Eating disorder treatment is almost exclusively focused on meal plans and weight in recent years. The end goal of recovery is settling at the correct weight, and any obstacles in that path are signs of a recalcitrant patient unable to get well.
This formulation of eating disorder recovery is a complete misconception of what an eating disorder is and how people get better.
The first step in treatment does need to be restoration of regular eating and maintaining a baseline of health. Weight is one data point in that process but far from the only one or the most important one.
Regulation of food intake and overall health are treated as the central part of recovery. Since eating disorders are the only psychiatric illness with immediate medical consequences, a risk-averse mental health practitioner might feel overwhelmed by taking on this medical liability. I agree that stability is important but not as a way to sacrifice crucial psychological parts of getting well. The limitations of mental health clinicians can’t change what’s necessary for successful treatment, not if we really care what happens to the people we try to help.
Once enough stability is established, the true work of recovery begins. As hard as it can be to stabilize food, the psychological work is always harder.
Eating disorder symptoms have many powerful effects on daily life: clear structure to the day, unquestioned feedback of success or failure, immediate numbing of emotions and complete reliability at any given moment. In a world where none of these four is a guaranteed part of life, it’s very difficult to give up such absolutes for the vagaries and uncertainty of life otherwise.
Typically, the eating disorder symptoms start at a young age. Thus, people grow up with the four cornerstone benefits of an eating disorder and organize their lives and their identity around these core beliefs.
Recovery isn’t just about eating regularly. It’s about creating an entirely new sense of self and way to cope with daily life.
No wonder recovery must take on an existential quality. No wonder the therapy relationship must be so central to this transformation. No wonder eating is not just about food but about reengineering a new identity.
At the heart of this post is the concept of what eating disorder recovery looks like. The current state of the treatment field mistakenly says that eating and weight are the mainstays of getting well. The truth is that stabilization of food and weight is only the first part.
Recovery is truly learning about oneself, building a new way to function every day and exploring and building one’s own identity separate from the eating disorder. It’s a tall order, but this process provides the ability to live a full life.
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