The Most Important Part of Eating Disorder Treatment

Recent exposure to non-clinical blogs and videos has led me to review my own blog and reflect on the overall message of my writing. I was surprised to see only a limited number of posts specifying treatment differences between anorexia and bulimia. However, there are a lot of posts about obesity and binge eating disorder, two increasingly recognizable eating disorders only now getting attention from the mental health community. 

But the majority of the posts concern the psychological experience of having an eating disorder and the treatment approaches necessary to counteract and heal that suffering. 

The nature of treating people with eating disorders has clearly inspired me to focus primarily on what leads to the difficult changes in the thought processes central to the eating disorder. My experience treating adults with eating disorders led me to realize that finding ways to fight the thoughts is necessary for recovery. 

The eating disorder treatment community has now created treatment centers, both inpatient and outpatient, that help people with eating disorders find immediate stability with food and nutrition. Depending on the severity of malnutrition and behaviors, almost every person can find appropriate care, often even covered by health insurance, to accomplish short-term medical stability. 

These patients leave treatment after a month or two and almost always quickly relapse within a few months. The gains of medical stabilization do nothing to change the eating disorder thought processes which inevitably consume the person's mind and restart the behavioral cycle. 

The path from seeking treatment options, attending a program followed by relapse is exhausting and demoralizing. The process of recovery really starts after discharge and involves help from an experienced team and the daily struggle of identifying the eating disorder mindset, questioning it while adjusting behaviors around food and body. That process, day in day out, is the work of recovery that leads to becoming fully well. It's painstaking work.

I have come to know the intimate details of what true recovery looks like. I have seen people suffer with relapse and struggle to apply everything they know for the purpose of getting well. This experience is both heartwarming and excruciating and has led me to want to share my experience two ways.

First, I want to help people in recovery understand they are not alone: there are crucial parts of recovery that are universal. Second, I want people in recovery to understand the key mental and relational components of what makes treatment more effective.

The urgency to share these two things has inspired the majority of posts to this blog. In my mind, these key points reflect the needed parts of a treatment plan that lead to full recovery and to open the door to personal discovery.

Recovery and Discovery

I was recently referred to a podcast called Finding Our Hunger hosted by Kaila Prins, a woman professionally and personally focused on eating disorder recovery, body positivity and women's wellness in general. Her approach to women's health around body and food is as refreshing as it is profound. Her freedom with herself and the world around her is clear from the opening words of her podcast. 

From the few episodes I listened to, I was struck by the vocabulary and use of terms that were much less clinical and very empowering. One phrase she used to describe the path out of an eating disorder or disordered eating is "recovery and discovery." Although the term is simple and straightforward, the language emphasizes the nature of wellness that steps out of the medical model and into the space of living one's life freely and fully. The pathology of eating disorders, still mostly tied to women's role in our culture, continues the age-old tendency to pigeonhole women's struggles as a sign of illness. The term discovery throws off that mantle for something very different. 

Recovery is a useful term to describe the process of normalizing eating patterns, the experience of hunger and fullness, body image and changing the punitive thoughts of restrictive eating. When applied to the exploratory nature of learning about one's own thoughts and feelings, likes and dislikes and overall identity, the term recovery implies that this search is a journey related to pathology. Instead, the journey of discovery is a path towards living life more fully and rejecting the pressure from society to overvalue body, weight and food over truly meaningful aspects of our humanity. 

I have written extensively about these two parts of treatment but labeled them as different aspects of recovery. A subtle change in terminology can be just enough to differentiate between illness and wellness, between a medial/psychiatric issue and the daily struggle of living life. 

Discovery is truly the end result of effective and successful treatment for an eating disorder or disordered eating. The goal is to find out who you are and to live life. And that is a lifelong process and philosophy. It's the bastion of hope to convince people that full recovery is possible.

A Novel Eating Disorder Revisited: Pathological Obesity

Although most people consider eating disorders to be solely based on eating behaviors and weight, the central problem with these illnesses is psychological. The relentless thoughts about food and weight and the incessant negative, punitive thoughts about oneself are torturous for people with eating disorders. With help to combat those thoughts, changing behaviors and full recovery are both very possible.

The newest and least talked about eating disorder is a result of societal pathologizing of being overweight. Medicine insists that obesity is the cause of endless health problems and in the end an issue with an easy solution: just lose weight. Rather than seeing weight as a complex variable with a plethora of possible causes, doctors approach weight as an easily fixable issue that is at its heart a dire medical concern. 

The public has followed this conclusion and pathologized weight long enough to create a large group of people plagued by constant doubt, shame and self-loathing. Since diets and weight loss plans are almost universally unsuccessful, people attempt to follow prescribed solutions, feel constantly like failures and are obsessed with food and weight instead of trying to live their lives. 

From a psychological perspective, the experience of these constant thoughts are synonymous with an eating disorder. The primary cause of the problem isn't eating or weight. Instead, it is the manifestation of a society excluding, isolating and shaming a population into a submission. In effect, sanctioned prejudice against overweight people has created a psychiatric condition and worsened the growing public health issue of eating disorders. 

The real solution to the problem is to stop pathologizing weight. Overweight people can also be healthy and medically well. The myth that a higher weight is directly linked to poor health is steadily being debunked by research. People deserve to live their lives fully and feel like complete, valued human beings no matter their weight. 

The growing movement of weight acceptance demands that people identify and question the bias towards those who are overweight, a very ignored and tolerated prejudice. Acknowledging the unfair treatment of this population is a big step towards challenging the accepted norms. It is no more acceptable to say one doesn't like fat people as it is to not like people of another race or sexual orientation. 

The best treatment for someone with pathological obesity is to work towards self-acceptance. Rather than believe life isn't worthwhile without weighing a certain number, healing comes with the growing idea that someone has as much inherent value no matter their size. Personal acceptance of that statement needs to accompany a more general belief that bias against someone because of their weight isn't acceptable in any form.

Reviewing the Concept of Full Recovery from an Eating Disorder

This time of year I don't write a post for several weeks, but my thoughts continued to churn about the concept of full recovery from an eating disorder. 

The cultural understanding of eating disorders is a chronic, incurable illness. The struggle to manage the illness may be beneficial, but the concept of full recovery doesn't translate into a world that lacks the general knowledge about these illnesses. 

The medical approach to treatment in the 80's and 90's is the main culprit in the communal hopelessness about recovery. Forced feeding combined with punitive therapy only entrenched people in their eating disorder and made the idea of recovery absurd. The failure of those initial treatments led the larger community to this erroneous belief about eating disorders. Even now the continued use of the medical approach to recovery spreads the notion that no one gets better from an eating disorder. 

The clinical approach from the last two decades presents recovery in a very different light. Refeeding and improved nutrition and health are crucial initial steps into treatment; however, these steps are necessary only for one's mind and body to begin to work again after an extended period of being malnourished. 

The focus of recovery is the transformation of the internal psychological experience of an eating disorder. Understanding the nature of the illness and the daily personal experience immediately helps a sufferer feel understood. Presenting alternate ways to identify and then question these eating disorder thoughts begins the process of freedom from the psychological component of the eating disorder, the part which keeps people so trapped. 

In addition, this mode of treatment centers on compassion for oneself and the struggle in recovery. The eating disorder thoughts are constantly punitive and make the person feel awful about themselves. The end result is isolation which only increases the power of the eating disorder. As I have written many times in this blog, compassion and love are the strongest antidotes to the eating disorder thoughts. 

No matter how many times I write about full recovery, it never seems to be enough. Full recovery is always possible for people with eating disorders and always needs to be the ultimate goal.