People Can and Do Get Better from Anorexia

One of the hardest question I’m asked about recovery from anorexia is the following: what strategies or concepts are the most effective to combat the anorexic thoughts?

The reason this question is so hard is that there’s no simple or easy answer.

Despite decades of research into the biological underpinning for anorexia, there are no new data to use clinically that makes recovery and regular eating any easier.

Research into all different medications, including psychedelics, don’t show much benefit to make recovery different.

However, the lack of new information doesn’t mean we should disregard the decades of experience we have treating anorexia, nor the fact that treatment is much more nuanced and sophisticated than it was only a few decades ago.

First, we do know that consistent nourishment over an extended period of time will reverse the food and body thoughts for most people. Sometimes these changes are fast and other times slow.

Second, we know that regular food logs and consistent accountability helps people move forward in their lives. Recovery has nothing to do with willpower. Instead, people need external support and reminders to chip away at the power of the eating disorder thoughts.

Third, we know that treatment must include listening carefully to what people with anorexia say, think and feel. No one gets better by treating the illness and not the person. If someone in recovery is moving away from the illness and not moving towards something important to them, the changes won’t last.

Last, the process of recovery needs to center on hope. Any sense of desperation or hopelessness strengthens the illness and derails recovery.

In order to sustain hope, clinicians need to be well versed in the nature of eating disorders and recovery and to understand the ups and downs of the path to get well.

The less we all look for the magic bullet for recovery from anorexia and the more we use the available knowledge and tools, the more successful treatment can and will be.

Praise Doesn’t Feels Supportive to People in Eating Disorder Recovery

The last post about listening to people with eating disorders applies to family and friends as much as it does to clinicians and treatment.

Families often feel like their job is to monitor and assess food intake and adherence to a meal plan. Similarly, families want to reward following the treatment plan with praise. Yet this praise almost always backfires and actually strengthens the eating disorder—a fact hard for most people to understand.

The conundrum of how to support people in eating disorder recovery stems from the nature of the illness itself. The eating disorder thoughts are powerful and hard to resist. They bring comfort and a sense of accomplishment, no matter how destructive they are at the same time.

If family or friends praise progress in recovery, people with eating disorders struggle to hear the positive reinforcement as it’s intended. Instead, the praise betrays the eating disorder thoughts by reinforcing the idea that that eating normally is a failure. Other people recognize the changes and reveal the person is normal, like everyone else, something abhorrent to eating disorder thoughts. Moreover, the praise stirs up the frustration and sadness at leaving the eating disorder behind.

If instead families ask how to help or offer the opportunity to listen, people with eating disorders will likely be able to speak about how they actually feel. After being buried under eating disorder thoughts, it may take time before they feel safe to start to talk about how they’re feeling. However, without the pressure to perform and the feeling of being watched, exposed or even praised, they will feel more able to make their own decisions and not react to outside intrusions.

Of course, these thoughts don’t apply to people who are in medical danger, and the distinction between health risk and psychological stability is often not as clear as it would seem. In addition, different clinicians and families may be willing to accept more instability to provide a safe environment to start recovery. No matter the situation, an open, warm, loving environment is necessary for any successful recovery.

People with Eating Disorders Need to be Heard to get Better

If inpatient and residential treatment can be traumatizing, family based therapy doesn’t work for people 18 and over and people with eating disorders are trapped by the power of the thoughts of the illness, what are the other paths forward towards recovery?

The urgency for families and practitioners to do something, to have a concrete plan, is overpowering despite the evidence that these steps are unlikely to work after the first couple of tries. Even after many failed attempts at the options mentioned above, families and clinicians will often repeat the same plan futilely.

Increasingly, the focus of treatment is on meal plans and maintaining a symptom-free period of time at a determined weight as a magic cure. The evidence does show that remaining at a target weight long enough improves the chance of recovery. However, eating disorder thoughts often remain so strong at these weights that relapse is a common result. When this plan does not work, the patient is blamed.

Our culture tends to focus on the latest shiny object on social media and that is no doubt the case for eating disorder treatment. More and more, patients find their information about recovery on TikTok, but we have forgotten how much older information about treating eating disorders remains as useful as ever. Many of the lessons learned about eating disorder treatment in the past are fading into history.

Young people with eating disorders are often used to not being heard or seen. The eating disorder tends to be the only mode of expression younger people find effective after years of being seen as their illness rather than a real person. Expecting family and clinicians to ignore their thoughts and feelings as “just an expression of the eating disorder,” people in this situation express their frustration through even more severe symptoms until relapse feels like their only mode of being in this world.

A tried and true element of treating younger people with eating disorders is to listen to what this person is expressing through their illness and what they have to say. They feel so trapped and don’t expect anyone to care or listen to them. The isolation of being seen only as their illness leaves them no recourse to say how they feel. Really listening to their concerns can open a new path towards healing.

With treatment as an easy decision for clinicians, recovery often starts with ignoring what patients have to say. Before long, they have gone through a variety of outpatient programs and inpatient programs aimed at weight restoration only. Patients learn that the only way to be heard is through symptoms and behaviors. They learn there is no point in being honest because honesty is labeled as “the eating disorder talking.”

It would behoove families and clinicians alike to remember that people only get better from eating disorders when they are heard. Of course, food and health matter, but they are never enough to get better.