To consider long-term effectiveness of eating disorder treatment, it is important to explore what an “effective” treatment journey truly is, how one defines “relapse” or “recovery,” and the role that treatment centers AND the individual themselves play.
For those struggling with an eating disorder diagnosis, the big question on their hearts and minds is “will this ever end?”
This hopeless and fearful plea is heard often in treatment facilities, as individuals bravely work through the most painful aspects of their mental and physical wellness in an attempt to loosen the grip the eating disorder has on their lives.
Many factors contribute to long-term treatment success, some of which depend on the treatment center and others that can be controlled by the individual themselves.
The Treatment Process
Eating disorder treatment is often referred to as one experience, however, few understand that eating disorder treatment is a progression of various levels of care that individuals work through to achieve recovery.
The level of care one begins treatment at depends on what an eating disorder treatment professional recommends during an initial assessment.
This assessment will ask for information on eating disorder onset, specific aspects of behaviors, treatment history, mental health history, family dynamics, substance use, psychiatric and medical history, and various other aspects of mental and physical wellness that indicate severity of the disorder.
Recommendations will range from the most acute level of care, Inpatient Hospitalization/Medical Stabilization, and move down to the following levels of care (in order of severity of disorder) – Residential Treatment Center, Partial Hospitalization Program, Intensive Outpatient, and the final stage for maintenance of recovery, Outpatient.
Individuals will move from the level of care recommended down each step until they are appropriate for Outpatient.
This means what is typically assumed to be a 1-3 month treatment experience at one location is actually often a journey that is, minimum, a year long.
It is not one treatment phase that dictates treatment or treatment success but participation in all required levels of treatment as recommended.
With this understanding, one can see why an individual in treatment would want to know that participating in this journey will help them achieve long-term recovery.
The answer is not as simple as one would hope, but, reflecting on the concept of relapse and the role of the individual can help to replace this fear-based question with empowerment and ownership of the recovery journey.
What is Relapse?
First thing’s first, defining what “successful” treatment outcomes are is important in considering the effectiveness of treatment.
A study published in the Journal of Eating Disorders aptly stated, “there are almost as many definitions of relapse, remission, and recovery as there are studies of them .”
The concept of “relapse” or “recovery” is incredibly subjective, especially considering not only eating disorder professional’s opinions but the views of recovered or struggling individuals as well.
It is difficult to put one specific definition on these terms, however, the study mentioned above did compile the results of numerous studies to attempt this.
The study suggested that definitions of relapse, recovery, and remission include “objective measures (BMI; observable behaviors of restricting, binging, and purging), subjective measures (fear of gaining weight, disturbance of body image), standardized ratings, and specific durations of follow-up (1, 3, 6, and 12 months) that are conducive to utilization across both clinical and research settings .”
Without this current definition as a mainstream measurement, it is important to consider that much of the research that has been done on the topics of relapse, remission, and recovery may be based on varying definitions.
Even so, a more general but helpful view of relapse is often to consider that it exists in the eye of the beholder.
Ask yourself what your life/behaviors/beliefs were when you were in your deepest eating disorder moments. If much of this is a reality in the present moment, that indicates relapse.
Even so, be aware that there is no firm definition for relapse or recovery, therefore, it is important to speak with treatment professionals about how you can recognize each for yourself.
Treatment & Success
There are many aspects of treatment that can lead to more positive long-term outcomes for eating disorder recovery.
Treatment modality is absolutely a factor in treatment success, as treatment centers should be considering the most evidence-based practices in their support of patients.
Treatment modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (the Maudsley Method) are proven to be effective in the treatment of eating disorders and are good to look-out for when choosing a treatment center.
Individuals are also more likely to effectively achieve long-term recovery if their family or support system is included in treatment.
For adolescents, there are specific methods of treatment created with family participation in mind.
Many treatment centers catering to adults include the family or support system as well but do not be afraid to advocate for this in order to experience the benefits that having informed support can have for recovery.
Individual Role in Recovery
Regardless of the above-mentioned aspects of treatment, the biggest factor in long-term treatment success is the individual themselves.
This might insight fear for those reading that are continuing to struggle but it is an important realization to have – you have to be the main proponent of your recovery.
It is, ultimately, the decisions made by the individual that make up recovery or contribute to relapse.
Therapists, Dietitians, support workers, nurses, doctors, family, and loved ones can all provide overwhelming support, insight, skills and advice, however, these are futile without the individual themselves turning them into action.
Recognize the power that you have to change the trajectory of your own future.
Resources Khalsa, S. et al (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5:20.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published May 24, 2021, on EatingDisorderHope.com
Reviewed & Approved on May 24, 2021, by Jacquelyn Ekern MS, LPC