Quasi-Recovery

Qausi-Eating Disorder Recovery Dandelion Pic

A previous post, Is Full Eating Disorder Recovery Possible?, brought up a lot of questions about a common challenge for people pursuing eating disorder recovery that I want to talk about today: partial recovery. I actually like the term qausi-recovery because the word “qausi” can mean both “almost but not fully” as well as “seemingly but not actually”. Though sometimes we are aware we are only partially recovered, other times, we think we are fully recovered when we’re not actually 100 percent there. My personal journey fell into the latter category. 

When I relapsed, I had been free of eating disorder behavior for 8 years and believed I was recovered. Slipping back into old behaviors took me by surprise because I didn’t think I was in danger of a relapse since I hadn’t really struggled with my eating disorder for so many years. I didn’t understand why it happened for a while, but eventually came to realize that all those years, I had really been in quasi-recovery.

Some might not agree, and that’s understandable. Part of the difficulty with this topic is that there is no one definition for recovery. Everyone defines it a bit differently, so for our discussion here, I wanted to clarify what I mean by recovery.

What is Full Eating Disorder Recovery?

From a clinical perspective, we would use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to see if a person still meets any criteria for an eating disorder. The three most-known are anorexia nervosa, bulimia nervosa, and binge eating disorder. However, many people don’t meet all the criteria for these disorders, but could still be diagnosed with an eating disorder known as Other Specified Feeding and Eating Disorder (OSFED).

OSFED is diagnosed when a person has feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. While some people start out with an OSFED diagnosis, some start with a different diagnosis and are later diagnosed with OSFED when they no longer meet criteria for anorexia, bulimia, and binge eating disorder. Some examples include:

  • Someone who has restored weight to a “normal” range but continues to significantly restrict
  • Someone who binges or binges/purges but not as frequently
  • Someone who doesn’t restrict caloric intake anymore, but has become overly conscientious about eating only “healthy” foods (now known as orthorexia

Anyone who still meets the diagnosis criteria for an eating disorder is still not recovered. I imagine most people would agree with that. But does not meeting criteria mean you’re recovered, as I was those 8 years? Perhaps from a clinical perspective, but I personally believe recovery goes beyond a clinical definition. For me, recovery from an eating disorder is more than just abstaining from eating disorder behaviors—it involves a real healing of the relationship with food and your body. 

What Quasi-Recovery Can Look Like

Some signs you might not be fully recovered from your eating disorder include (and during my qausi-recovery stage, I could check several of these boxes!):

  • Eating more than you did before but still not consistently honoring your hunger and/or eating an appropriate amount
  • Eating more foods than you did before but still labeling food as “good” and “bad” and avoiding “bad” foods much of the time
  • Having anxiety around food
  • Using exercise to “earn” or “make up” for what you eat
  • Having food rules about what, how much, or when you can eat
  • Continuing to hate your body and/or fear weight gain

How to Push Through Quasi-Recovery

Being honest with yourself about not having fully healed your relationship with food and your body is an important place to start, if you’re not there already. It’s equally important to believe that full recovery is possible. Don’t settle for believing that this is the best it can be for you, though I understand those feelings as well. I have vivid memories of saying through sobs that I would never be able to make peace with my body and therefore food, even though I wasn’t using explicit behaviors anymore. 

But recovery is about rooting out eating disorder thinking just as much as it is about quitting behaviors. So keep doing that internal work to challenge all the eating disorder/diet culture mentality that continues to drive food anxiety and fear of fatness. Here are some great books I recommend:

Read these and other anti-diet, fat-acceptance books and follow fat-positive, intuitive eating accounts on social media (sign up for my newsletter and I’ll send you a list of influencers!). Then unfollow, cancel, or otherwise disengage with people and content that continues to keep you in bondage to food issues. What we surround ourselves with influences us in a MAJOR way. Finding community with people who promote true body acceptance and food freedom is vital in changing your mindset. It made all the difference for me and I hear the same from so many others.

Final Thoughts

Based on my own experience and those of my clients, qausi-recovery is a common stage for many people with eating disorders. So if that’s where you find yourself, that’s totally okay. Please don’t feel like a failure or get discouraged. The journey to full eating disorder recovery is not a straight line, and it’s certainly not easy. Especially considering how disordered our culture’s relationship with food and bodies is! You CAN get there. It might be cliché, but it’s true:

Progress, not perfection, dear one.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is Full Eating Disorder Recovery Possible?

Is Eating Disoder Recovery Possible

Sometimes clients will ask me if I believe full eating disorder recovery is possible. This is such an understandable question given how difficult recovery is and, for some clients, how long they have been struggling. It’s not uncommon for eating disorder treatment to last years, and sometimes include repeated periods of being in a higher level of care.

Even with all those challenges, my answer to whether full eating disorder recovery is possible is YES.

I believe that because I’ve lived it myself and seen others recover too. And all of us questioned whether it was possible. It felt too hard at times. It was too messy, and we slipped up a lot. And it took much longer than we thought it should, much longer than we wanted it to.

Friend, I promise that is just the reality of eating disorder recovery and none of those things is evidence that you can’t do it.

What about “recovered” versus “recovering”?

There is some debate in the eating disorder community about whether people can be fully recovered without intentional maintenance or whether it is more like always being in recovery… that is, having to intentionally maintain being free of the eating disorder. Many alcoholics describe themselves as being in recovery, even years after they have stopped drinking. It implies a sense of fragility to recovery, as if losing that recovery is always a near possibility. I’ve found this thinking to be common in the 12-step communities.

I personally believe that full recovery without having to intentionally maintain it is possible. That is my experience and the experience of many others I’ve seen. However, I would never minimize the experiences of those who describe themselves in a state of recovery. I certainly have no right to tell them they are wrong. Yet I can’t help but wonder if those people just have settled for a state of qausi-recovery (a topic I’ll write about soon). It’s possible that they haven’t fully healed their relationship with food and their bodies, even though they are free of actual eating disorder behaviors. In the alcohol recovery world, that’s called being a dry drunk.

I have found qausi-recovery to be a very common experience for many people with eating disorders, so if that’s where you find yourself, you’re completely normal in that regard too. It doesn’t mean you’ve failed or can’t do it, it just means there are still some things to work on, things that still need healing. I was in qausi-recovery for 8 years so I know about that in-between place quite well. But against all odds, here I am, now completely recovered.

You can have full recovery too. Just don’t give up.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Eating Disorder Treatment

Eating Disorder Treatment

Deciding what level of care you need or your loved one needs can be daunting. Today I will give an overview of the five levels of care that are available for eating disorder treatment and describe the type of person who would be a good fit for each level. If you’re still not sure which is right for you, please reach out to me so we can talk about it.

When deciding what level of care is needed, several factors should be considered. Historically, weight was the main determinant, but thankfully, we are slowly moving away from that approach. Now, most treatment providers and insurance companies take into account your overall physical condition, psychology, eating disorder behaviors, and other factors. The American Psychological Association (APA) provides suggested criteria for each level of eating disorder treatment. These criteria include:

  • Medical status
  • Suicidality
  • Weight (as a percentage of healthy body weight)
  • Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
  • Co-occurring disorders, including substance use, depression, and anxiety
  • Structure is needed for eating and gaining weight
  • Ability to control compulsive exercising

Let’s take a look a the levels of eating disorder treatment and how the APA’s guidelines apply to each of them.

Level One: Outpatient: Outpatient treatment includes individual sessions with a therapist and/or dietitian, typically once or twice a week. Outpatient treatment typically last for months to years, and can sometimes include periods of being in a higher level of care. Also, sometimes outpatient care can include group therapy. Outpatient eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals
  • are able to at times limit your eating disorder behaviors, including compulsive exercise
  • are not suicidal with a plan or intent to harm yourself

Level Two: Intensive Outpatient Programs (IOP): IOPs usually include about three hours of programming for at least two to three days a week. At this level of care, you would live at home and could probably still work or go to school. Usually, one meal or snack takes place at the treatment center. IOP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals but need a bit of support/accountability
  • are able to at times limit your eating disorder behaviors, including compulsive exercise, but need a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Three: Partial Hospitalization (aka Day Programs): Partial hospitalization (PHP) is typically treatment during the day, while letting you still go home at night. PHP is usually 6 to 11 hours a day for at least five days a week, so the majority of meals are at the treatment center. PHP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have some motivation for recovery but are struggling to feel motivated at times
  • need structure and support for most meals 
  • struggle to limit your eating disorder behaviors, including compulsive exercise and need quite a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Four: Residential Treatment: Residential treatment provides 24-hour care for those who are medically stable but still require round-the-clock supervision meals and behaviors. Residential treatment is typically 6 weeks or longer. This level of care is likely right for you if you are medically stable and have a/an:

  • need for supervision to eat 
  • need for supervision to not purge or use other behaviors
  • inability to stop exercising
  • lack of treatment options near home

Level Five: Inpatient Treatment: Inpatient treatment is 24-hour care in a medical hospital. This level is for individuals who are not medically stable and need round-the-clock medical assistance or monitoring (including intravenous fluids, tube feeds, and constant monitoring of vital signs). This is often a necessary level of care for individuals who do not cooperate with treatment protocols at lower levels of care. Inpatient stays can last days to weeks. This is likely the right level for you if you are not medically stable or if you have:

  • unstable heart rate or blood pressure
  • significant weight decline and/or food refusal
  • evidence of malnutrition
  • other psychiatric disorders that would require hospitalization
  • suicidal thoughts with intent to harm yourself

A quick note in case you’re asking yourself Am I Really Sick Enough for Treatment?

I hear this question all the time. Sweet friend, the answer is always “YES!”

Your eating disorder will try to convince you that you don’t need or don’t deserve help. It will whisper lies about things not being that bad, about you being able to handle it, about not looking like you even have an eating disorder…

Don’t listen to any of that or any other excuse your ED gives you. Eating disorders don’t have a “look” despite the stereotype, and people at all weighs can have an ED. And you don’t have to be at the point of needing hospitalization to be “sick enough”. Please, please don’t wait for that point to get help.

You could miss out on spending years of your life with joy and purpose instead of spending them still consumed with your ED. You could do irreparable damage to your body, or yes, even die.

Don’t believe your eating disorder. You are worthy of help and support. Today. Not sometime in the future when things get worse. TODAY.

xo.

Final Thoughts…

Again, I know it might feel overwhelming trying to figure out the right eating disorder treatment for you (or your loved one). If you’re still not sure which is right or if you need a referral to higher level of care, please reach out to me. If you’re ready to start outpatient therapy, it’s easy: schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Why Can’t I Stop Bingeing?!

Why Can't I Stop Bingeing picture

How many times have you called yourself a failure after eating something you felt you shouldn’t have? After all, dieting is just a matter of willpower, right? So after every “failure” when we’ve eaten the wrong food or eaten too much food, we beat ourselves up for blowing it (again!) and are left feeling convinced we are weak… maybe even addicted to food. That would at least explain why we feel so powerless to stop the bingeing and overeating, even when we so desperately want to stop. “I am not going to do that again,” you probably promise yourself, and double-down on your commitment to follow the rules this time.

The truth is, your bingeing is not because you don’t have enough willpower. And it’s not because you’re addicted to food. It’s because dieting is a flawed methodology, with inherent side effects that cause its own failure. Notice I said that dieting is the failure—not you. Research shows that 80 to 95% of people who diet don’t lose weight long-term. That means it’s rare for people to sustain weight loss on diets, and those who do are statistical outliers. Still, dieting for intentional weight loss is prescribed all the time for all kinds of reasons! If dieting was a medication, it would never get FDA approval with such terrible success rates. Especially when you consider the mental and physical consequences of dieting, which I won’t go into detail today (check out this post for that). For now, I just want to look at the diet-binge cycle on a pretty basic level so you can see the domino effect that is set into motion the minute you start a diet.

  1. Dieting: Restricting certain food or limiting amounts of food.
  2. Dieting “High”: Initial feelings of control, accomplishment, and relief of anxiety related to weight and eating.
  3. Deprivation/Obsession: Preoccupation with food, hunger, feelings of deprivation, and cravings.
  4. Anxiety: Fear of losing control, anxiety around food.
  5. Binge/Overeating: Bingeing on restricted or “bad” foods, “breaking the rules”.
  6. Shame and Guilt: Feeling like a failure, beating yourself up.
  7. Anxiety: Worry about gaining weight due to bingeing.
  8. Dieting again to relieve anxiety… and starting the cycle all over again!

As you can see from this cycle, bingeing is an expected response to deprivation for most people (even some people with anorexia nervosa experience “binges”). There are biological reasons for this, in addition to the emotional ones, which we will discuss in the next post. So if you want to stop bingeing, you have to stop dieting and restricting. I know this isn’t the answer most people want, because it’s hard to accept that dieting doesn’t work. For one, we’ve been brainwashed to think it does and to blame ourselves for not being able to lose weight long-term. And also, because giving up dieting feels like giving up on the dream of losing weight and finally keeping it off.

Giving up on intentional weight loss is incredibly difficult given the weight stigma and biases that surround us, but it is possible. You can start rejecting diet culture by learning about Health At Every Size (HAES®), which provides a rarely-heard scientific perspective on issues related to weight. It would also be helpful to work with a good eating disorder therapist or dietitian who can guide you through the process of learning intuitive eating and healing your relationship with food and your body. If you’d like to talk with me about that, please contact me!

Check out the follow up post to this one, The Effects of Dieting on Your Body and Mind.

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

SaveSave

No Pain, No Gain (Not)

How do I hate this tank top? Let me count the ways… Listen friends, if you puke or faint during exercise, your body is telling you to stop! Intuitive eating and intuitive moment go hand-in-hand and have the same underlying philosophy—Listen to your body! Our culture has done us a huge disservice to by making us believe exercise has to be painful or unpleasant to be beneficial. Even just the word “exercise” fills most people with a sense of guilt or dread (or both). How many times have we started exercising only to quit because we hated it?

Just like how intuitive eating requires dieting rules go out the window, joyful movement (as intuitive eating author Evelyn Tribole calls it), calls for tossing the exercise rulebook out the window too. You don’t have to burn X calories, exercise for X minutes, or do X workouts a week. You don’t have to throw up or be able to barely move the next day. Many people are turned off from moving their bodies because they think if they don’t do it hard or long enough, it doesn’t count. It does! Even light exercise can have a lot of physical and emotional benefits, so give yourself the freedom to explore what kind of movement feels good to you. Maybe it’s stretching or some simple yoga poses on your lunch break? Or maybe riding a bike with a friend? One of the ways I love to move my body is to push my daughter in the stroller outside while I listen to an audiobook.

Movement can be challenging physically but it should be something enjoyable! It shouldn’t injure you or make you miserable and it certainly should NOT be a punishment for something you ate. Let’s be kinder to ourselves when it comes to exercise and maybe we’ll discover it really can feel joyful!

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

SaveSave