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April 24, 2018 Marion MacDonald

How Do You Measure Eating Disorder Recovery?

measuring recovery

A few weeks ago while researching another topic, I ran across a New York Times article entitled, "What to Look For in an Eating Disorder Treatment Center". By the third paragraph, I was shaking my head in disbelief. The article was written by Erica Goode, a science writer for the Times, but it reads like an apology for the insurance industry's tendency to fund only the lowest-cost least effective treatment possible.

"Place a priority on therapies that focus on behavior, rather than on identifying the roots of the eating disorder," says Goode.

This is the polar opposite of Mirasol's approach. We've been successfully treating eating disorders for 20 years. And if there is one thing we know for certain, it's that ignoring the underlying issues is a recipe for failure.

Eating disorders are complicated illnesses. They are frequently tied to co-occurring conditions including anxiety, ADHD, trauma and OCD. They typically take years to develop and they can be extremely difficult to treat.

The author goes on to say that treatment centers should "provide information about the average weight gain per week for anorexic patients ... and the percent of adult patients discharged with a body mass index of 19 or above."

In other words, the author defines recovery as achieving a "healthy" BMI. This is the definition preferred by medical model treatment centers and insurance companies, because it makes treatment so simple: just force the client to follow a rigid diet for 30 days and the eating disorder goes away, right?

But when the client returns home with no new understanding of the origins of the eating disorder and no new coping skills, the most likely outcome is a series of trips to the emergency room and a merry-go-round of admissions to in- and outpatient treatment centers. The client may eventually recover, but only after years of suffering. Even from the insurance companies' point of view, it would seem that focusing on short-term suppression of symptoms is not cost-effective in the long run.

Goode urges consumers to be wary of the outcome data posted on treatment center websites, and she has a point. Standardized tests for anxiety and depression will generally show at least some improvement at the conclusion of treatment. But what matters is how the client fares a year or two after treatment, and such data may be based on a small sample size. Whether they are doing well or poorly, most clients prefer to leave their treatment experience in the past and get on with their lives. Only a handful will respond to a survey with glowing testimonies and praise for the clinicians who helped them recover.

In the end, recovery can't be boiled down to a BMI, or even scores on standardized psychological tests. It's a change in the person's expression, in the way they carry themselves, in the timbre of their voice that says, "I know I will still face challenges, but I also know I am equal to those challenges."

How in the world do you measure that? No idea. But it's the thing that motivates all Mirasol clinicians to keep finding ways to help clients struggling with a dangerous and complex mental illness.

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