That is one of the most frequent questions I’m asked as an eating disorder treatment provider. I hear it from individuals considering treatment, those on their first day of programming and even those who’ve been in treatment for a while.
The short, least complicated – and perhaps most frustrating – answer is that every individual’s journey to recovery is different.
I know you’re probably saying, “Well, that’s unhelpful, Joanna.” I totally get it. Trust me, I wish I had a better answer. What I can say, fairly certainly, is that eating disorder recovery is rarely (if ever) linear. There are peaks and valleys – good days and bad days.
When I do try to answer this broad and somewhat ambiguous question, I typically do my best to include three steps that are critical in moving along in eating disorder recovery. It’s worth noting that none of these important components include any mention of pace. Lasting recovery means taking your time to collect the skills, coping techniques and behavioral understanding that will put you in a better position to say goodbye to ED.
Medical Stabilization: Medical stabilization is the first step in eating disorder recovery. This will again look different for each individual, but typically includes at least one of the following: weight restoration/maintenance, stabilization of vital signs such as heart rate and blood pressure, cessation or reduction in maladaptive coping behaviors, regulating body temperature and restoring adequate energy levels. Once someone is medically stabilized, the focus of recovery can then move to skill-building and significant cognitive change.
Psychological Work: Once the body and mind are better able to function optimally and process more complex thoughts and emotions (following medical stabilization), the work toward recovery can continue. In lower levels of care, patients are encouraged to explore thought distortions (“eating a bite of mac and cheese will make me gain X pounds”), challenge them and begin to understand the function that their eating disorder has served for them. For the majority of our clients, gaining this insight can be a lengthy process, one that needs to be faced with open-mindedness, self-compassion and transparency.
While the psychological piece to eating disorder recovery is often a life-long endeavor for many individuals, the average length of stay for our lower levels of care can vary from about four weeks (Partial Hospitalization Program) to eight weeks (Intensive Outpatient Program). Following that, individuals are encouraged to continue the important work with an outpatient eating disorder specialist. Interventions like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and motivational interviewing are great skills that can help reduce eating disorder thoughts and urges as well as increase cognitive awareness and self-esteem.
Addressing Environmental Component: One of the biggest goals that we discuss with our patients during treatment is the ability to function freely in their environment. This means students returning to school, professionals to their jobs and wanderlusts looking to book their next big trip. The environment that an individual returns to can have a major impact on recovery and is an important consideration as you move through treatment. Who do you live with? What do you enjoy socially? What about your environment is a trigger or potentially risky situation?
Evaluating these factors and creating a lapse/relapse prevention plan isn’t a set up for failure – it’s a highly effective method to cope ahead for the inevitable challenges that will arise outside the walls of treatment. Having the ability to understand how an environment can impact recovery success is a helpful way to gauge how you are progressing in your recovery. How are you dealing with everyday environmental stressors? Are you setting boundaries with your roommate? Are you removing yourself from situations that might feel triggering? If so, you are well on your way to living your life ED-free.
So while there isn’t a straightforward or definitive answer to the question “how long does recovery take,” medical stabilization, psychological interventions and a strong, supportive environment are important components that can help us to forecast recovery success.
Joanna Imse, LICSW is the Assistant Program Director of Walden’s Amherst, Mass clinic. In this role she oversees the day-to-day care of adults and adolescents in the partial hospitalization and intensive outpatient programs. She works closely with staff, providers, families and clients to help foster a recovery-focused environment. Her career at Walden began in 2011 when she served as clinician for adolescent IOP in Waltham. Prior to her current role, Joanna spent time as a clinician in Waltham, Worcester, Braintree and Peabody sites. She received her masters of social work at Salem State University in 2007.