In the eating disorder world, ‘ED’ usually refers to just that – eating disorders. Sometimes as an abbreviation, sometimes as if naming the disorder ‘Ed’ and personifying it to better understand the way the disease can manipulate people and drives their actions.
Today, though, the ‘ed’ I’m referring to is that which is attached to the word ‘recover’ – as in, recovered. I believe in full recovery. Here’s why.
Let’s just get this out of the way first. There are some who belong to the school of thought that says, ‘Once a patient, always a patient,’ and that if you have ever suffered from an eating disorder then you cannot fully recover and must always be on guard for relapse, no matter what level of mental, physical, and emotional health you achieve. Some research has suggested that there is a genetic predisposition to developing an eating disorder (you can read about some of that here, and I encourage you to do so). According to the most recent statistics available to the Eating Disorders Coalition (which you can download here), genetics have been determined to have an influence in the development of an eating disorder in 50-80% of cases.
Well, that’s the first reason that I reject the idea that no one can fully recover from an eating disorder. If current research says 50-80%, then that means that between 20-50% of cases, or a minimum of 1 in 5 people, have no genetic predisposition. From the above link at something-fishy.org, in case you didn’t read it:
“It is also important to note that there are people who develop an Eating Disorder who have no corresponding predisposition. While there may be genes that play a role…(for some people), the emphasis on emotional, behavioral and environmental factors cannot and should not be dismissed.”
To state that a genetic predisposition in 50-80% of cases means that there’s no such thing as full recovery is short-sighted, and a dangerous message to send to at least the 20-50% who aren’t included in that. Additionally, making a blanket statement on the effects of genetics on disease and recovery suggests that the cause of eating disorders has been determined.
Casuality, though, is a tricky subject, and a word that is generally avoided, lest we over-simplify. It’s easy to point out things that have contributed to an eating disorder, but rarely can you identify a singular cause, and this includes genetics, because being predispositioned to a behavior doesn’t necessarily mean you are destined to engage in it. Similarly, someone who is predispositioned to alcoholism will likely never develop a drinking problem if they never, ever drink. So we have the classic concept of genetics loading the gun and the environment pulling the trigger.
I’ve heard people say before, “Oh, I’m recovered. I mean, I still struggle sometimes with negative body issues or hating certain parts of myself, you know, I have bad days, but I’m recovered.” Sorry, but that isn’t recovered. Don’t get me wrong – compared to engaging in ED behavior, that’s a much better place to be in, and I absolutely do not mean to discredit anyone’s progress, because recovery is hard work. But full recovery means full acceptance of ourselves and all the things that make each of us unique. It means not hating your body or yourself. It means not being triggered anymore.
Research arguments aside, I can attest from my own personal, day to day experience that full recovery is possible. Simply put, I believe in it because it’s something I have experienced in my life. I was anorexic for two years, and considered myself in recovery until about 2007. In other words, I was actively engaged and struggling with the disease and behaviors for about two years, and spent maybe another three identifying and weeding out all the tiny compulsions that, when I was sick, would have definitely led to ED behavior, but for a time afterward simply triggered some anxiety that I learned to deal with in a healthy way. After a certain amount of time, the positive, self-compassionate response to life’s difficulties was all that was left.
I’ll be the first to admit, again, that recovery is hard work. There’s no set amount of time that it will take to get better. Sometimes, co-morbidities with other mental health problems, life events, and yes, genetic predisposition, may make the recovery process longer. Some people may indeed always have to be on guard for ED’s voice in their ear, telling them to hate themselves and engage in eating disordered behavior. And there’s nothing wrong with that, because recovery is a journey. You can’t be so focused on the destination that you never look down to check the path you’re on, lest you stumble.
But that’s exactly what the field at large is starting to do over this promising and important research – stumbling. I hear a very contradictory message sometimes, one that says there is hope in recovery, but that that hope is finite because once you’ve been there, you’ll never get out completely.
Such a message does a disservice to the very people that activists, writers, researchers, and advocates want to help. I’ll close with something a dear friend of mine recently wrote:
I feel a human being is a very powerful energy of intellect, energy, perseverance, ability, presence, science, spirit, soul and ability (among many other things). In my opinion, there is no obstacle that a human being cannot overcome, especially when they add in the mindfulness and belief in prayer, meditation and God (however you define God) to nutritional and cognitive discipline. To place limits on what a human being/human brain and body can or cannot do is an injustice and insult to science and something that our society does not need. Our world is already lacking in hope and is broken-spirited in so many ways. To further that brokenness by revoking the very basal and intrinsic desire for and existence of hope from a human being’s soul by placing limits on their abilities, violates the amazing mystery of life that we were each born into. Clearly, I am a firm believer that a human being can heal the body and the brain; I have seen it happen.
As always, I want to know what you think. Sound off in the comments!
UPDATE! There was so much discussion that I wrote a follow-up post, which you can find here!
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” But full recovery means full acceptance of ourselves and all the things that make each of us unique. It means not hating your body or yourself. It means not being triggered anymore.”
I debate the idea of full recovery. Further, I debate the term “recovery” as it applies to the topic of a mental illness. In another light, your argument suggests that those who have survived cancer cannot claim a recovered life if they continue to demonstrate depression from the illness, despite having no longer a physical turmoil. The mind and body are two individual entities in my perspective; one can be ill while the other thrives. Yes, I agree with the sentiments that it is possible to overcome the physical side of anorexia / bulimia / over-eating and EDNOS. But I do believe that the mental aspect takes a much, much more powerful treatment plan before one can pronounce “cured.”
It’s hard to put this into perspective, especially when the push is to succeed in a full recovery, rather than to push for understanding. I am now in my 13th year of having an ED. While I do not engage in the physical as much as I once did, I do struggle mentally on a daily basis. I am not ashamed, or feel a sense of guilt in admitting this. I believe in an acceptance of who I am as a person and don’t push for the “Recovery” goal to wear as a badge on my sweater. I want to understand why the idea of self harm, hate, and abuse seemed more relaxing / calming in my childhood than that of asking for help.
This is – and perhaps always will be – a debate within me; the idea of being fully recovered / cured. I celebrate those who have “won” both mentally and physically over their ED’s, but I accept and love those who are still fighting.
I appreciate your comments and perspective, Megan. One of the things I was trying to convey is that its complicated, and therefore I think its unreasonable for anyone to state with any certainty that, hypothetically, full recovery isn’t possible. But, that is exactly what many in the ED world are doing due to genetic links that have been associated with EDs.
I don’t share your perspective that the mind and body exist separately; I think the health and function of one is indelibly linked to the other. It is often difficult and challenging work, though, to get them in perfect harmony!
I do agree though that treating the mental side can be longer and more difficult. I think often the focus is so much on physical health that the mental side gets neglected. That doesn’t mean it’s impossible, though, which is what matters.
I’m going to have to agree with you and your friend. It sounds cliched and a bit childish, but I believe you can do anything you put your mind to! It’s incredibly important for everyone (not just those suffering) to know full recovery is obtainable.
I love reading positive posts like this one. I wholeheartedly agree with you, Matt and applaud you for sharing along with the only strong voices out there who believe and KNOW that full recovery is possible.
“I’ve heard people say before, ‘Oh, I’m recovered. I mean, I still struggle sometimes with negative body issues or hating certain parts of myself, you know, I have bad days, but I’m recovered.’ Sorry, but that isn’t recovered. . . . But full recovery means full acceptance of ourselves and all the things that make each of us unique. It means not hating your body or yourself. It means not being triggered anymore.”
The thing about a statement like this is that . . . EVERYONE has insecurities sometimes. Sometimes they are body related, or career related, or personality related, or family related. Having insecurity is part of being human. Insecurity – at times – can be a catalyst for growth. Of course, there is also insecurity that is not necessarily productive, and that is harmful. That said, I don’t know if I’ve come across in a woman in the U.S. who never has days where she experiences some negative body image. Even the women I know who’ve never had eating disorders can feel triggered to want to lose weight, or change their bodies in some way. I suspect this might be increasingly true for men. I think that, in the spirit of determining who is recovered, it’s possible to hold people in recover/remission/recovered from eating disorders up to an ideal of having the perfect body image, the perfect self-acceptance . . . and I’m not sure anyone has that. Not anyone I’ve met, anyway.
About ten years ago, I considered myself Recovered. (Yes, capital “R.”) I remember distinctly thinking, “I can’t imagine having an eating disorder anymore. I can’t even imagine wanting one.” I’ve relapsed a few times since then, and now I am in recovery and I think that this recovery will really stick. It’s different than past recoveries in a number of ways, and I also think I’ve finally found the right treatment team and the right treatment program. And one of the things that is helpful for me in recovery is being able to talk about the fact that most women in the U.S. have some level of body image struggles. The fact that I don’t have a perfect body image and 100% self-acceptance at all times doesn’t mean that my recovery isn’t strong.
Personally, I find the most problematic part of the debate about defining recovery to be when we determine for other people what recovery is, or determine for other people whether they are or are not recovered (or whether they should be thinking about recovery in terms different than they are). A treatment center from my past very much believed in the “Being recovered means embracing yourself completely, ‘flaws’ and all” model. I’m sure that that works for some people, and if it helps people recover, then I’m all for it. For me, it caused me to spend years doubting my recovery and, my ability to ever achieve “full recovery.” It made me feel like a recovery fraud because, you know what? I’m human, with a range of human emotions, and sometimes those emotions include insecurity. And sometimes that insecurity is about my body.
I do a fair amount of e.d. education and advocacy, and when people ask me how I define recovery, usually I say something like, “This is something that’s often debated, and people define recovery in different ways. For me, personally, I think of my eating disorder as in remission. I think that I was/am predisposed to eating disorders in a number of ways, including genetics. AND I think that I have the tools to keep it in remission indefinitely, and it does not have to be part of my daily life or thought process.” That’s how I define it for me. Some may define it similarly, some may cringe at my use of “remission.” And that’s okay. That’s how I think of recovery for myself, in terms of my own journey and my own experiences. And I would refer to you as recovered, because that is how you see yourself. I wouldn’t refer to you as in remission or doubt your understanding of the course of eating disorders because you get to set the standard for yourself. I just don’t think it’s right to make ourselves recovery authorities who get to determine who’s in or out.
Thanks for your thoughts, Sarah. I think your comments just emphasize one of the most important aspects of the discussion: recovery is an extremely personal subject and is going to be a little different for everyone. Some of the things that I did in my recovery might not work for everyone (or anyone!) else, and likewise, the definition of recovery that I find most applicable to my life and health might not be the same for everyone.
My intent was to write about the potential for full recovery in reaction to what is a louder-every-day voice in the professional and activist community that one cannot ever fully recover. In doing so I guess I also started a discussion on what recovery actually IS, because if I’m going to claim you can fully recover, I guess it’s necessary to explain/define it.
I agree, everyone does have insecurities sometimes. The statement I made in the post, though, was about not HATING one’s body or self – a big difference between that and feeling insecure or self-conscious about something, and I wouldn’t necessarily assume that insecurities in and of themselves are rooted in an eating disorder or aren’t part of recovery.
You said, “Even the women I know who’ve never had eating disorders can feel triggered to want to lose weight, or change their bodies in some way. I suspect this might be increasingly true for men. I think that, in the spirit of determining who is recovered, it’s possible to hold people in recover/remission/recovered from eating disorders up to an ideal of having the perfect body image, the perfect self-acceptance . . . and I’m not sure anyone has that. Not anyone I’ve met, anyway.”
I think in this context, we must be deliberate in our use of the word ‘triggered’, because someone without an eating disorder is not going to experience it in the same way. Surely people are influenced by what they see on TV or diet ads, etc and may feel motivated or driven to lose weight, but the word trigger definitely has a specific context and meaning to someone with an eating disorder/in recovery. When I say it means not being triggered anymore, what I mean is not feeling triggered for disordered eating behavior – obsessing over weight, a desire to restrict/purge/over-eat/etc, things like that. When I was sick and during most of recovery, I would get triggered regularly and it was a constant battle to make healthy choices consistently. Until one day I realized – I’m not being triggered by anything anymore. There’s nothing that makes me want to restrict, lose weight, etc, and the things that used to do that, I’m able to view objectively without internalizing those messages on myself.
I fully agree and support your last paragraph – it’s important to let people identify as they will. I do indeed regard myself as recovered, and will talk myself hoarse with anyone who thinks I may not be! I do think though that it’s important for people to be in touch with how they are actually doing and to practice self-awareness. It would be problematic for someone to be talking to people in recovery, claiming full recovery, and then exhibiting an unhealthy relationship with food, anxiety around meals, etc – I’ve seen it before and it’s quite a difficult situation.
I’m thinking all these comments might be grounds for a second post to further discuss this topic. I appreciate your thoughts!
I think you are absolutely right Matt. It is people like you, and writings like these that make me truly believe that full recovery is possible. Although it is hard to vision this possibility, it is out there
You inspire me 
Well said Matt. I hope I didn’t come off as too abrasive or defensive in the wrong regard. Often I hear in recovery groups the negative repercussions that manifest when one doesn’t obtain 100% recovery. Relapses quickly follow and, sadly, there have been cases where those individuals do end their lives. You’re absolutely spot on when you say that the ED world is quickly using genetic make-up as a marker to either state one will recover, or one is “doomed” to live this vicious cycle. Above all else I strongly believe it’s in the individual to will the acceptance and fight the fight.
Congrats on the recent lobby, too! I heard good things through the Eating Disorder Coalition.