Once a person begins the recovery process from an eating disorder, expectations around the duration may often hinder the recovery work and keep the person stuck in using their eating disorder behaviors to handle their anxiety. Further, the education around the timeline of recovery is important for all involved. Clients have often stated their fears of burdening their family and loved ones during this process is their main concern. When all members of the support system are aware of the different stages of recovery, they can model for their loved one non-judgment and patience, which may ultimately lead to a swifter recovery.
The stages below were published by Carolyn Costin in her book, The Eating Disorder Sourcebook.
∞ Presence of behaviors with no sense of a separate eating disorder self. At this stage clients often do not even accept that they actually have an eating disorder, much less an eating disorder self. The behaviors are seen as being something they are either willfully or uncontrollably doing.
∞ Denial of seriousness. When clients do admit they have an eating disorder, they are almost always in denial of how serious it is or can be.
∞ Beginning awareness of a split self. Continuing their behaviors, in spite of wanting to get better and their own ambivalence about recovery, helps clients begin to see that they have both a healthy self and an eating disorder self.
∞ Active engagement with the eating disorder self and the healthy self. Clients journal from and dialogue with the two selves. This helps to discover the function of the eating disorder self.
∞ Need for behaviors while developing the healthy self. The eating disorder self will still be acting out through behaviors, while the client is strengthening the healthy self.
∞ Decrease in behaviors but thoughts/desire for behaviors, strong. The healthy self gets stronger and can fight off some of the eating disorder urges. The habitual nature of the symptoms begins to diminish, but the eating disorder self is often still in control.
∞ General symptom control with reduced thoughts/desire. The healthy self is in control most of the time, but clients still battle eating disorder thoughts and act on them occasionally.
∞ Control of symptoms by healthy self but remaining thoughts/desire. At this point the healthy self is in control of the symptoms, but clients are at risk for returning to the behaviors, because the need for the behaviors has not been resolved and eating disorder thoughts are still present. Treatment should continue until the need for behaviors is significantly diminished. It is common for clients, significant others and insurance companies to think that at this point clients are recovered or well enough to stop treatment. This is not the case and often leads to relapse.
∞ Integration of eating disorder self and healthy self (recovered). Clients do not have to work at abstaining from eating disorder behaviors because there is no desire to engage in them. The need for the eating disorder is gone. Clients turn to people or to their inner self to regulate emotions or otherwise get needs met. There is no separate eating disorder self; it has been integrated so there is one whole self. The person has a normal, healthy relationship with food and weight and does not need to use eating disorder behaviors to deal with problems. At this point, they are now ‘recovered’.