discussed in this blog over the years, the therapeutic relationship is the cornerstone for eating disorder recovery.

Even if that relationship is sometimes confusing and complicated, no treatment works without fully engaging with the patient to pull her out of the clutches of the eating disorder. Hopefully, education about the necessary components of eating disorder treatment will allow for more acceptance of this form of therapy.

Meal Plan After Bariatric Surgery

All Bariatric surgery shrinks the stomach down to a much smaller size than a typical stomach. The purpose of the surgery is to limit the amount of food a person can eat at one time. Eating more than this new stomach can hold leads to discomfort, pain and even vomiting.

The risk of overeating and the lack of familiarity with this newly transformed organ often leads to severe food restriction and a fear of eating. A significant number of people lose a lot of weight in the months after surgery because they are afraid or unable to eat enough.

Clearly, as explained in the last post, undereating is not a sustainable way to live. One possible result is surgical anorexia, and another option is a new form of disordered eating aimed at overcoming the limitations of having such a small stomach.

The most successful people after surgery learn a new, sustainable and reasonable way to eat. This new plan takes into account their caloric and nutritional needs, the capacity of their stomach and the rhythm of their daily life.

Sadly few nutritionists appear to focus on helping the many people who now have Bariatric surgery. The worst culprits are the ones who work in the Bariatric centers. Their sole goal appears to be short-term weight loss, the overall sign of success for these centers. Long-term health and quality of life rarely factor into their suggestions.

The new meal plans need to incorporate a few simple ideas.

First, meals need to be small, rarely more than a cup of food. This basic fact acknowledges the limitations of the new, small stomach.

Second, a cup of food is not enough to sustain someone more than a few hours. Thus, the typical plan of three meals and two snacks is rarely effective after surgery. Instead, a new meal plan needs to include eating a small to medium size amount of food more often through the day, usually every two hours or so. Instead of meals and snacks, this plan has mostly snacks.

Third, the food needs to be varied throughout the day. Since it is harder to eat enough due to the small stomach, the new plan needs to consider the nutritional value of the food to ensure one gets enough nutrients through the day. Typically, a varied diet will always include enough nutrition. Since a small stomach only allows limited food per day, it is important to be sure to eat enough nutritious food.

Essentially, people who have had Bariatric surgery have to manage a damaged stomach the rest of their lives. Just as anyone who has had an injury, these people can accommodate their diet to take into account the injury and ensure adequate nutrition.