Clients, family, and even outside providers are often frustrated by the length of time clients are in active treatment for an eating disorder. While we all wish this was a sprint to the finish line, the truth is this is a marathon. It takes months, years, and even a lifetime to recover from diseases like anorexia, bulimia, binge eating, compulsive exercise and related behaviors.
Why does this take so long?
Because this is a brain disease that has many different components. While the first order of business may be re-feeding someone or stopping binge, purge, or over-exercising behaviors, this is hardly the entire issue. The best way to think about eating disorders is that they are part of a larger umbrella of mental health concerns. Eating disorders are deeply embedded with anxiety, trauma, depression, neglect, mood disorders, obsessive compulsive disorder, ADHD, and other neurologic conditions. When you take away the eating disorder, which is how someone learned to cope with the underlying mental health issue, the fundamental diagnosis becomes much more prominent.
Imagine a loved one named Denice has been sexually assaulted early in life and they turn to food to calm themselves whenever they feel unsafe. Their sense of calm is temporary. So, more binges may result. In a society that shames anyone for binge eating or being “fat,” Denice is likely to feel intense guilt and humiliation for eating and may try to throw up or stop eating for a long time to “undo” the binge. The act of purging increases dopamine and adrenaline which feels better for a time. The act of not eating may bring about a sense of control over their body – that is until the restriction leads to a sense of overwhelm from hunger cues and obsessional thoughts about food. Then the binge eating is back, and the cycle continues. Denice eventually may even come to look forward to the cycle of behaviors and feel increased mastery over the experience. For someone who is biologically susceptible to an eating disorder, this behavior seems to help take away the anxiety just like a drug and they will do it again and again. The eating disorder has now taken hold.
Denice may work on stopping the eating disorder behaviors in treatment, but that means the underlying anxiety and trauma now resurface. The hard part about recovery is that nothing will work as well as the eating disorder to alleviate those feelings. And the thoughts may never go away. On top of it, this is not just a biological or brain-based issue. The environment Denice lives in is a constant trigger with its focus on thinness for women and muscularity for men. Like all of us, Denice is bombarded with media prescribing how some product or diet will make a body more desirable and life more wonderful. Like all of us, Denice overhears random conversations at the local café or gym where folks gossip about who lost weight, who looks younger, and how they did it. It’s nearly impossible to escape. Put it all together, and you have a society that normalizes eating disorder behaviors and trumpets fat phobia, the very things that reinforce the eating disorder.
Denice, like all clients, must develop trust in treatment professionals to help, which is incredibly difficult when you suffer anxiety. Once trust is established, it takes a long time to stop the eating disorder behaviors. There’s no magic set of tools that helps everyone reduce their anxiety enough to quit their behaviors cold turkey. It’s an act of trial and error until a certain number of skills are mastered. And then Denice still has to work on the root cause of the anxiety and trauma. Digging into that work too quickly can lead to a significant relapse. All the while, Denice needs to create a healthy environment to recover and live in. Educating family, friends, and loved ones on eating disorders and how to best help Denice is step one. Denice may also need to disengage from those who are not able or willing to help them recover or who inflict real emotional and physical harm on them.
And this is just one example of a million variations of how eating disorders present and treatment may ensue.
You can image how long it must take to revamp an individual’s body, mind, and environment. Now imagine that person has struggled for years and even decades with an eating disorder. This is a long road and the destination we call “recovered” may seem unreachable. The end result is worth it. But it may take a while.