Eating Disorder Recovery

Recovery is one of the most powerful and commonly used words in eating disorders. What does it actually mean and how does it apply to young people and their lives after inpatient treatment?

Defining recovery is something that not even the professionals agree on. There is consensus that recovery must include maintaining a normal weight (and physical markers such as menstruation), eating normally and having the social and behavioural capacity for a ‘normal life’. Of course, aside from the physical markers, what constitutes ‘normal’ is highly variable and open to interpretation.

From a parent and family perspective, it may be helpful to think of the different stages of recovery at each point of transition. “When a young person leaves Newbridge, they will look so much better than at their time of admission,” explains Dr Caz Nahman, consultant psychiatrist. “It is important that this highly visible physical recovery does not mask their acute emotional vulnerability and the fact they are at an early stage in recovery.”

In this transition from inpatient unit to home, Dr Nahman urges families to stick very closely to the Newbridge meal plan. As the young person returns to school and other activities, they will need more, not less food and activities should be increased gradually. For parents, there is the challenge of managing their own anxiety at this transition, but also being vigilant for real signs of potential relapse. Dr Nahman, who worked for Newbridge for four years and is part of Nottinghamshire Healthcare’s eating disorders CAMHS team advises: “Be watchful if the meal plan streamlines, if your child starts to refuse foods they were previously eating, particularly the higher density foods. Social functioning is as important as food intake: social isolation and mood deterioration would be ‘red flags’ during this transition back to home life. Be watchful too for signs like dishonesty around food and activity and trying to control the kitchen and meal times.”
The first six weeks after discharge should be seen as a period of stabilisation and after that, if there is no weight loss, there can be an increase in activities. Of course, there will be wide variation from one individual to another. “We see, for example, young people continuing to follow the Newbridge meal plan in a way that means their weight is stable but because they are only able to eat planned foods at particular times, they are not engaging in the social activities of other teenagers,” says Dr Nahman. “I think we should see recovery in terms of four components: physical, psychological, behavioural and social (entering a normal life). Recovery in some areas will take longer in some areas than in others.” Professionals agree that body image concerns commonly persist longer, after other aspects of the eating disorder have subsided.

It is important to consider recovery in the context of the life phases young people and young adults go through. A young person living at home with parents at 16 or 17 can be in a stable recovery, but how will that be challenged by moving away from home to university? Dr Nahman suggests: “The questions to consider will be – how will the anxiety and stress of this transition affect the eating disorder? Try to talk about this and be prepared for the transition to have an impact – as it does for all young people moving away from home for the first time, not only those in recovery from an eating disorder. Think about the things they are not yet able to do and whether this capacity is important before they move away to university. How do they cope around others who are talking about dieting? Can they eat with others – and can they eat when others aren’t eating?” There is often a relatively short period of time after leaving inpatient treatment and recovering at home to choosing and moving away to university. Reaching university can be a powerful signifier of recovery; that normal life has resumed and the young person is back on the same track as peers. Before this step, however, consider how robust recovery is in all four components. For some but not all, a gap year can be a useful building block for recovery before embarking on the challenge of moving away from home.

*This article is published in the first edition of Moving on and Recovery, a publication developed for young people and families who are facing the transition from inpatient service to community, CAMHS to adult services, moving on to university and all the many issues relevant to the process of recovery. Please contact us if you would like full copies of this publication.