Given the complexity of the brain, and the reality of everyday life, all of us are prone to some psychological issues. All psychiatric disorders may therefore have long term implications.
Anytime a person has had any psychological issue, whether it be anxiety, depression, panic, substance abuse, or an eating disorder, they’re always at greater risk for the return or relapse of this disorder. Recovery involves many things. Treatment must then be seen as having multiple phases.
For eating disorders these phases include:
· Medical stabilization - Insuring that the cardiac, brain, bones, endocrine (i.e.: the return of menses) and other systems are intact.
· Refeeding - Gaining an appropriate amount of weight, usually 95% of pre-morbid weight to prevent relapse.
· Behavioral control - Stopping or reducing binging, restriction, purging, over-exercise, and pill usage.
· Feeling better about oneself - Increasing self-esteem, better body image, general increased levels of happiness and the ability to experience multiple different emotions.
· Changing the way a person thinks about food, body size, and shape
· Having the life a person truly wants to have
One will see a therapist or be in a formal program for a significant amount of time, often measured in years. A person will also need caring and connection for the rest of their lives. Formal eating disorder treatment is likely to last one to five years given the complexity of the multiple stages of healing. All of the above happens in the context of building a supportive, knowledgeable, community that one will be able to experience for the rest of their lives. Each phase of treatment takes a variable amount of time, but no one who has ever suffered from an eating disorder should ever be without their community of care and support. In this way, although significant advances towards recovery may happen in as little as one year, healing should be seen as life-long.
Getting into recovery from an eating disorder is an extraordinary and rewarding experience. From the perspective of evidence-based therapies, particularly DBT, recovery is a path a person follows, not an end to be achieved. As an eating disorder gets better, a person gets to appreciate and enjoy their lives more and more. They come to fully inhabit their lives. For people with and without eating disorders, the process of achieving and continuing to be the person we most want to be is a joy we work towards forever.
Next week: How do we determine goal weight?
Contributions by Sarah Emerman