Defining Recovery in Anorexia — and Addiction

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How do you define recovery from anorexia? Tuesday’s New York Times explores this question — and highlights striking similarities to the debate over defining recovery from alcoholism and other drug addictions.

Reporter Abby Ellin describes the case of Dr. Suzanne Dooley-Hash, who developed anorexia at age 15 and doesn’t know if she’ll ever fully overcome it. After many years of maintaining a healthy weight — during which time she became an emergency room doctor — she relapsed in 2005. She lost one-third of her body weight, and took 19 months off work to fight her illness.

Writes Ellin:

Like many patients with eating disorders, however, she is not sure what recovery means.

“Does it mean ‘functional?'” asked Dr. Dooley-Hash, 45. “I’m a physician at a really high-powered institution, and I’ve published in well-respected journals — I’m functional. I don’t think functionality is necessarily a good measure.”

People recovering from drug addictions face the same question. Experts are unanimous in saying that recovery can’t be defined solely by failure to engage in self-destructive behavior. Being able to engage in productive behavior and healthy relationships counts, too.

But beyond that, experts disagree on whether recovery requires complete abstinence from all former behaviors and destructive thoughts — or whether it can include, for example, “moderate” levels of alcohol use — and whether or not one can ever be completely rid of the disorder and be considered cured.

For example, what about situations in which people avoid unhealthy behaviors, but continue the same obsessions and preoccupations? Ellin asks whether a person can be considered “in recovery” from anorexia if she is able to stay at a normal weight and function well, like Dr. Dooley-Hash, but is still obsessed with calorie-counting and weighing herself daily. How well do you have to be to be better?

Similarly, alcoholics talk about “dry drunks” — people who have stopped drinking but still behave as erratically and carelessly as they did while imbibing. Is being sober itself enough? In contrast, is a person who still drinks moderately but no longer exhibits alcohol-related bad behavior considered to be in recovery?

As Ellin shows, there are parallel debates on multiple issues. In anorexia or addiction, these questions are of tremendous importance to patients, because their answers determine the goals of treatment. But in both cases, it’s also clear that one size doesn’t fit all.

“In the absence of expert consensus, patients and caregivers have come up with their own definitions of recovery,” Ellin writes. Indeed, for people who are struggling with addiction as well, patients and their families need to familiarize themselves with multiple perspectives on recovery, and find the help that best suits their particular situation.

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