How much recovery is possible for someone with a severe eating disorder?
In a new Norwegian study, 30 per cent of patients recovered completely. But researchers believe we need to ask ourselves what ‘healthy’ really means.
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A few years ago, a Swedish study showed that two out of three patients who had anorexia in their youth recovered completely.
The participants were followed up for 30 years. Despite the fact that many have recovered, some still struggle with eating habits into their 40s.
How does this apply to Norwegian patients with eating disorders?
Hanna Eielsen set out to find out. She is a PhD candidate and psychologist at the treatment centre Modum Bad.
Eielsen and her colleagues followed 62 patients who had been admitted to the treatment centre with a serious eating disorder. They investigated how many had recovered and how many still struggle with eating 17 years after they were admitted.
Half of the patients recovered
Half of these patients overcame their eating disorder diagnosis during the 17 years following admission.
However, shedding the diagnosis does not necessarily mean that the patient's health was fully restored.
When Eielsen looked more closely at some of the symptoms, she found that many patients were still struggling.
This included issues like dissatisfaction with their own body, the importance they places on weight and body shape for their self-worth, or the number of unhealthy eating rules they still followed.
When researchers took these factors into account, only 30 per cent had fully recovered from their eating disorder.
The study was conducted on a very specific group of patients, so it may not necessarily be representative of everyone with eating disorders. The group also had other mental health problems and had been ill for an average of 13 years before being admitted.
Hard to break habits
Eielsen emphasises that a significant improvement is that about 30 per cent of the patients fully recovered. Still, she wishes the results had been even better.
"I had hoped we could say something like, 'if you just give it enough time, most people will eventually recover'," she says.
“We know that the longer the illness has gone on, the more difficult it is for patients to break the patterns they’ve become stuck in.”
Disappointing but not surprising
Inger Margrethe Halvorsen says Eielsen’s new findings are disappointing, but not surprising.
“Other studies on adults who’ve been ill with long-term eating disorders suggest that some still recover despite having the disorder for a long time,” she says.
Halvorsen has previously studied and treated patients at the Regional Department for Eating Disorders (RASP) at Oslo University Hospital.
The patients at Modum Bad are adults with an average age of 30. They had been ill for a long time before their first admission, and many had previously received inpatient treatment – without it having helped.
“Adults generally have a worse prognosis than youths do,” says Halvorsen. “We therefore expect outcomes for adults to be worse than those of younger patients with shorter illness duration and without inpatient treatment.”
What is reasonable to expect?
According to Eielsen, the question is also one of defining what it means to be healthy. This is something that is debated in the professional community and not everyone agrees on.
"Can we expect someone to just turn off their focus on the body after perhaps being sick for 20 years?" Eielsen asks.
She compares the situation to a broken bone:
“If you break your leg, you might always be affected by it in some way. For example, the bone structure might change as it heals,” she says.
"Perhaps it’s too much to expect that there won’t be any lingering effects after having had an eating disorder."
More than one way to measure recovery
According to Eielsen, there are several ways to measure good health.
One way is to track the physical symptoms, such as weight and – in the case of bulimia – the number of episodes of vomiting.
Another way is to include the mental and emotional aspects.
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This could include how much body dissatisfaction they still have or how much time and energy they spend thinking about their body, weight, and planning food and meals.
“These factors include a lot of what is disruptive to everyday life,” she says.
According to Eielsen, it is only when the eating disorder no longer impacts daily life that we can talk about a full recovery.
As healthy as the average person
Since Eielsen and her colleagues included physical criteria for recovery as well as mental and emotional criteria, she believes it is positive that so many patients actually become "as healthy as the average person."
This is a term professionals use when a patient is no longer considered ill.
“People without eating disorders are also concerned with their body, weight, figure, and such things, but in a non-pathological way,” she says.
Young people with anorexia
Halvorsen talks about her own studies, where the proportion of those who recovered is slightly higher than in Eielsen's study.
In Halvorsen’s studies, the patients were younger.
Her studies include a survey of young people with anorexia who received inpatient treatment at a specialised unit between 2008 and 2014.
At the follow-up approximately five years after their stay, 58 per cent of the respondents no longer had an eating disorder.
Another study from 2004 looked at young people with anorexia who were referred to Child and Adolescent Psychiatry Unit (BUP) and were followed up nearly nine years later. The treatment was intensive and involved family therapy and a structured plan for relatively rapid weight gain.
After about nine years, only nine out of 51 patients still had an eating disorder, of which one had anorexia. Of the remaining 42, 15 had a somewhat challenging relationship with food and eating.
Importance of being declared recovered
Halvorsen agrees with Eielsen that we need to discuss what it truly means to be healthy.
She points out that it is important to be declared recovered from the diagnosis itself – even if you still have symptoms like body dissatisfaction and a difficult relationship with weight, food, and meals.
"Having an eating disorder diagnosis has a significant negative impact on physical and mental health, social functioning, and quality of life," she says.
References:
Eielsen, H.P. Longstanding eating disorders and personality disorders, mediators for 17-year long-term outcome, Doctoral thesis at the University of Oslo, 2024.
Halvorsen et al. Good outcome of adolescent onset anorexia nervosa after systematic treatment. Intermediate to long-term follow-up of a representative county sample, European Child & Adolescent Psychiatry, 2004. DOI: 10.1007/s00787-004-0408-9
Halvorsen et al. Naturalistic Outcome of Family-Based Inpatient Treatment for Adolescents with Anorexia Nervosa, Wiley Online Library, 2017. DOI: 10.1002/erv.2572
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Translated by Ingrid Nuse
Read the Norwegian version of this article on forskning.no
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