There was a point early on in my eating disorder recovery where I really thought I was “cured” of my illness. After all, I was eating dietitian-approved meals and snacks, and had significantly reduced my time in the gym. What I didn’t know at the time was that I had actually just reached a strange sort of limbo in my recovery: I was doing the “right” things, and it probably looked like I’d gotten a handle on my disease to the outside world. But inside, I was still obsessing over every bite I ate and every treadmill session I didn’t do, and still feeling massive guilt for “defying” my eating disorder. Though I wouldn’t realize it until later, I had entered a common but risky gray area sometimes called “quasi-recovery.”

Equip Peer Mentor Jamie Drago had a similar experience in her own recovery. “For me, quasi-recovery looked like making a lot of deals with myself and negotiations with the eating disorder,” Drago says. “For example, I’d tell myself, ‘I can eat X but only because I did Y,’ or ‘it’s okay for me to do X as long as I do Y.’ I focused so much on things being ‘not as bad as before’ that I wasn’t able to see how much better things could still have been even from that point.”

This gray area isn’t talked about very much in the recovery discourse, but it’s common, and more harmful than you might think. Plateauing in eating disorder recovery is risky for a number of reasons, including the physical implication of medical instability and the psychological implication of incomplete cognitive recovery. Read on to learn more about “quasi-recovery,” its associated risks, and how to move past it.

What is quasi-recovery?

Quasi-recovery in eating disorders, sometimes referred to as “semi-recovery” or “partial recovery,” is a way to describe a state in which someone is no longer in the depths of their illness, but has not yet fully recovered either. For example, a person in quasi-recovery may be able to follow their meal plan but won’t let go of disordered behaviors like body checking.

According to Equip Lead Therapist and Clinical Supervisor Brittney Lauro, LCSW, quasi-recovery is essentially the act of picking and choosing parts of the eating disorder that a person decides they’d like to get rid of, rather than challenging all parts of the disorder. To those without an eating disorder, this might seem confusing—but remember that eating disorders are often coping mechanisms gone awry, so someone might feel like they need certain behaviors in order to deal with life. What’s more, toward the beginning of recovery, the eating disorder brain is still running the show, and that brain places a high value on certain aspects of the disorder—like weight, dietary restriction, and exercise—and may refuse to let them go.

“When I think of ‘quasi-recovery,’ I’m reminded of some of the things I hear people say when they’re starting treatment,” says Lauro. “Statements like, ‘I really want to stop binge eating or purging, but I don’t want to change my healthy eating habits,’ which often means restriction. Or sometimes it’s, ‘I’m willing to gain a few pounds, but I refuse to go past XYZ number.’ Other times it’s, ‘I want to let go of parts of my eating disorder but I don’t want to stop exercising every day.’”

Drago describes this confusing stage as having “one foot in, one foot out” in recovery. For many people navigating recovery, stopping the most dangerous habits associated with their eating disorder might feel like they’ve achieved enough, leaving them clinging to behaviors that are still disordered but aren’t “as bad.” “Maybe eating disorder thoughts are less intrusive and they’re able to live a more flexible life than before,” Drago says. “But there are still some strings attached.” More often than not, living with those attached strings means prolonging the treatment process, increasing the chance of relapse, and impeding true, full recovery.

Why people get stuck in quasi-recovery

There are a number of reasons someone may get stuck in quasi-recovery and have trouble moving into full recovery. Some common contributing factors include:

• Persistent dietary restraint (i.e., continuing to restrict food or follow food “rules” in some capacity)
• Overvaluation of weight/shape (i.e., lacing a high value on weight and body shape)
• Compulsive exercise

Overvaluation of weight and shape is a major contributing factor for many. While this might not seem like that big of a concern, placing a high value on one’s body and appearance can cause someone to stay cognitively “in the eating disorder, making it difficult for them to move into full recovery, even if they’re performing all recovery behaviors “correctly.”

“There’s what feels like a persistent ‘need’ to look a certain way, or control one’s food or exercise a certain way,” Lauro says. “The overvaluation refers to a mindset where these things—weight, food control, etc.—are so highly valued, that nothing much else matters. It’s an intensive mindset, and truly is the driving force that sets people with eating disorders apart from folks who experience periods of disordered eating.” The good news is that overvaluation of weight and shape is effectively addressed in CBT-E, helping patients move into “all-in” recovery.

Similarly, both compulsive exercise and dietary restraint correlate with eating disorder severity and relapse vulnerability. Lauro believes that one major reason so many people struggle with quasi-recovery is because diet culture has normalized disordered behaviors around restrictive eating and unhealthy exercise. “I feel for folks,” Lauro says. “There’s so much messaging in our society that supports ‘quasi-recovery.’ Exercise is praised at all costs with little discussion about rest, and there are constantly new fad diets disguised as ‘lifestyle changes’ or ‘wellness plans.’ It is all so confusing knowing what to do and what to trust.” This experience can be especially common in life after eating disorder treatment.

It’s important to note that the phrase “all-in recovery” may be subjective, as eating disorder recovery itself can take many forms. Recovery is not necessarily a destination but an ongoing journey that many experts view as a dynamic, evolving process marked by stages, setbacks, and shifts. While traditional treatment has often focused on measurable markers like weight, behaviors, or absence of symptoms, experts now believe that recovery should be rooted in clinician-guided plans that prioritize how patients actually feel and describe their experiences, and what optimizes their entire well-being.

The risks of quasi-recovery

“The greatest risk of quasi-recovery is always relapse,” Lauro says. “And we know that relapse and active eating disorders take away from your ability to live life and fully experience joy. Any time we leave any element of the eating disorder unchecked, we run the risk of reigniting the whole thing. I have seen this numerous times in my practice. It is always best to make sure we leave no stone unturned.”

The definition of “relapse” varies in scientific literature, as does the definition of “remission.” With that in mind, a systematic review reported that eating disorder relapse rates range from 9 to 52%, and tend to increase as the duration of follow-up increases (i.e., the longer someone has been in recovery, the higher their likelihood of experiencing a relapse). While the definitions may vary, there is a consensus among experts that the risk for relapse in those with anorexia is especially high within the first year following treatment. Relapse risk can spike for a number of reasons, including:

• Stressful life events
• Being under your body’s “set point” weight
• Returning to unsupervised exercise
• Sustaining ongoing rules around food and exercise

Relapse can be of particular concern when someone in quasi-recovery experiences a major or stressful life event. “If someone hasn’t allowed their body to reach its natural weight set point, for example, or still has a disordered relationship with exercise, they could be at risk for relapse prompted by life events like a wedding or having a child,” Lauro says. “On the flip side, I find that those who have allowed themselves to maintain their natural set point, and have done all of the work to eliminate restriction and all compensatory behaviors, don’t end in relapse despite stressful or major life events.” Research also shows that a lower body mass index (BMI) at treatment discharge predicts higher relapse risk in those with anorexia, and there can be physical and mental tolls to lingering food restriction, weight suppression attempts, and compulsive exercise.

Drago says that in her experience with quasi-recovery, the biggest risk was succumbing to the slippery slope of increasingly disordered thoughts and behaviors. “As many times as I told myself I would be able to sustain a semi-recovery state, it never stayed that way for very long,” she says. “These are really strong illnesses and even things like ‘cutting corners’ with a meal plan or doing something ‘just a little bit’ eventually sends things downhill every time.”

Lauro says that in her opinion, there simply isn’t enough information published about the hope that comes with full recovery. “Most articles focus on life events that trigger relapse and it's usually painted in a hopeless light,” she says. “The truth is, there is hope. And there’s a strong chance you won’t relapse if you reach full recovery and let go of quasi-recovery.”

Quasi vs. full recovery: a simple self-check

While there is no clinical definition for quasi-recovery and no diagnostic assessment to determine whether you meet quasi-recovery or full recovery criteria, asking yourself certain questions can help you get a sense of where you fall. If you’re concerned you might be lingering in quasi-recovery, ask yourself:

1. Do I have rules or make “deals” with myself around food, movement, weigh-ins, etc.?
2. Do I experience anxiety if I miss a workout?
3. Do I perform body checking behaviors or avoid looking at myself completely?
4. Do I have an ongoing need to only eat “safe foods”?
5. Do I avoid weight-related medical care?

When answering these questions, it’s important to remember that “full recovery” can mean different things to different people. But the scientific literature shows that “cognitive recovery” (i.e. shifting disordered thoughts and mental habits) is an essential part of being fully recovered. In other words, only changing behaviors does not necessarily mean a person is fully recovered, and weight restoration does not equal full recovery—because eating disorder psychopathology can persist even after weight and behaviors have been normalized.

How to get out of quasi-recovery (a step-by-step plan)

While it’s relatively common to temporarily land in quasi-recovery, it’s not a place to settle or get stuck. The goal is always to find true freedom from the harmful tethers of the eating disorder—but this can admittedly be a big challenge.

“Getting past the hurdle of partial recovery is really tough, because doing that first half of the work is already hard and scary and exhausting, so the idea of having to do even more can sound out of the question,” Drago says. “To make that final push, you need to sit down and really investigate where you are still seeing eating disorder thoughts, urges, and behaviors popping up.”

In addition to continuously challenging food fears and anxiety-provoking situations, Drago believes that constant, clear communication with one’s treatment team is essential to achieving full recovery. “With a lot of our society really encouraging and praising a focus on changing our bodies, and many folks experiencing frequent instances of weight stigma, it’s important to process with your providers how you can care for yourself and support your recovery in the face of that,” she says.

If you do feel that you or a loved one are stuck in quasi-recovery from an eating disorder, it’s important to take action and pursue full recovery. While there is no single method or timeline for full recovery, the following steps can give you a sense of how to get out of quasi-recovery:

Return to regular eating patterns

Because restrictive eating predicts eating disorder symptoms and relapse, it’s important to work with an eating disorder-trained dietician to incorporate all food groups with consistency. “Don’t be afraid to go back to basics,” Lauro says. “That includes three meals and two to three snacks eaten at regular intervals of time and inclusive of all food groups. Pay attention to be sure that portion sizes align with what your treatment team would have recommended.”

Pause, then rebuild movement carefully

Temporarily putting exercise on hold can be an important step in moving from quasi-recovery to full recovery. Working with a clinician or dietitian to plan a graded return to movement can help address any compulsion risk and prevent a slide back into disordered behaviors. Working with a team to plan a safe re-entry into movement may include first getting medical clearance, then putting together an appropriate fueling plan, setting time and type limits, and creating non-aesthetic goals. A few red flags for compulsive exercise include:

• Anxiety if exercise is skipped
• Obligatory or rigid patterns around exercise
• Exercising despite negative consequences
• Needing to exercise more over time to relieve anxiety
• Prioritizing exercise over other aspects of life

“The most effective way to do this is to go cold turkey for a period of time—at least a week or so—without any exercise,” Lauro says. “If this feels unattainable, try to cut back little by little. When you’re ready to re-integrate exercise and movement, start with activities that aren’t linked to your eating disorder. Consider group classes or walking instead of running, etc. If your eating disorder has rules about how much time you should be on an exercise machine, experiment with intentionally stepping off the machine a few minutes early.”

Work the cognitions (CBT-E/DBT skills)

Working with a skilled clinician to target persistent issues—like overvaluation of weight and body shape, body checking, rules, and perfectionism—through CBT-E and dialectical behavioral therapy (DBT) can help advance recovery. These two modalities can also help you tackle body image work, which further supports recovery.

Expand your clothing options

“If you’re still only allowing yourself to wear certain clothing styles or colors, consider experimenting with fashion that you genuinely like without a focus on weight or what your body looks like,” Lauro says.

Make a scale strategy

It’s important to work with a team to strategize how to approach weight monitoring, and whether doing blind weights or having exposure to the numbers will be most helpful. “For some folks, this might mean removing the scale completely from their home and only having weight checked at doctors appointments when it is medically necessary,” Lauro says. “For other folks, the opposite might be true: it might mean reaching back out to their treatment team to work on exposure to seeing a number on the scale. Some folks tend to choose this option as a means of protecting their future selves, so if they are ever in a situation where they will have to see their weight at a medical appointment, they are less likely to be impacted in a negative way.”

Create a relapse plan

Making a relapse prevention plan is a core step in the recovery journey. To do so, work with your treatment team, supports, or both, to identify personal triggers and early-warning signs, and plan who to contact and what kinds of prevention skills to practice (urge surfing, opposite action, etc.) in the moment. This is often one of the last steps of treatment, but it can also be done post-discharge, and can be an essential part of reaching full recovery.

Seek support

It’s important to know that it’s always okay to need more help. Just because treatment didn’t “fully” work in the past doesn’t mean it won’t help now. If you or a loved one experience medical instability, suicidality or self-harm risk, or rapid deterioration, it’s critical to seek additional support and to step up care. And even if you’re not in an acute situation but still want support reaching full recovery, you deserve—and may need—to reach out to professionals for additional help.

While the specific ways someone challenges themselves to move out of this gray area may look different from someone else in the treatment process, it’s important to keep the ultimate goal in mind: total recovery. Quasi-recovery is common, but it can be a dangerous place to stay, so recognizing the signs of it and knowing how to move beyond it is essential to achieving true and permanent freedom from an eating disorder. Remember: if you need additional support to fully recover from your eating disorder, that’s not “failure.” Quasi-recovery is a step on the way to full recovery, and most people do get there. Recovery takes time—but it’s always worth it.

FAQs

What does quasi-recovery mean?

Quasi-recovery in eating disorders, sometimes referred to as semi-recovery or partial recovery, is a way to describe a state in which someone is no longer in the depths of their illness, but has not yet fully recovered either. This state of quasi-recovery can involve both behavioral and cognitive components.

Why is weight restoration not enough by itself?

Psychological symptoms can persist even when weight is restored or stabilized. Without making intentional cognitive and behavioral changes, the risk of relapse still persists.

Is it normal to fear stopping exercise?

Yes. Exercise compulsion is common and having fear or anxiety about missing exercise sessions or pausing workouts completely can be anxiety-provoking. Because of that, it’s important to work with your team to pause and re-introduce movement safely.

How do I avoid relapse during life stress?

Creating a comprehensive relapse plan and building a team of supports can go a long way in helping to prevent relapse. It’s also important to be aware of early relapse warning signs and to maintain structure while recovering.

What does “full recovery” involve?

“Full recovery” entails making physical, behavioral, and cognitive changes that support your overall well-being. Research has shown that only individuals who were behaviorally and cognitively recovered were comparable to controls on measures of body dissatisfaction, disordered eating, drive for thinness, and endorsement of the thin ideal.