When the Road is Full of Potholes

WHEN THE ROAD TO RECOVERY IS FULL OF POTHOLES

By: Julie B. Clark, PhD

You seem to be sailing along with the wind in your hair and then bam! - you fall into a pothole. Finding yourself engaging in the same eating disorder behaviors you've been fighting so hard to be free from can be discouraging. Some refer to this pothole process as a lapse. This means using the old familiar but unwanted behaviors of the eating disorder to cope. It does not mean a complete return to the eating disorder. Recovery is a roller-coaster ride and it certainly has its ups and downs. The ride can be discouraging and feelings of fear and hopelessness often creep in for anyone trying to recover as well as for their friends and family members. Fortunately there are also those exhilarating moments of success. Hang on and learn how to enjoy the ride!! Don't ever give up or quit!! The reality of recovery is that it takes time. Dr. Michael Stroeber did research on the long-term outcome in anorexia nervosa for recovery. He found that nearly 30% of patients had weight loss following hospital discharge, prior to achieving either partial or full recovery. For most patients the time to recovery was 57 months for partial recovery, to 79 months for full recovery. The relapse rate after partial recovery was 10%, but 0% after full recovery. He also found in his sample of 95 patients that 75% met criteria for full recovery with 86% of the sample achieving at partial or full recovery (recovery was defined in terms of partial or full remission, maintained for a period of no fewer than 8 consecutive weeks). Individuals suffering from bulimia typically have a larger percent in full recovery and it usually doesn't take as long to achieve.

Let's focus on lapses and what to expect. Lapses in recovery are a step in the process and provide opportunities to learn and utilize better coping strategies. Dr Craig L. Johnson, who is one of the leading researchers in the area of eating disorder treatment, states:

"Our program operates on the philosophy that patients who have long histories of eating disorders and other comorbid symptoms usually require long-term treatment. In our minds long-term treatment is measured in years, not days, weeks or months. In our opinion there is no shortcut to the process of undoing previously disappointing relationships and establishing new ones. In our experience, talk is cheap when working with these patients. Our more difficult patients have taught us that anorexia and bulimia are episodic disorders and that recovery is a process of taking two steps forward and one step backward. It is a process that requires a great deal of patience.."

This may be comforting and overwhelming all at the same time. I have heard so many say "I just want it to go away-now!" Just remember that the eating disorder didn't develop overnight and it will not go away overnight. It is a hard-fought battle but so possible. Dr. Paul Harper suggests that "recognizing the stages of the lapses can help you recognize the danger signals leading to relapse which can help you control and stop the negative trends." Life is full of "opportunities" to encounter situations that test the fiber of your change. The situations that can be difficult include (I might add that this is true for any human being) painful emotional states, interpersonal conflict, social pressure, unhealthy dietary and health approaches, and failure experiences. Hello! welcome to life. Maybe the partial key to recovery is in normalizing the journey of life. It is realizing that we all struggle and are doing the best we can in these roller-coaster situations. Unfortunately, rigid expectations and perfectionism can be sabotaging to the process. Instead of learning to do it better and letting the lapses be a step to recovery many will see the lapses as failure. Often family members, friends, and therapists become discouraged and inadvertently or overtly support that notion. I like what Dr. Maria Root said in a recent article she wrote on relapse. She said: The chance of a relapse exists for anyone who has had an eating disorder, even after being symptom-free for years. Humility, coupled with hope and a sincere willingness to carefully examine what happened during minor or even major slips, is what defines recovery.

Family members and friends can make a great difference in the process of recovery by providing encouragement and expressing confidence in your loved one's ability to succeed. Avoid criticism. It is not a motivator to change. Keep up the expressions of love and acceptance. Whatever the emotional process to change is, it definitely takes repetition and constancy. Measure success on new dimensions and look for the change that is happening. Sometimes our expectations for ourselves and others can be too constricting and rigid and we label our efforts as not good enough. The fear of the destructive eating disorder behavior can also send us into a panic mode and create additional stressors. Using guilt or shame against the eating disorder won't help. Remember that your loved one already has plenty of this. What they need most is love, acceptance, and a belief in their ability to overcome the eating disorder. In a similar way you must accept and value your abilities and efforts. The journey is a painful and joyful one for all involved. This challenge of recovery can provide the soil for the growth of incredible relationships and understanding hearts. With love, encouragement, and continuing effort, the number of potholes will decrease as the road ahead becomes more smooth and predictable.