It is important to assert, before beginning this article, that recovery from an eating disorder is absolutely possible.
That said, it does not come easily and, on some occasions, does not come quickly.
While the hope is that an individual’s disordered eating patterns are recognized and treated early and that interventions and treatments lead to longstanding recovery, this is not always the case.
A “significant portion” of individuals struggling with eating disorders experience longstanding disorders “despite the use of well-established and evidence-based treatment forms .”
Risk & Protective Factors
The longer an individual engages in disordered eating behaviors, the more these behaviors become ingrained, making them more difficult to treat. Research has indicated a few factors that make achieving recovery more difficult and put an individual at risk for a longstanding eating disorder.
Some of these factors include “comorbidity (i.e., anxiety and depression), weight concern, shape concern, and bulimic episodes.” Studies also indicate that excessive levels of exercise “predict a poor outcome of treatment, as well as an increased risk of relapse.”
Just as there are factors that increase the likelihood of a longstanding eating disorder, there are others that support recovery such as an individual’s motivation to change as well as their initial response to treatment . Rapid response to treatment seems to be associated with higher levels of recovery.
Clinical View of Longstanding Eating Disorders
While more challenging, treatment of a longstanding eating disorder resulting in recovery is still possible.
There is a debate in the treatment community regarding whether eating disorders can become “chronic,” with some researchers and clinicians feeling that, “after the eating disorder has been present for a decade, care should focus on the quality of life, rather than on symptom remission .”
Others, however, maintain that an eating disorder should not become a given or accepted circumstance simply because it has existed for ten years or more.
In fact, one study determined that about two-thirds of individuals that did not recover from anorexia or bulimia by nine years did so by 22 years . This study shows that recovery from an eating disorder is always possible.
In treating these disorders, clinicians often focus on amplifying the protective factors mentioned above and combatting the risk factors discussed above.
One study specified that inpatient treatment for longstanding eating disorders is “primarily concerned with the processes hypothesized to maintain the patients’ ED psychopathology, aiming to view cognitive processes as central, altering abnormal attitudes to body shape and weight, replacing dysfunctional dieting with normal eating habits and developing coping skills for resisting bingeing and purging .”
This study emphasized that their treatment is individualized, looking at what thoughts and beliefs are in place that maintains the individual’s eating disorder pathology and to then work against them .
Longstanding eating disorders are not often discussed, likely due to the helpless feeling those struggling, their families, and clinicians feel in attempting numerous, evidence-based, treatments, and still not seeing the desired result of recovery.
However, it is because of this that treatment of longstanding disorders needs to be examined and discussed. Those individuals are not alone, they are not hopeless cases, and recovery is still possible for them.
Resources: Bratland-Sanda, S., K. A. Vrabel (2018). An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders. Journal of Eating Disorders, 6:15.  Stiles, L. Evidence against palliative care in long-term eating disorders. Retrieved on January 8, 2019 from https://www.psychiatryadvisor.com/eating-disorders/study-finds-evidence-against-palliative-care-in-long-term-anorexia-and-bulimia/article/631329/.  Eddy, K.T., Tabri, N., Thomas, J.J., et al. (2016). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. Journal of Clinical Psychiatry.
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 on January 31, 2019.
Reviewed & Approved on January 31, 2019, by Jacquelyn Ekern MS, LPC
Published on EatingDisorderHope.com