Why Do Some People Go To ED Treatment and Not Get Well?

We live in an age of instant gratification, and this translates to everything, including our beliefs about treatment.

Many enter eating disorder treatment expecting to be given a “magic pill,” the solution that will fix everything in an instant.

Sadly, treatment and recovery are not that black-and-white, and there is no “one-treatment fits all” approach to overcoming an eating disorder.

Research has determined a few factors that can work for, or against, recovery and, often, these factors are the difference between relapsing, or fully recovering, from a disorder.

Family Support

Not that long ago, the family was frequently excluded from the treatment process due to the belief that they were the cause of the disorder and, therefore, would exacerbate the problem.

Albert Einstein said, “the definition of insanity is trying the same thing over and over and expecting the different results.” As such, sending an individual to attend treatment to make positive mental and emotional changes, then returning them home to an environment that remains unchanged sounds a bit like insanity.

Clinicians and researchers agreed and began to look into the true relationship the family can have in fostering recovery. Studies have since found that family-based therapy improves the recovery rates of adolescents and adults alike [1].

Considering this, most clinicians now make the inclusion of the family unit a priority in treatment, helping individual’s process past experiences and relationships and helping to foster a smoother transition after treatment.

Social Support

An individual’s relationship to their peers is just as important as their relationship to their family. A 2015 study found that “the feeling of being loved, cared for, valued, and held in high esteem by society” is a noteworthy protective factor against eating disorders [2].

Those who have developed consistent friendships based on good communication, trust, and acceptance have a lower risk of even developing an eating disorder. Tapping into these relationships during, and after, ED treatment provides individuals with another line-of-defense against relapse.

Motivation to Change

One of the biggest determinants as to whether or not someone will finish treatment “changed” is obvious – do they want to change? Studies have found that patients with “self-endorsed pursuit of change,” are more likely to have success after treatment and show “better treatment adherence, lower depressive symptomatology…And less eating preoccupation [3].”

The “self-endorsed” aspect of motivation is crucial, as these patients display a personal and internal desire to change their lives and recover, as opposed to simply attending treatment due to external pressures or expectations.

In a 2014 study, researchers found evidence to not only support the importance of self-endorsed motivation to change but determined aspects that can foster this motivation, namely, feelings of autonomy, competence, and relatedness [3].

Autonomy relates to an individual’s feeling of being capable of working toward and achieving, their goals independently.  Those that feel competent display an ability to overcome challenges and incorporate what they are learning to their treatment and recovery.

Finally, relatedness refers to the individual having a trusted support system.  All of these aspects foster an individual’s desire to change because they believe they are capable and have support in doing so.

Treatment Method

Most treatment centers are multifaceted, and there’s a good reason for that – it gets results! Studies have shown that purely addressing an individual’s eating habit or psychological state is not enough to bolster successful and prolonged recovery. The disorder is multifaceted. Therefore, the treatment should be as well.

ED treatments that are often multidisciplinary include collaboration with nutritionists and physical therapists in treatment. Physical therapy has shown numerous psychological benefits, the tendency to increase self-esteem and body image being one that is particularly helpful in eating disorder recovery [4].

Likewise, nutritionists have been described by the American Dietetic Association as a “fundamental member of the treatment team with unique skills to address food-related behaviors and assist in medical monitoring [5].”

Treatment centers that promote individual’s processing their emotional concerns while learning practical applications of positive coping mechanisms, nutrition, and exercise, foster a less daunting, and more positive, transition back into the “real world.”

Support after ED Treatment

The work is not complete once treatment ends. In fact, many people say that the challenge of leaving treatment and reintegrating their new selves into their old life was the most difficult. Those who often plan for this challenge have a better chance of overcoming it.

As previously discussed, tapping into a support system is important. Family and friends are valuable protective factors against disordered thoughts and behaviors. Additionally, planning for “bad days” after treatment can assist an individual in tackling a difficult moment head-on with the resources and supports they put in place.

Anticipating these moments and creating a plan-of-action before leaving treatment is important. Individuals in treatment should have a treatment team lined up on the “outside” and look into what eating disorder recovery support is in their area.

Planning for the worst may seem bleak, but it is often the difference between being blindsided and reverting to old, negative, coping mechanisms or facing a challenging moment, looking it in the eye, and knowing how to overcome it.

Self-Compassion

Those who achieve recovery do not walk out of the doors of their treatment center magically fixed. In fact, many of them may relapse multiple times before feeling free of their disorder. A final aspect that promotes successful recovery is self-compassion and self-forgiveness.

Remember that one slip-up does not mean you need to fall back into the hole of disordered eating. Recovery is not a decision that once made, occurs completely and immediately. You will have to choose recovery over and over again, each moment of each day.

Every time you do, you will feel your strength grow, your resilience shines through, and you will move toward freedom from your eating disorder until freedom is all you know.

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About the Author: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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References:

[1]  Lock, J. (2011). Evaluation of family treatment models for eating disorders. Current Opinion in Psychiatry, 24, 274-279.
[2] Uzunian, L. G. et al. (2015). Social skills: a factor of protection against eating disorders in adolescents. Ciencia & Saude Coletiva, 20:11, 3495-3508.
[3] Van Der Kaap-Deeder, J. et al. (2014). Fostering self-endorsed motivation to change in patients with an eating disorder: the role of perceived autonomy support and psychological need satisfaction. International Journal of Eating Disorders, 47:6, 585-600.
[4] Soundy, A. et al. (2016). Considering the role of physical therapists within the treatment and rehabilitation of individuals with eating disorders: an international survey of expert clinicians. Physiotherapy Research International, 21:4, 237-246.
[5] Dejesse, L. D., Zelman, D. C. (2013). Promotion optimal collaboration between mental health providers and nutritionists in the treatment of eating disorders. Eating Disorders, 21, 185-205.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on September 26, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on September 26, 2017.
Published on EatingDisorderHope.com