How Long Does It Take to Recover from Bulimia or Anorexia? Part III
What does it take to Heal from Bulimia or Anorexia?
Healing from anorexia and bulimia requires development along all seven points I described in my last post.
But what does it take to actually heal? And why does this healing take a long time?
When I went back to college after a 13-year absence from academia, UCLA gave me a yellow piece of paper that listed my required courses. When I completed everything on the list UCLA would grant me a degree in psychology.
The sheet was 81/2 x 11 inches. I tacked it on the wall above my desk and set to work. Every four months I checked off three classes. It took me three years to work through that one sheet of paper and qualify for my first diploma.
Below is a short list of developmental tasks that can take several or many years to move through. Still, like my yellow sheet on the wall, the list can inspire a person to keep on keeping on.
Perhaps, most importantly, the list confronts a person with realistic goals when her mind starts making excuses and rationalizing false beliefs.
Necessary Developmental Tasks Stated in Affirmation Form
Here are some of the developmental tasks written affirmation form so even reading them is a beginning.
1. I tolerate my feelings.
2. I am realistically aware of what is going on outside and inside my own skin.
3. I know how to establish and honor personal boundaries
4. I know how to make myself safe.
5. I know how to recognize reasonable and honorable people.
6. I know how to enlist the help of reasonable and honorable people in a fair and honest way.
7. I know how to discriminate between healthy and unhealthy activities, environments and companions.
8. I know how to makes honest, self-caring and honorable choices based on healthy observation.
9. I know my own genuine weaknesses and strengths.
10. I take responsible action in the world.
11. I know when to say, “No.”
12. I am able to say, “No,” even if I am uncomfortable about saying so.
13. Regardless of the challenges life presents, I know and trust that I have what it takes to live a good life.
Thirteen Breaks the Pattern
I created thirteen tasks in this list. The number thirteen has significance. It means breaking an old pattern. It means emerging as something new or a new variation on an old theme.
Actually, as I write this I surprise myself because I began this post by revealing my thirteen-year hiatus from school. I didn’t make the connection till just now. That’s how the psyche works.
After thirteen years out of school I returned to resume my education on a new path, build a career and create a new life that was and is much better than the life I had completed. Thirteen was the break the pattern signal. And I didn’t know that consciously till just now.
Developmental Benefits
When a person makes positive strides in the direction of achieving these developmental tasks, the eating disorder has less of a function in her life. The person discovers much better ways of taking care of her psychological and survival needs and expands her life into more enriching experiences. The eating disorder is less or even no longer necessary.
How long does this take? It takes as long as it takes to accomplish these tasks. The actual time differs with each person. How each task is accomplished involves the work in psychotherapy that leads to the past, the present and the future. It leads to new ways of thinking, feeling and responding. It leads to grand discoveries of where a person is truly interested and of how she wants to invest her life energies.
Recovery doesn’t happen overnight and the work isn’t easy. However, the good news is that you don’t have to wait for full recovery to reap benefits of healing. Every step of the healing process allows the person to be more competent in the world, experience the joy of being more capable and especially, able to connect with other good people in a satisfying and healthy way.
By all means, let me know your thoughts about this. I welcome your sharing.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com
How Long Does It Take to Recover from Buliimia or Anorexia? Part II
Why does recovery from anorexia or bulimia take years? Because vital developmental tasks must be addressed, and development takes time.
Let’s look at what needs to be accomplished in recovery.
Psychological Function of Eating Disorders
Eating disorders develop to serve a protective psychological function.
1. They protect a person from being aware of what they cannot bear to know or feel.
2. They give a person a sense of control when the person has little real control over what’s important to them.
3. They give a person a private island of limited sensation and limited awareness. This is a defense that helps when a person is incapable of preventing physical, psychological or emotional boundary invasion.
4. They create an obsessive sense of entitlement to make up for the lack of boundary awareness or the lack of knowledge or skill in honoring personal boundaries or limits.
5. They protect a person through numbness and obsessive thinking from knowing what they feel such as anger, fear, disappointment, regret, guilt and shame. A person may even need to block feelings of love, passion and joy if knowledge of those feelings would disrupt the status quo of her environment.
6. Eating disorders allow limited but intense feelings to surge within the person and explode out as a form of relief from tension. These episodes are often highly dramatic and can be both manipulative and destructive in relationships.
7. In many situations eating disorders protect a person from knowing she is competent, intelligent, capable and creative when such knowledge might be disruptive to her present life and the imagined (and sometimes real) consequences are intolerable.
Necessary Psychological Development
Healing from anorexia and bulimia requires deep, rich and healthy development along many layers of the personality. When this is achieved the person can cope with the difficult ordinary and sometimes extraordinary challenges life presents without the protection of the eating disorder. Healing also frees a woman to be capable of giving and receiving honest emotions in worthwhile relationships.
As a matter of fact, healing frees a woman to actually be a woman.
I’d be glad to elaborate on any of these points. Please feel free to ask questions and share your opinions and experiences in the comments.
In the service of easy blog reading I’m trying to keep posts as short as I can while still giving you as much recovery information as possible.
In my next post I’ll talk a little about some of the work required to heal from bulimia and anorexia.
How Long Does it Take to Recover from Bulimia or Anorexia? Part I
Realistic Answer
How long will recovery take? This is a reasonable question I’m often asked.
Not only can I not provide a specific time, but also I can’t guarantee that someone will indeed recover. And I certainly can’t give the answer so many people want, which is days or a weekend or at most, a quick stay in a residential program.
The question is complex with a different answer for every individual.
If you are still reading after this undesirable news, please let me talk a little about eating disorders and recovery.
Purpose of an Eating Disorder
People develop eating disorders for a reason. Eating disorders help a person cope with living when the person has not developed other ways to successfully take care of herself.
Healing Tasks
Healing has to do with developing a competent, mature and aware sense of self and awareness in the world. It has to do with restarting stalled emotional development so that the person can take care of herself realistically in the face of simple and complex life challenges.
How long does it take to accomplish the required developmental tasks? A substantial period of time from several years to many years, depending on the challenges of each individual.
Recovery is a Process
But please don’t despair at the thought of the time involved. Recovery is a process. As you move through time and stages of recovery, you reap benefits as you go. Your life improves as you gain more health.
During the healing work, yes, you will need courage to face your pain. But you will also experience joy as you discover the authentic worthwhile you.
I’ll write more about the recovery process in my next post.
Professional Boundaries with Eating Disorder Patients: considering right brain studies and work of Dr. Allan Schore
(elaborating on my comment in Eating Disorders for Professionals Blog)
Humanity Appreciation
Today, happily, we have evidence based scientific research to back up the use of our humanity in our clinical work with patients.
Appropriate boundaries between patient and psychotherapist are essential in any psychotherapy and particularly in the field of eating disorders.
However, the topic is often discussed in terms of content: e.g. a patient asks my age, if I’m married or divorced, if I have children, my religion, if I’ve ever had an eating disorder.
I believe that when a patient wants to know about my private life or wants to include me in her private life (weddings, funerals, births, graduations, award events, etc.) that the patient wants and needs a particular psychological emotional experience she believes will come from sharing such an experience with me.
Sharing Specific Personal Information
In other words, its not the information or event that is the issue. The sharing of our humanity is the point. The patient wants to know that she will be understood and appreciated. She wants to know I have a history that will inform me in terms of being present and empathic with her.
She wants to know that I can appreciate her pain and personal dilemmas. She also wants to know that I have survived my challenges and her stories will not shock me or cause me to judge her. Perhaps most of all, she hopes that I have healed from what she suffers and that if I have healed then she can heal too.
Person to Person - Right Brain to Right Brain
The valuable experience between us is not content, but right brain to right brain communication. We use words because we have to. We communicate far more than words, We need more than words to heal and be healed.
Allan Schore, in his fantastic research on affect regulation, impacts many areas of social science and biology by showing that right brain communication is received by the right brain and actually changes brain structure to allow developmental progress. Developmental progress is exactly what is needed for eating disorder recovery.
The discoveries revealed by the increased sensitivity of neuroimaging validates what many sensitive clinicians have known for a long time. Honesty, caring, empathy, sharing spontaneous imagery, acknowledging physical responses to clinical material makes for effective connection, growth and increase possibilities for healing.
Answering Personal Questions
The key question I ask myself before I reveal personal information to a patient is this: Will my answering this question burden the patient or will my answering support her healing? Often, when I’m asked a personal question I will respond by saying, “I will answer your question. But before I do, can you tell me why you want to know or what meaning this information has for you?”
People suffering from eating disorders have rarely experienced a quality relationship where their boundaries were respected. In general, they know little about respecting boundaries. Responding with respect and care to their questions helps begin the process of learning and appreciating what personal boundaries are - mine and theirs.
This kind of communcation also shows a woman with bulimia or anorexia that she can meet limits and caring from a person at the same time. Such an experience is often new and always in the service of health and personal development.
People recovering from eating disorders need the presence of honest, caring and respectful human beings in their lives. I believe, with the backing of neuroscience, that we psychotherapists can’t keep true to our profession unless we are true to our humanness.
Perspectives on Eating Disorder Recovery and Relapse
Meaning of “Fully Recovered”
A thirty-three year old man wrote to me saying he had been a binge eater most of his life and now was fully recovered because food has been a non issue for two years.
Of course, I am glad he is happy with the strides he has made in his life. But his post got me to thinking.
I have been working since 1980 with people who have and who have had eating disorders. I don’t know what people mean by “fully recovered.”
While it is possible that people can have two years or more of being in a state where food is a “non-issue” that doesn’t necessarily mean they are “fully recovered.” By the same token, someone who has not binged or purged for some time and then begins again may actually be signaling growth rather than relapse (although, of course relapse is possible too.)
Effective Ongoing Recovery Work
As I see it, people develop eating disorders as a way of coping with what they cannot bear. The people committed to getting well work in psychotherapy, 12 step programs, spiritual programs, nurture their creativity and gain education and skills necessary for them to function as they choose in this world. As part of this life long process they feel their emotions, recognize and bond with trustworthy people, and develop a sense of self worth. As they develop they learn and discover how to address their inner and outer life situations without the eating disorder.
Symptom Return Can Signal Need to Grow
However, as they age, develop, mature, take on new challenges, are confronted with life’s strong pleasant and unpleasant surprises, aspects of the eating disorder may return. If it’s not a relapse, (meaning collapse and surrender) it can be a signal that a new strength needs to be developed or that the person is overstretching his capabilities and needs to pace himself.
The eating disorder, a tried and true mechanism developed to a person survive, returns to some people not as an enemy but as a guide to teach the person about how they are feeling or not feeling. The teaching occurs in a language the person understands perhaps better than any other. This is the language of the eating disorder, which for many has been a life long companion.
“Recovered Person”
In my opinion the “recovered” person, is consciously aware of his or her liaison with the eating disorder. It’s as if the eating disorder were some kind of sleeping general or police force who, when the person takes on more than they can bear, rises up to alert, protect and defend the person using the old eating disorder methods. This gets the person’s attention dramatically. The “recovered” person recognizes the return of the eating disorder urges or actual behavior as a signal to pay attention to something that is out of conscious awareness.
Past recovery work allows the person to reevaluate what’s going on in his/her life knowing now that something is being denied. He or she can then do more inner work so they can be fully present for their experience without needing the numbing protection of the eating disorder.
When Symptoms Return
There can be gaps of five, ten even twenty years of no acting out and then the old faithful protector emerges to wake up a person who is involved in more than she/he can bear and doesn’t know it. The eating disorder lets them know it. It can last for only a few days and be of tremendous value.
I would not like people who have occasional psychological informative incidents of their eating disorder symptoms to believe that they have lost their recovery. Nor would I like people who have no symptoms for two years to believe that their disorder is over.
Need for Continued Growth and Learning
No one knows what challenges life will present in the future. I doubt that any of us are fully equipped right now to deal with what the future will reveal. We all need to keep learning and growing to survive and thrive in this life. And we all have signals that let us know we need to learn and grow beyond our current limitations.
A return of eating disorder urges is one kind of signal that more growth and learning is required.The more recovery work the person has done the more capable he or she is of continuing the recovery work when those inevitable life challenges emerge. Those urges can help open a blind eye or a dulled psyche to a new challenging reality and help a person continue to live a full life.
Helpful Quiz, Ability to Conceive, Osteoporosis
Breaking the Mirror posted answers http://www.breakingthemirror.com/ Quiz Answers!January 11, 2008 to a to a ten point eating disorder quiz posted on a teen fashion site.
Posting this quiz is a wonderful idea. It helps provide clear information that can combat prevalent and false ideas about eating disorders.
I would add that while birth control is always a good practice when someone is sexually active and not prepared to conceive a child, it is also true that severe anorexia can seriously
limit a woman’s ability to conceive.
Another point missing from the quiz relates to bone strength. Many young women with eating disorders develop osteoporosis. It doesn’t hurt, and it doesn’t show. Some anorexic women who are
only 17 years old have lace bones comperable to a very old and fragile woman.
That said, stating health risks will not scare a person into recovery. But they might scare a person into treatment!
I hope so. I’ve recovered from bulimia and have been a psychotherapist dedicated to eating disorder recovery for many years. It seems that girls and women need to notice that the eating
disorder eventually causes more pain than they can bear before they are willing to risk giving it up.
This requires a desperate kind of courage because they genuinely face the unknown in the therapy work. It can be almost impossible to imagine a life without the eating disorder. Yet, a
glimmer of the freedom that might be possible if they were genuinely free of the behavior, the thoughts, the anxiety, the planning and strategizing, the need for the cover up lies
can keep a person on the recovery road.
I’m glad to know that in the sea of high drama, repetition and hype on the internet relating to eating disorders, some realistic information is being offered that can be truly
helpful to people looking for solid recovery.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com
Eating Disorder In-patient and Residential Treatment
A worried mother called me this morning, concerned that she had not yet received my eating disorder in-patient/residential treatment program list. http://www.poppink.com/list.html
I was on vacation in Maui with my family and couldn’t send the list until today.
The mother, in the Midwest, is deeply concerned about her 25 year old daughter on the east coast who is a compulsive overeater and obese. They are both looking for an in-patient program that will get her started in recovery. Well, actually, I think they hope that checking into the best program they can find will result in cure.
I’m always concerned when someone says that “some kind of support might be needed after” a residential treatment experience. To me this phrase reflects a naive hope that a person can go away ill, come back cured and the burden of the illness will be lifted off everyone involved.
This fantasy simply must be dispelled so that unnecessary disappointment and feelings of failure don’t delay or even destroy positive moves toward recovery that are being made. Residential treatment can help people get on the recovery path. After residential treatment people with eating disorders still have to walk that path, or climb or crawl or, as 12-step says, “trudge” their way to recovery.
When you know you are working toward progress, even when you are backsliding a bit, you can keep your energy directed on the healing task in front of you. You might feel frustrated at times. Who doesn’t? But you can handle feelings of frustration. We’ve all had lots of practice with that.
When you know that in-patient is a first, not a last step you can be less hard on yourself. You can ease into the program and do the best you can. You don’t have to feel a sense of failure at all. By putting yourself in a healing environment you are making yourself a winner. When that healing environment becomes your own inner self, your recovery becomes more solid. The transition between in-patient treatment and solid inner recovery is usually long term psychotherapy.
How long is long? It’s long enough to make that internal healing environment in you as solid as can be. It’s long enough for you to have solid practice and experience in living a healthy life in a new way without needing bulimia or anorexia or a binge or a cutting or starving episode to get through. It’s long enough to guide you, support you, ease you, escort you to a healthy life.
Please remember, the search for something “perfect”, the desire to find the “perfect” program, the urge to reach the “perfect” size or be the “perfect” person in any way at all is a symptom of an eating disorder. We humans are not designed to be “perfect”. Our design is that of a human being with all our flaws and contradictions. There’s something wonderful about being like a kaleidoscope, an endless colorful variety of perspectives, intact and whole.
I hope with all my heart that the woman who called this morning and her 25 year old daughter who is locked into her own mind and body by her eating disorder, can find the help and the direction they both need to get relief from their suffering and find their eating disorder recovery path.
Joanna Poppink, MFT, psychotherapist eating disorder specialist, Los Angeles, CA bulimia, anorexia, compulsive overeating recovery, www.poppink.com
Eating Disorder In-Patient Experience
A wonderful, honest, detailed and accurate description of what it’s like to go through an eating disorder in-patient experience is posted on: http://ballyhoo.typepad.com/mollyblog/eating_disorders/index.html
Molly Freedenberg shared her eating disorder recovery viewpoint and by so doing, gave a gift to the eating disorder recovery community.
Her post dispels myths and fantasies about early recovery. I’m especially glad that her vivid examples make clear that in-patient or residential treatment is the beginning, not the end of recovery.
I’ve heard from too many people who believe that “going in-patient” is both a last resort and also a complete treatment experience after which a person with an eating disorder will be “cured.”
Even in the news where celebrities with eating disorders are discussed, I see the idea expressed that the eating disorder in-patient programs “failed.”
While it’s true that some programs are better than others and some programs are more suited to an individual’s needs than another, it’s vital to remember - or learn for the first time - that in-patient treatment programs are the beginning and not the end of treatment.
To request a list (free) of eating disorder in-patient programs, please go to www.poppink.com and click on “in-patient programs” in the sidebar. Be advised: the list is international, comes as an attachment and is 94 pages long. I’ve been building it for many years.
Thank you again, Molly, for your generous and insightful post. I hope many people who need to begin their eating disorder recovery will find your post and get an accurate and thorough snapshot of what in-patient eating disorder recovery programs can offer.
Joanna Poppink, MFT, psychotherapist, eating disorder recovery specialist, Los Angeles, CA
anorexia, bulimia, compulsive overeating, binge eating recovery; www.poppink.com
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