Getting an eating disorder diagnosis and finding the right treatment can be a long and winding road. Depending on the treatment approach and the severity of the illness, treatment may last from months to several years.
But what happens after eating disorder treatment ends?
So much of the answer to this question depends on where someone is in their recovery when treatment ends and the nature of their support system. Staying in recovery after treatment can look different for everyone.
How Do You Know When Your Loved One Is Ready To Leave Treatment?
Being fully nourished and weight restored if necessary — to the right recovery weight range for one’s body — is the foundation of a solid recovery. In addition, eliminating eating disorder behaviors (such as restricting, purging, or overexercising) is an important part of the recovery process.
While weight restoration is necessary for many patients, it’s not always sufficient for recovery from an eating disorder. Developing effective coping strategies, self-care practices, and emotion regulation skills is often crucial. Some patients also need support for processing trauma and treatment for co-occurring mental health conditions, such as depression or anxiety. Every patient benefits from building a life worth living outside of their eating disorder; having authentic interests and relationships to explore is another signal of readiness to move beyond treatment and into relapse prevention.
For patients with ARFID, there may be some treatment targets that remain a focus even after formal treatment is done, such as trying new foods. In general, the goal of treatment is to ensure that any ARFID symptoms are no longer causing significant problems in a person's life: they have no nutritional deficiencies, are not reliant on supplements, and can fully enjoy the activities and relationships that are meaningful to them.
It’s worth noting that too many people lose access to treatment prematurely because of limitations in their health insurance coverage. An abrupt discharge from a higher level of care can be a frightening and confusing time, especially if there aren’t plans for ongoing support. This can also aggravate existing beliefs about not being “sick enough” to deserve treatment.
Having family involvement during eating disorder treatment can help foster a smoother and more supportive transition into and through recovery. With the support of loved ones who understand eating disorders, patients have a better chance of maintaining recovery, and a safety net in the event they struggle with a return of symptoms.
How Do Treatment Teams Prepare Patients To Stay in Recovery?
To give patients the best chance at long-term recovery, treatment teams focus on helping to heal the whole person and arming them with the tools needed to stay in recovery. Treatment usually involves the following key areas:
- Prioritizing weight restoration when applicable
- Normalizing eating patterns
- Addressing any co-occurring conditions, including but not limited to depression, anxiety, and/or obsessive-compulsive disorder
- Developing body image resilience when needed
- Teaching coping skills
- Empowering family or friends to support their loved one
- Stress-testing recovery by engaging in real-life challenges
- Exploring passions and goals outside of recovery
- Developing a concrete relapse prevention plan
How Can You Stay in Recovery in a Diet-Obsessed World?
In a culture that prizes thinness, praises weight loss, and demonizes certain ways of eating, staying in recovery after treatment isn’t easy. For patients in large bodies, these challenges can be even more difficult because the outside world’s fatphobic tendencies collude with the eating disorder’s thoughts at nearly every turn.
Here are some common approaches to maintaining and even strengthening recovery:
- Relapse Prevention Plan. Having a relapse prevention plan that includes the continued support of family and friends is often a critical final step of treatment. The plan should provide clear strategies for monitoring and bolstering recovery and addressing any struggles that arise.
- Advocacy at the Doctor’s Office. Someone in recovery from an eating disorder may need to advocate for themselves — or have a loved one do so for them — with doctors they encounter after treatment. Disclosing an eating disorder history and articulating individual needs can help patients get the appropriate medical care they deserve. For instance, a patient may ask not to be told their weight or request that they not receive weight-loss recommendations or be prescribed restrictive diets.
- Recovery Weight Range or Weight Minimum. With the guidance of their treatment team, some patients and families may identify and continue monitoring a recovery weight range or minimum. For children and adolescents who are still growing, the recovery weight range will be an upwardly moving target.
- Body Image Resilience. Maintaining healthy body image is an important way to protect recovery, and doing so in our society requires resilience. Healing the relationship with the body can take different forms and may evolve over time. Concepts such as body positivity, body neutrality, body acceptance, and body liberation are just some of the frameworks people in recovery can explore to develop a sense of empowerment in their bodies. Fat activism offers a social justice framework that can be especially powerful for patients in large bodies.
- Anti-Diet Mentality. By adopting a flexible, all-foods-fit approach to eating, someone with an eating disorder can help protect their hard-earned recovery. Any kind of restrictive diet — even if it’s not specifically focused on weight loss — can increase the risk of relapse. This includes eating behaviors that have become normalized in our culture, like eliminating certain food groups (gluten or dairy, for instance), or intermittent fasting.
- Support Groups. Attending support groups after treatment can be an important component. Being surrounded by other recovery-minded individuals and getting guidance during stressful times can offer essential support while navigating life’s inevitable ups and downs.
What Does Eating Look Like After Treatment?
Recovery looks different for everyone, and there isn’t one “right” way to approach eating after treatment. Many patients and families in recovery are eager to adopt intuitive eating — an eating approach in which you trust and listen to your body in order to make food choices that feel good for you, free of any internal judgments shaped by diet culture — and there can be a lot of pressure to cross an imagined finish line and “get there.”
Intuitive eating, by definition, is individualized, and many eating disorder dietitians recommend that patients start slowly and incorporate only certain elements of intuitive eating early in recovery.
Some patients find they need some level of ongoing meal support with a family member or friend, especially during stressful times. Other patients find they stay in recovery by following a meal plan or eating “by the clock,” especially if hunger and fullness cues aren’t always accessible or reliable.
As mentioned above, eating disorder experts caution patients about the risks of engaging in restrictive diets, even if they are described as “healthy eating.” In fact, the idea of “healthy eating” itself can be damaging, as this vague phrase implies the existence of good and bad foods and almost always involves eating less. Eating disorders tend to fixate on numbers and rules, often making diets more rigid or more extreme than even intended. Unless truly medically necessary, someone in eating disorder recovery should avoid eliminating foods from their diet or following an eating plan from anyone other than a dietitian who specializes in eating disorders.
What Is the Role of Family After Treatment Ends?
The end of a loved one’s treatment can be a time of celebration or an extended exhale, but also a time of uncertainty. For the family of a loved one who’s been in treatment, it’s common to wonder when or if you can ever stop worrying. Some may even find themselves surprised by the emergence of delayed feelings of distress after their loved one is in recovery.
After months or years of treatment, many families are understandably eager to return to “normal.” It’s tempting to assume your loved one is recovered enough not to need your support. In most cases, however, patients benefit from an ongoing support system that can continue to monitor recovery progress.
For decades, there was a pervasive and harmful myth that relapse was inevitable or that someone could never fully recover from an eating disorder. While recovery looks different for everyone, we now know that true healing is possible. Families can benefit from continuing to participate in recovery communities and ongoing virtual support groups, such as those hosted by FEAST, FEDUP, and Equip.