Eating disorders and recovery

Eating disorders are complex illnesses caused and maintained by a combination of biological, psychological and social factors. Their manifestation as concerns about weight, shape and appearance and different ways of controlling these belie the fact that at their heart these disorders are often less about eating and body image than other challenges related to identity, emotional coping, thinking style, relationships, neurodiversity, sensory integration, biological responses to starvation, trauma and a host of other determinants. The interaction of different biopsychosocial factors can complicate the picture further, creating a vicious cycle that pulls people deeper into their illness.

While restricting their eating, eating excessively and compensatory behaviours such as purging or over-exercise can help people feel better in the short-term, these actions often exacerbate the very difficulties they initially appear to resolve and undermine people’s other ways of coping, creating further stress and reliance on the eating disorder as a way to manage. Some with eating disorders may find their illness provides a sense of identity, boosts their confidence, facilitates self-regulation, helps them to communicate distress and manage relationships, allows them to avoid stressful situations or enables them to navigate a world that otherwise seems unmanageable, even while from an outside perspective their illness makes these things worse.  However, this does not mean that those with eating disorders want or choose to be unwell. Given a clear path out of their illness, the internal resources (e.g., a sense of identity, confidence and self-worth) and external support to overcome their eating disorder and the opportunity to build a personally fulfilling life, in our experience people invariably choose recovery.

Manualised eating disorder treatments and measures of clinical outcome have tended to focus on improvement in weight, reduction in compensatory behaviours and reduction in eating disorder cognitions (e.g., fear of gaining weight and body image disturbance). By contrast, the personal accounts of people who have overcome eating disorders tend to focus on the so-called CHIME domains of recovery: connectedness, hope, identity, meaning and empowerment.  One of the aims of the treatment programme at Newmarket House is to integrate these perspectives. Thus, we view the restoration of physical health and reduction in eating disorders symptoms as necessary but not sufficient factors in recovery. For sustained recovery to be achieved, patients must also be given the tools to develop autonomy, manage challenging situations, identify and engage with personally meaning goals and establish and maintain positive relationships. For many people, recovery not only means leaving their eating disorder behind, it is also about building a new and exciting future.