How to Move Beyond “Mostly Recovered” to FULLY Recovered
Katy Harvey, RD, CEDRD
Eating disorder recovery is hard work, and that’s no exaggeration. Just ask someone who has been in treatment for a while. They’ll tell you that it’s exhausting - whether it’s being in a treatment center or attending outpatient appointments. It requires a lot of time and commitment (and $, but that’s a topic for another day).
And then there’s the emotional labor involved. Recovery requires a person to tend to their deepest wounds. This can be daunting and painful, but also very healing.
Recovery is a process of healing the body, brain, and spirit.
What does “mostly recovered” look like?
It’s easy to see where a person might want to stop at a place of “mostly recovered,” especially when things are significantly better than they used to be. They figure, “Things are so much better than before.” Just because things are better, relatively speaking, doesn’t mean that things are as good as they can get. I believe that you can reach full recovery, and I believe that it is worth fighting for.
Here are a few examples of what partial recovery might look like:
Eating just enough for the body to get by and function ok.
Putting limitations on what you’re willing to do in recovery.
Avoiding or distrusting your body’s appetite cues.
Having fewer episodes of restricting/bingeing/purging (or whatever your ED symptoms are).
Accepting your body or weight, but only up to a certain point.
Putting unnecessary restrictions on food.
You can see that there is still a lot of fear-based and rigid thinking going on here. These are not signs of a brain that has fully healed from an eating disorder.
Sometimes a person believes this is as good as things will get and that they should just settle. I’m here to tell you that you don’t have to settle.
What is Full Recovery?
Part of the challenge in this pursuit is that there is no consensus among professionals about what full recovery even looks like. You’ll also find that people want to argue the semantics of “recovered” vs “recovering” vs “in remission” and things like that.
By “full recovery” I mean that your eating disorder no longer negatively impacts your life.
And it essentially boils down to healing your brain.
You see, eating disorders are BIOLOGICALLY-BASED illnesses. This means that eating disorders are not a choice, or a phase, or a lifestyle. They are an actual mental illness of the brain. Studies are showing >50% of the variance for anorexia, bulimia and binge eating disorder comes from genetic factors. They are even starting to show which precise genes are affected.
Having a genetic susceptibility doesn’t guarantee a person will develop an eating disorder, however. It’s the old saying, “genetics load the gun, environment pulls the trigger.”
Thus, eating disorders are caused by a perfect storm of many factors, including genetics, temperament, life stressors, trauma, brain chemistry, culture, and even your gut microbiome. There’s still so much we don’t know about what causes eating disorders, but what we DO know is that the causes are multifactorial - it’s never just one thing.
Why is it important to understand this? Because when we can understand why eating disorders occur in the first place, we can find better and more effective ways to treat them.
Back to the Brain
If your brain doesn’t heal, you won’t fully recover.
Neurobiology research is showing that the brain structure and function are different in people with eating disorders, and even within eating disorders there are differences among type of diagnosis (i.e. anorexia, vs bulimia, vs binge eating disorder).
You can think of an eating disorder sort of like an injury to the brain, and recovery like healing the injury.
The brain is highly influenced by our eating, and nutrients in food serve as powerful “neuromodulators” - meaning that what we eat impacts our brain chemistry and can also impact the actual structure and functioning of the brain.
I’m not going to go into all of the areas of the brain and what they do, because that would take all day, but if you want to read more about this you can click here.
Let’s move on to what you can DO to help your brain heal. Because remember, if your brain doesn’t heal you’re not going to fully recover.
Tips for Healing Your Brain for Full Recovery
Connection is essential. People don’t heal alone. Human beings are wired for connection. As your relationships deepen, so will your recovery.
Be well-fed every day for your brain to function properly. Nutrition is powerful stuff. Being well-fed also means not trying to suppress your body’s weight. You need to allow your body to weigh what it wants to weigh, as uncomfortable as this may be in our weight-biased society.
Move beyond following a meal plan. The meal plan can be a useful tool at certain stages of recovery, but full recovery means rebuilding trust with your body to tell you what to eat and how much to eat. Intuitive eating is where you will find full recovery.
Mindfulness and cognitive flexibility are all components of a healthy brain. Practice these skills and you will get better at them.
Coping skills will help you build new neural pathways that support recovery rather than the eating disorder. Broadening your window of tolerance for emotional distress and having healthy ways to cope with unpleasant emotions is key.
Medication may play a key role. Some people are highly opposed to the idea of taking medication, but if you have a chemical imbalance in your brain, medication may be a big part of your solution. There’s no shame in this.
I’ll be the first to acknowledge that this is an oversimplified and incomplete take on the recovery process, because recovery is an extremely complicated thing. Each person’s story and journey are different, meaning that their recovery will be a unique experience. What I am trying to say is don’t settle for sub-par recovery. You deserve the richness of full and lasting recovery and the life that goes with it.
Katy Harvey, RD is a Certified Eating Disorder Registered Dietitian (CEDRD) from Kansas City. She has an outpatient private practice where she helps individuals heal their relationship with food, exercise and their body. She also blogs at Katy’s Blog.