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Real-world eating disorder recovery

Important Considerations for Eating Disorder Treatment…and Life Afterwards

It’s National Eating Disorders Awareness Week 2014! Dedicated non-profits and treating professionals champion for heightened awareness of eating disorders’ diagnosis, treatment and recovery throughout the year. NEDAW represents a time during which the general public joins these non-profits and professionals in a larger, more widespread effort to raise awareness about eating disorders.

In the spirit of advocating for accurate eating disorder information, I’ve been thinking about the concept of “real-world recovery.” In other words, how patients and families take the education and tools learned in the structured treatment environment and put them into action in their everyday lives following discharge. This is the period of time when many professionals argue that the real work of recovery begins. As I’ve mentioned in previous posts, eating disorders are challenging illnesses to treat, and it can be even more challenging to sustain recovery. Once integrated back into “real life,” protecting recovery can feel challenging in the face of so many seemingly unavoidable food, eating and body related triggers. We can’t avoid food, movement, mirrors or unrealistic body ideals portrayed in magazines, movies, TV and the internet. Recovered myself from an eating disorder, I feel strongly that eating disorder treatment should acknowledge real-life challenges of recovery, both in the setting of treatment and the tools provided to patients and families to help them protect their recovery following treatment.

I had a conversation recently with a mother who, also, felt strongly about the notion of real-world recovery when considering eating disorder treatment options for her daughter. “I can’t send my daughter on a vacation to address her illness,” she explained. “What good does it do her if she learns how to interrupt her eating disordered thoughts and behaviors at some peaceful mountain retreat alongside a handful of peers if she has to come home to a totally different environment and circumstance? She’ll need to know how to resume her life without her eating disorder in a cramped apartment with roommates and function alongside tens of thousands of students in a busy metropolitan city. I believe my daughter needs to learn real-world recovery skills in a real-world setting.”

This mother clearly understood the illness and had done her homework about treatment options. However, I started thinking about the hundreds of families I’ve counseled and coached over my 30+ years in the eating disorder treatment field who felt alone and frightened and had no idea where to start in researching a higher level of care for their loved one, or what to expect when they returned home following treatment. Along these lines, I feel strongly that professionals in the field—psychiatrists, therapists, dietitians, primary care doctors, pediatricians, etc.—have an opportunity to educate their patients and families about the phases of treatment and recovery thereafter. It’s crucial to help them understand the considerations involved in identifying the right treatment center and the implications of those considerations for lasting recovery. To this mother’s point above, many of the decisions made about eating disorder treatment can have a significant impact on maintaining and protecting eating disorder recovery upon returning to daily educational, professional and/or family obligations and routines.

A particularly significant consideration when identifying a treatment center is setting, and a diverse range of options are available. Because eating disorders tend to be isolating illnesses and even the smallest of everyday tasks can feel overwhelmingly difficult, it’s not surprising that some people feel the desire to “get away” and elect to seek eating disorder treatment at intimate beachfront programs or private wooded campuses far away from the hustle and bustle of ordinary life. However, it is important that they are aware of the foundational components of a higher level of eating disorder care, including seasoned experts qualified to address medical and psychiatric symptoms and comorbidities, structure and containment to interrupt thoughts and behaviors, evidence-based interventions, family involvement and intensive focus on learning and practicing recovery skills in a supportive environment. The goal of these interventions is to help patients and families understand recovery and apply recovery skills in their everyday lives following discharge from treatment. True, an ocean view or a private room can bring temporary peace and calm during a time of increased stress and anxiety, but discharging from the structure and protection of the treatment environment can be challenging enough without patients enduring a jarring change in environment. The real effectiveness of program lies not in its location or other superficial aspects, but in the expertise, support and content offered.

Another important consideration when pursuing a higher level of eating disorder care is discharge planning, aftercare and alumni programming. Many patients and families alike mistakenly believe that completing a course of eating disorder treatment means that they are “cured” of their illness. It might sound like a cliché, but eating disorder recovery truly is a journey, not a destination. Much of the programming at a higher level of eating disorder care should address life after treatment and sustainability of recovery. The treatment program should help patients and families think about life after treatment during treatment. This involves teaching and practicing skills to help ease the transition back to their daily lives, developing a detailed aftercare plan complete with an outpatient team for ongoing treatment and support, and also follow up with patients at regular intervals to ensure they are receiving ongoing recovery support in the form of newsletters, events and workshops.

Obviously, there are many important considerations when selecting the right eating disorder treatment center. There’s no one-size-fits-all philosophy regarding eating disorder treatment and all patients and families have unique recovery needs and situations. However, in the spirit of NEDAW and championing for accurate information about eating disorder treatment, I encourage professionals to thoroughly educate their clients about these important treatment considerations and the implications of these decisions on the likelihood of maintaining and protecting recovery. I encourage patients and families to do their research about treatment options and to ask questions about how a treatment program acknowledges, addresses and supports long-term, real-world recovery.

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