Bright brochures coloured the walls near the reception desk providing a distilled portrayal of ED recovery. An unfathomable battle compressed into a palatable four paged leaflet. The pamphlets seemed like laughable propaganda in comparison to the hellish two year struggle my family and I had endured. As I approached the reception desk, the receptionist asked me when I was available for my next appointment. An oh-so familiar question. I responded by handing over my discharge form and informing her I wouldn’t be back. I was officially recovered from anorexia.
In the years following my discharge I have come to realise the complex and uncertain nature of being recovered. I have gone through periods during which I have had very poor body image. I have experienced moments, days and weeks of wishing my body looked very different to the reality. Intrusive thoughts related to food consumption occasionally resurface, particularly when life becomes stressful. I even have times when I wonder whether I can meaningfully consider myself recovered when there is no ridding myself of the challenges associated with my predisposition to anorexia.
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What is an eating disorder?
“An eating disorder is a serious mental illness associated with severe disturbances in people’s eating behaviours and related thoughts and emotions,” explains Dr Shona Fullarton. The Senior Clinical Psychologist has supported many adolescents through the eating disorder (ED) recovery process in her position at Clare House, a Government funded mental health service for adolescents in Tasmania.“There is often a preoccupation with food, body weight and shape, and exercise.”
There is no single cause, rather it is believed that a range of environmental and genetic factors contribute to the development of an ED. Certain genotypes are increasingly being acknowledged as having the capacity to increase one’s risk of developing an ED. An individual with a family history of an ED is 11 times more likely to develop one themselves. Epigenetics – the study of the environment affecting how genes are expressed – is also believed to influence the develop of an ED.
“Research indicates that the development of an eating disorder is a complex interaction of genetic, biological, psychological, behavioural and social factors,” Dr Fullarton said.
As far as social and behavioural factors go, Dr Fullarton highlights low self-esteem, perfectionism, the cultural value of ‘thinness’ and dieting to increase one’s risk of developing an ED.
Eating disorders are estimated to affect approximately four per cent of the Australian population. About 64 per cent of ED sufferers are women, however the prevalence of eating disorders is increasing in the male population.
How is recovery from an eating disorder characterised?
Dr Fullarton characterises recovery from an ED as the return to normal eating habits, thoughts and behaviours. According to her, recovery from an ED encompasses weight restoration, realistic thoughts and behaviours around food and a realistic body image. She further states the recovered individual should no longer struggle with ED cognitions or emotions and should have the capacity to engage in proactive relapse prevention.
“What we know is that the earlier treatment begins, and the sooner the young person is weight restored, the better the likelihood of full recovery,” she explained.
Whilst Dr Fullarton believes that full recovery is possible, she echoes the widely accepted caveat that the concept of ED recovery can be elusive.
“There is very little consensus to the definition of recovery from an ED. There is physical recovery – reaching your ideal body weight, menstrual cycle returning – but there is also the cognitive and emotional recovery from an ED. Recovery needs to focus on each of these,” she said.
Dr Fullarton suggested lines can become blurry post-recovery. She explained that an individual who has recovered from an ED may experience intrusive thoughts at times – this doesn’t necessarily mean they have relapsed.
“Intrusive thoughts can still occur once recovered. What is important is how the person responds to the intrusive thoughts.”
She explains that ideally, once recovered, one can recognise intrusive thoughts and put strategies in place to manage them.
Negative body image or an eating disorder?
It is also important to distinguish between negative body image and an eating disorder as they are not mutually exclusive.
“A negative body image alone does not mean that you have an ED. In terms of recovery, the aim is that the person can develop realistic body image and acceptance of this. It does not mean that they like it, but they no longer engage in maladaptive behaviours in response to the dislike,” Dr Fullarton clarified.
Chelsea Hanlon (20) was diagnosed with anorexia nervosa in 2015. Since then, she has undergone both inpatient and outpatient treatment but does not yet view herself as recovered. Ms Hanlon describes the recovery process as deeply challenging.
“For me, it’s not a glamorous thing at all. It’s tears, arguments and giving up. It’s pushing away everything and everyone who’s trying to help you. It’s raw, it’s lonely and it’s dark,” she said.
Ms Hanlon explains that while she believes it’s normal to have a fluctuating body image, she is careful to notice when her thoughts shift into dangerous territory.
“It’s a fine line. It’s understanding when it’s becoming bad again.”
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Is relapse normal?
Relapse is understood to be common in the process of recovering from an ED. The rate of relapse in those working to recover from anorexia and bulimia is suggested to be approximately 35 per cent. The highest risk of relapse is said to occur in the first 18 months of recovery.
Dr Fullarton says there are many triggers that can cause an individual to relapse. As part of the final stages of treatment, she encourages her patients to consider what some of their triggers may be, what they might notice themselves doing, and how they might respond if a trigger occurs.
In an effort to minimise the temptation to revert to unhealthy behaviours Ms Hanlon says she tries to avoid exposure to weight and calorie related information. Though, she explains that this isn’t an infallible process.
“Unfortunately you cannot ever fully implement precautions. There will always be a temptations to read labels or look at my weight at a friend’s house.”
Despite the challenges associated with ED recovery, she doesn’t doubt that with appropriate support and perseverance she has the capacity to fully recover.
“It is most certainly going to have ups and downs, but I hold onto hope.”
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So, am I recovered?
In my case, recovery was a slow and difficult process consisting of many ups and downs. For a long time, nothing was to co-exist with my anorexia. My extreme anxiety surrounding the consumption of food and weight gain ruled every crevasse of my mind and every aspect of my life. But slowly, small signs of recovery became apparent.
With the support of experts and my family, very gradually I learnt there were better ways to show strength than through starvation. My mind began to work the way it had in the past. Having struggled to even concentrate on reading a paragraph when I was unwell, I began to enjoy learning and deep thinking. I began to feel like a participant, rather than a passive bystander in my life.
I still have bad moments – days even – when my thinking will veer onto the unhealthy side. I eat healthily, but I am careful not to diet and I am an active person, but I monitor my exercise habits carefully to ensure it doesn’t become excessive.
Am I living free of a predisposition to anorexia? No, and I never will. But my life has purpose completely unrelated to food or numbers on the scale, so I claim the word ‘recovered’ as my own.
If you are worried about yourself or someone in your care, the best thing you can do is talk to someone. Please contact the Butterfly Foundation 1800 33 4673 or chat online.
