Debunking The Myth that People with Eating Disorders can't get Better

There's a myth about eating disorders that people can't really fully recover. I have encountered many clinicians in the community who may not state this directly but organize treatment as if these were incurable, chronic illnesses. Even people who know little about eating disorders often ask me if any of my patients get better, fully expecting the answer to be no. This commonly held myth is widely believed and leads many people seeking treatment to give up hope. 

To be honest, I've thought a lot about why eating disorders are viewed this way. The body of medical and psychological literature reports that people can get well. There are many books of recovered people describing their painful, but ultimately successful, path to full recovery. There are many clinicians who have fully recovered themselves. So if all the easily found information doesn't propagate a message of hopelessness, where does this myth come from?

I think the first culprit is the belief that having an eating disorder is a lifestyle choice, not a devastating illness. Although media outlets don't state this directly, there are very regular headlines that infer that restricting food intake and increasing exercise to maintain very thin weights are the ideal lifestyle choices one can make, not the signs of an illness. 

Accordingly, it can be difficult for many people to differentiate between these supposedly "healthy" goals and an eating disorder. In fact, many magazine articles imply that choosing to eat less and overexercise is simultaneously healthy and synonymous with eating disorders, an extremely confusing and contradictory message.

The truth is that people with eating disorders struggle to eat every meal, not because of vanity, but because it's a symptom of an illness. To most people, it's almost unthinkable to have trouble eating, so it only makes sense to view eating disorders as a lifestyle choice. When people cannot comprehend something, they will concoct a theory that makes sense to them, so explaining to people that not being able to eat is a symptom, rather than a choice, is very challenging.

The second likely cause for the myth has to do with how long people stay sick. Many patients are sick for a long time before seeking help and, once they take the first step, experience treatment with a clinician who isn't knowledgeable about eating disorders. These initial forays into therapy imprint the idea that treatment won't ever really make a difference. It also means that many patients are sick for years before starting a true path to recovery. That extended time without much change in the illness makes it appear to others that eating disorders are lifelong. For friends and family, it's not surprising that they start to believe this will be a chronic curse, an inescapable maze the person is trapped in for life.

I have written much in this blog about family support. Bridging years of separation caused by the eating disorder is challenging but critical to recovery. I find that a significant part of recovery rests on being able to educate families and patients that eating disorders are curable. This step can invigorate all involved to muster enough energy and attention through the difficult process of getting better.

The raw, painful, emotional experience of nourishing oneself and re-entering life doesn't look like getting better, at first. The person usually seems to have things more together when she was even sicker because the eating disorder symptoms numb any emotions. Starting to eat again instead unleashes these feelings. If family and friends work hard to understand that the painful process is necessary to lead to full recovery, the chance of really getting better goes up significantly.

There's one other reason our society has trouble seeing people with eating disorders get well. It has to do with how we glorify these illnesses. Idealizing thinness, even being clearly underweight, reflects our collective understanding about eating disorders. The process of getting sick with an eating disorder is encouraged by the outside world. There are too many stories of adolescent girls enjoying praise as they lose weight only to find that they cannot stop the descent into an eating disorder.

As long as we make extreme thinness a goal, we will conflate desire with disease. In this case, how can anyone see an eating disorder as curable? Part of shattering the myth that eating disorders are lifelong is convincing people that there is nothing desirable about being too thin or about being sick. No one would choose a lifestyle that strips so much of life away.

Family Support in Eating Disorder Recovery

For those lucky enough to have it, family support is a critical part of eating disorder recovery. Family dynamics though often play a role in the inception of an eating disorder so that type of support is far from a given. In fact, distancing oneself from family often behooves a person trying to get well. That doesn't mean families cause eating disorders, a once standard explanation for the cause of these illnesses. However, if the family situation wreaks emotional and psychological havoc, the child can be more susceptible to developing an eating disorder to begin with and can have more success in recovery with separation from family dynamics.

In the situations where families can heal from prior emotional troubles and provide support for the child in recovery, family education is of primary importance. As I have written extensively in this blog, it's not intuitive for anyone to understand the fundamental struggles of someone with an eating disorder.

Eating meals when hungry and stopping when full are standard daily activities for everyone, much like brushing your teeth. Imagining each bite of food to be a monumental struggle is beyond most people's comprehension.

Families need to read books, talk to clinicians and, most importantly, speak to their loved one regularly. This immersion in self-education is a necessary and meaningful attempt to truly understand the torture of an eating disorder and will enable family members to learn how to comfort and support their family member who is ill.

Typically, the person with an eating disorder has withdrawn during the illness. The symptoms, both behaviors and thoughts, are all consuming and lead to isolation from daily life and interpersonal interactions. So families become used to that distance and imagine the family member functioning independently, self-sufficiently and much more capably than she really can.

The process of recovery and re-engaging with the family can be a shock. This typically independent family member instead appears very unstable, intensely emotional and very scared about the seemingly innocuous task of eating several times per day. As recovery progresses, even more so when the progress is steady, she becomes much more emotionally unstable rather than less in the following months and much more outspoken about needing help.

Anyone's instinctive conclusion would be that these emotions represent regression, not steps towards recovery, but the opposite is actually true. Nourishing one's body and mind unleashes intense emotions and forces the ill family member to create new ways of coping with daily life without the numbing effects of the eating disorder symptoms. Not only does this surprise families but also elicits powerful emotional reactions. 

The most common family reaction is frustration. As recovery continues and eating remains difficult, family members lose patience to remain outwardly supportive. It becomes more and more difficult to understand why a meal could be so hard even after a period of treatment. Families inevitably express the same reaction at several points of recovery: "Just eat more food!" "It can't be so hard to have breakfast!" "Why do you still feel so bad after all this time?" 

These comments are part of their family member's eating disorder internal dialogue every day. In fact, these are the thoughts she is trying to escape. She is aware of how hard it is to get better. She knows she can't do something that is simple and automatic to people without eating disorders. She routinely has similar critical thoughts that remind her of these facts many times per day. When families confirm these thoughts with their own frustrations, the family member will quickly retreat back into her shell. Those reactions only reinforce the illness.

As challenging as it can be for families, the best support is always kindness and compassion. Anyone with an eating disorder has to deal with constant internal criticism. That pressure is exhausting and demoralizing. No amount of kindness and encouragement is too much.

Kind comments, even repeated every day through the process of recovery, make a world of difference: "I'm so proud of you." "How are you doing today?" "We all are behind you and know how hard you're working every day." "We love you and will always support you any way we can to help you get well." 

If family struggles can be put in the past, then consistent, reliable, compassionate support will help the family member persist through the struggle to recover. If family dynamics have been too painful or traumatic, then the clinician must make it safe for the person to protect herself from family in order to get well. The most important quality of any support is kindness. It is what makes recovery possible.