Saturday, May 11, 2013

Do you believe recovery just isn’t possible, at least, not for you?

Lessons from ICED 2013

I see 30-40 individuals suffering from anorexia, bulimia, binge eating disorder and disordered eating each week. Men and women, preteens through age 70+.  So short breaks and vacations are, of course, quite refreshing.

But last week’s Academy for Eating Disorders Conference, the International Conference on Eating Disorders (ICED) offered anything but relaxation.

Stimulating, inspiring, fascinating and hopeful—even these words do little justice to the conference presentations. I became pumped, and felt validated that the progress I see with my patients is not random. I was sparked by the incredible research demonstrating the progress in the understanding of eating disorders and their treatment. It only confirmed my belief that there’s reason for you, too, to know that recovery is possible.

Let me tell you about a session I was most excited about—Lisa Dawson, a PhD candidate’s research presentation entitled Recovery From Chronic Anorexia Nervosa: The Tipping Point for Change. You don’t have long-standing anorexia? Don’t stop reading. The lessons from this psychologist’s research are inspiring for all.

Dawson decided to select those individuals who recovered from anorexia—and I mean truly recovered—because by looking at this population we can figure out what elements are critical for recovery in anyone living with an eating disorder. They had to be free of anorexia for 7+ years, in an objectively normal weight range, and free of eating disorder behaviors. “You mean such people really exist?” you’re thinking? You bet. And she identified the common elements that contributed to their movement toward and their ultimate full recovery, based on extensive interviews with the participants. Here are some key points she identifies:

There are 4 stages to recovery, which individuals move through in one direction, and for differing amounts of time:
  1. unready/unable to change
  2. the tipping point of change
  3. active pursuit of recovery
  4. reflection and rehabilitation

In the first stage, people feel like they didn’t know why they were doing what they were doing (wrt ED behaviors) but felt they just couldn’t stop. They internalized the eating disorder and they perceived treatment as unhelpful. They felt misunderstood and lacked insight. In summary, recovery seemed impossible; they didn’t feel like anything they did made a difference for recovery, they had low motivation and had a sense of helplessness and hopelessness.

Over time, they realized that their eating disorder wasn’t helping them. Those who recovered also started to experience feeling understood. They were able to externalize the eating disorder and over time gained insight into their condition. They became more worn out by their eating disorder as well. Motivation increased. They started to feel that they had the power to change their situation, that they could impact their curse.

More value was placed on life outside their eating disorder. They learned skills to help them cope as they let go of their eating disorder behaviors.

Self-discovery, self-acceptance, and learning to love oneself were components of the maintenance stage.

It was a long, and slow process. But it happened.

So here’s an email I received this week from a patient of mine who, in spite of living with anorexia for more than 25 years, is now in recovery. The timing couldn't have been more fitting for this post:

"I've been continuing to do well with food.  I know I was upset at my last apt with life in general, but that did not affect my eating.  To date, I still have not purged or restricted or exercised.   Can you believe it? And... I don't want to forget to tell you so I'll share now, re: exercise...  I have been taking walks after dinner with either one of the girls or my husband or all (not every night, but several) and it didn't dawn on me til yesterday that I can go on these walks and I haven't:

  • thought about how many calories I'm burning
  • gone at fast pace to burn more calories
  • obsessed over having to walk each and every night/same time/same pace/same path 
Instead, I:
  • go on a walk if I feel like it
  • enjoy whatever pace I seem to be going at, without thoughts of burning calories
  • actually enjoy being present with the people I'm walking with!!! 
I do not fret if I can't make a walk.  I do not keep track of how many nights I've walked. I do not feel it's necessary if I've eaten a larger dinner. The obsession is not there!  Where did it go? I don't feel it, all I feel is the happiness that I'm going on a walk with a very loved family member where we can chat and talk and laugh. 
Huh? When did this happen?! Although it may not seem big, it really didn't hit me until yesterday that these walks are not the same walks as in the past. Not one bit. I am totally present and I completely enjoy them. And I continue to eat. Normally. I think I now know what normal is. At least, my normal. And I never, ever thought I would find "normal". And "normal" to me means:
I can eat when I'm hungry, know when I'm full, eat what I want in moderation... and because of this, I have not gained 30 lbs in 5 days as previously thought. I have gained weight.  I am working on accepting the feelings that accompany this. I think I'm in a better place to work on this. Nobody likes to gain weight, that's pretty much reality. But... I'm healthy.   
I put myself, my body, through hell. Can you imagine deliberately depriving your own body of nutrients it needs to stay alive? Can you imagine the destruction throwing up food causes? Or ingesting a plethora of pills to help further the weight loss process? How good is THAT for your body?! Oh my God, I sit and think how the hell am I still alive!!!  This has been going on for decades!  
I am at a really low point - sad, lost, confused, lost, angry, lost...  I feel like everything is out of control in my life.  Where did I turn for all those years to gain control over something when everything else felt so out of control? Ed. But what is happening now? Everything feels so out of control, yet the ONLY thing that feels IN control is my decision to eat well. Isn't this the complete opposite? What is going on here?  
So, the point of this email is to tell you that I have the strength to continue fighting this and I will succeed.  You are not going to see me relapse. Everything about this eating disorder is finally beginning to make sense. I have so much more to share but I'll save that for our next meeting. 
Lori, boy I can't begin to tell you how everything you've taught me is now landing in place and making sense and how in the world do I thank you for that?I was so, so sick.You saved my life.I still have work to do, I'm a work in progress, but slowly I'm regaining inner strength - which is just what I need to move forward. 
Thank you, thank you, thank you..."

I share this, with her permission, because while recovery is challenging, to say the least, it happens. And what I hear from her and from others confirms what Lisa Dawson shared in her study—that belief that you can recover, that change is in your hands, is essential for recovery. And that working with providers who get it and help you feel understood, and provide hope that full recovery is possible, can make all the difference.

Your thoughts?


  1. Lori, thank you to you and your patient for sharing this poignant and insightful message. I am really moved – to tears actually – and somewhat encouraged that full and determined recovery is possible. I mean, I eat and I take the steps towards that incredible shift but it still eludes me. One day...I hope...and so I continue moving towards it...

  2. Lori,

    As I am on my start to recovery this is truly inspiring!! Thank you for sharing and thank you to your patient for allowing you to share. I have become very hopeful that I too will recover and think about food normally again. Thank you again for your support and thank you for sharing.

  3. I used to believe that I was the exception. That recovery was possible for everyone but me. This last February I relapsed hard and voluntarily admitted myself into inpatient treatment. It was there that I met some of the strongest people I know and finally saw myself on an even playing field. I genuinely believed in the recovery and healing of everyone around me, so why couldn't that include me? It does and since then I haven't looked back. In less than a week I will be getting married, something that wouldn't be possible if I wasn't actively choosing and pursuing recovery. Hope is a wonderful thing and its freely available if you allow it. Thanks so much Lori for this post and to your patient for having the courage to push forward and share it with the rest of the world.

  4. Belief that I can recover is something that I have and then I lose and then I have and then I lose. Sometimes the hope stays with me for a good chunk of time. Other times it is gone in a minute. I cant imagine a life when obsessive thoughts are history, when eating comes naturally, and I dont feel that food and its importance is overrated. I cant imagine a day when there is no calculator lodged in my brain. I dont actually remember a time when this was not the case. But, I do believe it is possible. For me, my well of hope fills up when I hear of other people who have felt the exact way I do and have recovered - have stopped living this subpar life. Working with a team of people like you, who reassure me that it IS possible, despite the morbid statistics, is crucial. There was once a moment when I thought one of my providers had given up on me, lost hope for me, and I was devastated. I didnt know how I could even consider moving forward in recovery if I was hopeless in her eyes. I agree with the study you reference- when I see the rest of my life as more important than my eating disorder, that is when my hope can sneak in and stay for awhile.

    1. I was right where you are- eating food and maintaining a semihealthy weight but I was soooo unhealthy inside. I was obsessed with calories, wouldn't stray from my set food schedule, weighed myself several times a day, and couldn't imagine life without ED seeping into ever part of my life. But when I started seeing Lori, she encouraged me to take the little steps- stop weighing myself (5 months today since I let the scale have power over me!!!), start paying attention to my hunger cues-then, with time, start responding, make a few increases to my basic meal plan, start making myself treats (food to eat-fabulous source of ideas!:)), think about the non-appearance positives of each part of my body such as strengthetc. At first it was just actions, and I struggled to really respond to my hunger but eventually, it started to become more and more mental. Now I can't imagine ever going back- I have so much strength, joy, and freedom! I don't think about weight all day and I eat when I'm hungry, not when it's "time". Take hope, and take the little steps!

  5. Last year on mothers day you urged your readers to have hope that recovery was possible because you KNOW it is. I held on to that for dear life over the last year. This year I am pleased to say that I have more and more frequent glimpses into the life your patient described. Today I can say for myself that I believe that I WILL recover fully. Thank you for letting me know a year ago when I first started reading your blog that it was most certainly possible and of course for this encouraging and inspiring post!

  6. I still don't feel like I'll ever be "normal." I've had an ED for 20 years, and don't think that I could ever be free of it. It's nice to see that others can though.

    1. While recovery is possible, it's not passive. The first step is believing that recovery is possible; if you're stuck there, it will never happen.

    2. Exactly what Lori is saying: If you're stuck there, it will never happen. I know this because I was stuck there for a long, long time. And I resigned to the fact that I would not recover. Others can, but it's just not in my cards. And as a result I didn't try that hard so clearly I didn't or couldn't succeed. It wasn't until I understood fully that I have to choose to recover and not half-assed, either. It is really only up to me, I'm the only one that can make this happen. Lori's right, recovery is absolutely not passive! It doesn't just 'happen' to you because you want it, you have to actively make it happen with all the strength you can gather! You have to make the decision to want it. I believe recovery is a decision, it's a choice, and it's hard work. But recovery IS possible.

  7. OK, at 5'1" and 160 pounds, I am overweight. I exercise and take care not to overeat, but the number on the scale doesn't change. I am not interested in dieting because WW et al. leave me feeling trapped and constantly thinking of food. I know logically that I am doing my best to live a healthy lifestyle, but sometimes I feel guilty if I'm full at the end of a meal. Is this a symptom of ED, or is it normal to be frustrated in my situation?

    1. Guilt does not constitute an eating disorder, nor does frustration. You seem to be sensible to know that restrictive eating sets you up for trouble. Perhaps the work to be done is accepting that your weight may be just fine for you--if you are healthy and fit, particularly if this is a normal place for you, if you have always been larger than average or that the charts dictate is 'normal'. The best change you can make is freeing yourself from the guilt!

    2. Thank you. That really helps.