Author: Dariya Smith, LMSW, CSW-I
Picture this: You’ve been in eating disorder treatment for a long time. Perhaps many months, perhaps several years. Perhaps even the better part of your lifetime. And you’re in a better place than you were when you first started. Perhaps you’ve regained enough weight that you’re no longer suffering serious medical complications. Perhaps you’ve managed to gain control over some of your eating disorder behaviors, like binging and purging.
But at the end of the day, you’re still suffering. You still count calories or fat grams or carbs. You still avoid certain foods. You still make sure to exercise every day, and you feel anxious and overwhelmed if you don’t. You still hate your body.
And you start to wonder, is this what recovery is? A constant struggle—never feeling at ease in your own body, or in your relationship with food? Struggling every day to find some way to stay alive while still maintaining a sense of control over your body? Out of hell, but still in purgatory?
Have you ever felt this way?
If you have, you are not alone. This is a stage called partial remission, or what I like to call pseudo recovery.
What is pseudo recovery?
The word “recovered” often gets thrown around as though it has a clear-cut definition. Yet in reality, it’s not as simple as “sick” or “recovered.” Recovery happens on a continuum.
In the early stages of recovery, patients work toward recognizing the seriousness of their eating disorder and building motivation to change. In the middle stages, patients begin to make changes—eating more consistently, cutting back on binging and purging, and limiting compulsive exercise. In the final stages of recovery, patients work towards improving their self-esteem and learning to accept their bodies unconditionally (Costin, 2011).
But here’s the catch: many patients get stuck somewhere in the middle stages of recovery. They let go of some eating disorder behaviors, but not others. They may attain a “normal” BMI but continue to restrict their eating in an effort to ensure that they do not gain any more weight. They may eat three meals each day but continue exercising excessively. They may eat normally but continue to compulsively body check and insult their bodies.
Why do people get stuck in pseudo recovery?
People get stuck in pseudo recovery in part due to the nature of eating disorders, and in part due to problems inherent in the way that eating disorders are treated.
People in pseudo recovery often struggle to acknowledge that they still have a problem, because they feel like things are so much better than they were before. Even those who recognize that they are still sick are often hesitant to make the changes necessary for full recovery, because they fear that letting go of the perceived “control” they have over their weight will make them feel even worse.
In addition, many treatment programs do not adequately encourage patients to pursue full recovery. For patients with anorexia, many treatment programs focus on getting them to eat enough to maintain a minimally normal weight. However, there may be a big difference between the amount of food that is sufficient to keep someone at their target weight and a truly normal diet. This is in part because many eating disorder programs set target weights far too low, so patients have to continue restricting in order to maintain the target weight that was set for them (Boring, 2020).
There is also a push among providers to keep treatment as short as possible, to avoid interfering with people’s lives. Providers are often taught that once people get to a certain place in recovery, they will continue making progress even without any outside support (Fairburn, 2008). This is not necessarily true. Many patients continue to struggle with disordered behaviors and thinking patterns, long after they are weight restored (Van Bree et al., 2023).
What are the risks associated with pseudo recovery?
Patients who only achieve partial weight restoration, those who continue engaging in disordered eating behaviors, and those who continue to struggle with body dissatisfaction are all at higher risk for relapse (Keel et al., 2005; Sala et al., 2023).
Even in cases where patients can control their eating disorder enough to avoid relapse, their quality of life suffers immensely due to the thoughts and behaviors associated with their eating disorder.
Our Approach
We believe it is best to treat the patient’s eating disorder until they are fully recovered, rather than release them from treatment as soon as they are able to survive without us. We try to help people get fully recovered before releasing them from treatment, because we don’t just want people to survive; we want them to live.
We want them to be able to go out for dinner with a friend or a lover without worrying about how many calories are in their meal. We want them to eat cake on their children’s birthdays without feeling guilty afterwards. We want them to go swimming with their friends and be present in the moment, rather than being wrapped up in checking and criticizing their bodies. We want them to go on vacation with their families and enjoy time sleeping in and relaxing on the beach, rather than spending their mornings holed up in the hotel gym.
Survival is not enough; we want freedom.
What can you do if you are in pseudo recovery?
Pseudo recovery is a tough place to be. Some people believe that an eating disorder will always be with someone and they just have to accept it. We beg to differ. If you are stuck in partial remission, there are steps you can take to move in the direction of full recovery.
Identify the behaviors that are keeping your eating disorder going (dieting, body checking, compulsive exercise, etc.), and work with a therapist on eliminating these behaviors completely. The eating disorder is like a weed that grows in your garden, choking the life out of the flowers. If we only trim the leaves off the weeds, they will continue to grow back. We have to tear them out root and stem to give the flowers a chance to grow.
Embrace an anti-diet, Health at Every Size approach. In addition to eliminating eating disorder behaviors, it’s important to challenge the entire ideology that underlies your eating disorder. Recognizing the inaccuracies and inequities inherent in diet culture will help you to let go of these influences for good.
If you are suffering from an eating disorder, you deserve true recovery. We try to help people get to full recovery before ending treatment. We don’t just want people to survive; we want them to thrive.
References:
Cognitive Behavioral Therapy and Eating Disorders by Christopher G. Fairburn
Eight Keys to Recovery from an Eating Disorder by Carolyn Costin
https://onlinelibrary.wiley.com/doi/10.1002/eat.23950
https://www.sciencedirect.com/science/article/abs/pii/S002239562300002X
