Defining "recovery"

I came across an article from the NY Times the other day titled "In Fighting Anorexia, Recovery Is Elusive" (link). I'll be honest, I've been feeling a little discouraged lately and I'm not sure this article helped.

Here are a few excerpts (actually, I had a hard time picking quotes because there were a lot of interesting points so this is actually most of the article):

Most medical experts agree that a third of people with the disorder will remain chronically ill, a third will die of their disorder, and a third will recover — with one significant caveat. There is surprisingly little agreement as to what “recovery” means for people with anorexia.

It is difficult to define recovery from an illness that has both physical and mental dimensions.

If, for example, a patient reaches “normal weight” — which researchers define as either 85 or 95 percent of a person’s ideal weight — and starts menstruating again, she would be considered to have recovered in most studies.

But what if she still weighs herself daily, monitors her calories with a vengeance and obsesses about food and the size of her ankles? Or, as is often the case, moves from anorexia to bulimia or binge-eating disorder?

“About 50 percent of people with anorexia will be able to reach and maintain a normal weight, but most of them are very preoccupied with the calorie content of food,” said Dr. Katharine Halmi, professor of psychiatry at Weill Cornell Medical College in New York City.

Still, she added: “Many people who’ve never had anorexia watch their diet carefully. So the big issue is, how do you define recovery? Maintaining a normal weight, recurrence of menstruation is easy to document. Mental status is a different problem.”

“I say to patients, ‘This is your Achilles’ heel,’ ” said Dr. Daniel Le Grange. “If you have another crisis, you’re predisposed to resorting to starvation as your way of managing that issue. It would be foolish of us as clinicians not to prepare our patients that they should be on the lookout for a recurrence.”

Most doctors believe recovery from anorexia is rarely absolute and more often occurs by degrees. While patients may get better, aspects of their disease will continue to nag at them.

“The literature suggests you can have physical recovery from the weight loss, but the cognitive symptoms might not continue to get better. They definitely do improve, but one of the things we wonder is, how well does one have to be to be ‘recovered’? And how well does one actually get?”

And what exactly is ordinary? “That thinking about food does not consume large quantities of your time and energy,” (Harriet Brown, author of the recently released “Brave Girl Eating,” a memoir of her 14-year-old daughter’s bout with anorexia) said in an interview. “You enjoy food, you don’t undereat or overeat often, you don’t meet any of the diagnostic criteria for anorexia. Your weight is in a healthy range for you. And most of all, you’re able to live life in a way that’s not completely organized around food and eating.”

For Ms. Liu, recovery is a “full restoration of nutritional, physical, emotional and psychological health.” But in a telephone conversation, Ms. Liu, who was actively anorexic from age 13 to 20, acknowledged that without good treatment many people spend years in what she called the “half life” of anorexia.

“They recover nutritionally and suspend the behaviors of starving, binging and purging,” said Ms. Liu, who suffered a relapse 11 years ago. “But the self-criticism, self-abuse, perfectionism, judgmentalism and restrictive mind-set persist.”

Still, both doctors and patients emphasize the importance of believing that full recovery is an option.

Kathleen MacDonald, a policy assistant at the Eating Disorders Coalition in Washington, was anorexic and then bulimic for 16 years, but considers herself fully recovered since 2004.

“People always said once you have an eating disorder, you’re always going to have an eating disorder,” she said. “I tell people, ‘There was a time in your life when you didn’t have an eating disorder, and if that’s possible, anything is.’ ”

I feel somewhat confused and conflicted about these statements. I wish I could say that these people don't know what they're talking about and that total, 100% recovery is possible for everyone whose ever struggled with an ED, but unfortunately after working on these issues for YEARS I don't think it's that simple.

I have so many thoughts on this I could probably fill a novel and bore you all to death (or at least convince you to stop reading my blog) but Hannah has been a fussy little peanut today and won't seem to nap unless she's in my arms. And I think I've reached my one-handed typing limit so we'll save the thoughts for tomorrow. I know many of you who read this haven't struggled with eating disorders but I'd love to hear your input on this if you have any.