"Recovered" From Eating Disorders: Myth or Reality?

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Research has shown that people who have recovered from eating disorders can be “indistinguishable” from people with no history of eating disorders (Bardone-Cone, 2010). So, we know that full healing is possible, but what is recovery? How do we know if we’re recovered?

I remember thinking I had recovered from my own eating disorders decades ago, but at the time, the field emphasized “in recovery.” To be honest, that seemed defeating. After all the work and years it took to gain freedom from eating disorders' thoughts and behaviors, the field’s messages conveyed that I could never be free of it. But I felt free of it!

What Is Recovery?

In the early 2000s, I was drawn to Carolyn Costin’s teachings. She was one of the few leaders in the eating disorders field who advocated for "recovered," past tense. Her treatment facilities were known for their recovery philosophies and utilized many clinicians who openly identified as recovered. She defined what that was to her and her facilities:

Being recovered, to me, is when the person can accept his or her natural body size and shape and no longer has a self-destructive or unnatural relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life and what you weigh is not more important than who you are, in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on a scale (Carolyn Costin Institute, 2020).

A definition that has received attention in the eating disorder field follows (Kenny et al., 2022). For someone to be “recovered,” they must meet all of the following for at least three months (Bardone-Cone et al., 2010):

1. No longer meeting the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders
2. No binge eating, purging, or fasting
3. A body mass index of at least 18.5
4. Specific score ranges on specific eating disorder assessments

However, this version is used for research and favors the medical model. One study showed that people with personal recovery experiences did not support it as a universal definition (e.g., duration too short, not comprehensive enough, too absolute, and issues with BMI [Kenny et al., 2022]).

I reached out to Reba Sloan, a registered dietitian specializing in eating disorders for more than 40 years, a survivor of anorexia nervosa back in the '60s, and a firm believer in “recovered” (past tense) to comment. She has watched this field’s development from basically its birth. I asked for her point of view, and she shared the following:

The lack of a concrete definition of “recovery” can be challenging for those who are suffering from eating disorders, those who love them, eating disorder practitioners and researchers alike. Just as eating disorders develop over time, so does recovery. There is no single factor that can be singled out as the causal factor for the development of an eating disorder. There is no single factor that will cure an eating disorder. No single definition of what recovery is or when it is accomplished. There is no bell to ring like a cancer survivor gets the thrill of ringing when their chemotherapy is complete, and they are in remission. No x-ray that confirms recovery like one can observe as they recover from a broken leg. What we have is murky water.

In research regarding recovery, she shared an acronym developed by Leamy et al. in 2011, and it stuck:

• C = Connectedness with self and others
• H = Hope and optimism
• I = Identity
• M = Meaning of life
• E = Empowerment

CHIME might cover much of what a recovered life looks like.

I asked Reba to summarize her experiences of the recovery process after her many decades of treating those with eating disorders.

Being recovered does not mean that you never have a disordered thought about food, eating, weight, exercise, etc. It means that you are no longer controlled by the thought. There is a true difference between being affected by a thought (or even a behavior) and being controlled by it. I believe that the recovery effort can come in fits and starts. There can be lapses and relapses. It is a hammer and chisel journey: No bulldozers are involved. Those impacted by eating disorders or treating eating disorders struggle with that description, and insurance companies really do. I see this journey as much a skill development as anything else. No one develops an eating disorder just about food, eating, weight concerns, etc. Some need is “met” by leaning on the eating disordered thoughts and behaviors. If you don’t learn how to get those needs met in a genuine, life-enhancing manner, recovery cannot happen. Even if all the proverbial checkmarks are checked and the eating disordered behaviors are being contained—like a lid on a boiling pot—at some point, a metaphorical explosion may happen, and the person is back in eating disorder prison. (This is where and when patience is required.) One then has to go back and pick up skills that they missed out on developing when they were ensnared by their eating disorder, such as interpersonal skills, the ability to feel emotions and process them in a productive way, self-acceptance and self-transcendence, compassion, and personal empowerment. All of this can be complicated by comorbid mental health issues such as obsessive-compulsive disorder, depression, anxiety, etc. Still, healing is possible.

Bottom Line

For anyone who needs this piece, I hope it helps to inspire you. No matter how murky the definitions may be or how impossible the process may feel, recovery can be possible.