4. Slips and Progress Go Together It’s been important to Tarpley not to settle in her middle place, but to keep moving forward. “Even if I don’t know whether full recovery is possible for myself, I still see a dietitian. I still see a therapist,” she says. If she slips, she asks herself why and what she can do to get back on track. She often encounters slips as she makes progress. And in researching her book, she found the same was true for many others. “You can’t slip if you’re standing still,” she says. “A lot of times when we’re doing really hard work and trying to move forward, that’s when we slip.” Major life transitions — especially those that come with bodily changes, like pregnancy — are also common triggers. For example, in one small Norwegian study of 24 pregnant women with a history of eating disorders, 23 experienced a worsening of their symptoms during pregnancy.e60dc2a1-f33c-4a05-9b50-8e3e8e59762969c36817-9a5f-48d2-9dab-175af9f9a15f Armed with this knowledge, you may be able to think ahead about the coping strategies and support systems you’ll need to stop a slip from becoming a relapse. 5. The Middle Place Isn’t Always Temporary While some people might be in the middle of recovery for just a few months, others may be there for decades. “I’ve been in this middle place for 20-plus years, and I would love to be fully over my eating disorder, but it’s still something I contend with,” Tarpley says. It’s difficult to establish how many people with eating disorders remain in the middle place versus making a full recovery after treatment, since follow-up duration and recovery criteria vary widely among studies, according to the Australian review. The report suggests that approximately 50 percent of people with eating disorders of any type who complete treatment fully recover. But a significant portion of those who no longer meet full diagnostic criteria still experience some residual symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e59762972dd81cb-4a07-4726-ab55-aa29c327e715 A supportive care provider will check in regularly to see how you’re feeling about your progress. If you want to push on because your symptoms still feel limiting, they should help you do so, Goldberg says. “If someone has worked hard to reach a stable middle place and is functioning well, they should not be forced into further change,” she continues. If you don’t feel you can have an open conversation with your provider about what recovery looks like for you, it may be worth exploring other options, Goldberg says. The National Association of Anorexia Nervosa and Associated Disorders treatment directory is a good place to start.e60dc2a1-f33c-4a05-9b50-8e3e8e597629926292f2-84dd-4522-99ec-327743ef7346 6. You May Have to Ask for Exactly What You Need Loved ones often want to help but don’t know how. “I’ve had to learn to ask for the help that I need,” Tarpley says. Being honest about her experience while in the middle place has given her the confidence to speak up when challenges arise, she notes. For example, she’s asked her husband to listen rather than lecture, and for family members to avoid discussing other people’s bodies in her presence. You may want to ask someone to listen without judging or commenting.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297af8040d-0015-4eec-9263-e8af9f621d9d You might even share some resources so they can learn more about what you’re going through.e60dc2a1-f33c-4a05-9b50-8e3e8e59762910b7e7b3-57ce-4414-af59-00ecd4031285 As with all parts of recovery, there’s no one-size-fits-all approach. A therapist with experience treating eating disorders can help. 7. You Don’t Have to Wait for ‘Recovery’ to Live Your Life Tarpley says that as long as you’re honest about where you’re at in recovery, you don’t need to wait to pursue goals, like meeting a romantic partner, hunting for a new job, or starting a family — start prioritizing those desires now. While some of these life changes can be stressful, they can also yield benefits. One small study of 66 people found that for individuals living with eating disorders while partnered, their romantic relationships were sources of love, intimacy, and support throughout recovery.e60dc2a1-f33c-4a05-9b50-8e3e8e59762988fb4757-7528-4d29-b999-67633db8fcd0 “I met my husband, got married, and had kids from within this middle place,” she says. “Those experiences, while challenging at times, also helped me to move forward in my recovery.” It’s similar to living with any chronic medical condition, Goldberg says. Challenges may still arise, and you can use those moments to explore how lingering thoughts or behaviors might be holding you back, she explains. “Life changes themselves are often the most impactful catalysts for deeper healing, whether it’s fear of missing out socially in college, building a new relationship, preparing for pregnancy, or the desire to model healthier patterns for children,” she says. Talk with your loved ones and care team about your goals and how your eating disorder may affect them. For example, before conceiving , it’s important to discuss how emotional and physical changes might trigger challenges in your recovery, as well as how you’ll manage slips while pregnant.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a7a0207-6481-44f7-bbd8-3e2132dd00f8 “Just because you may not have reached ‘full recovery’ doesn’t mean you can’t live a full life in the middle place, or that you can’t keep striving for progress,” Tarpley says. The Takeaway Eating disorder recovery is nonlinear and looks different for everyone. There’s no standard definition of a “full recovery,” and many people contend with disordered thoughts or behaviors, even though they’re not acutely ill. Acknowledging that the healing process is imperfect can help reduce stigma around eating disorders and empower people living with them to seek help. Talk to an experienced mental health care provider for support at any stage of eating disorder recovery, or ask your primary care doctor for a referral.
Defining what recovery looks like after an eating disorder is tricky. Mallary Tenore Tarpley was in and out of residential and hospital treatment for several years before realizing she would never be the poster child for anorexia recovery. “For a long time, when I was sick, I felt like I had to be perfect at the eating disorder,” says Tarpley, an assistant professor of practice in the school of journalism and media at the University of Texas at Austin. “Then after treatment, I thought I needed to reach this gold standard of full recovery.” In fact, there is no standard definition of “full recovery” — it looks different for everyone. Realizing this, Tarpley says, was crucial for healing. That’s part of the reason she wrote Slip: Life in the Middle of Eating-Disorder Recovery . “I kept telling everybody I was fully recovered, because I was ashamed to admit that I wasn’t,” she says. “I felt like I was failing at anorexia and failing at recovery.” She began to consider what it would mean if she let go of the perfectionist ideal and aimed instead for a middle space between acutely sick and fully well. She hopes sharing some of the imperfect, messy parts of eating disorder recovery — including these below — will help others feel less alone.
1. There Is No One Definition of ‘Recovery’ Some clinicians and organizations measure recovery from anorexia as achieving a certain body mass index (BMI) , a measurement of weight-to-height ratio used to estimate body fat composition.e60dc2a1-f33c-4a05-9b50-8e3e8e597629587d4bc3-9f97-4fbd-8fbb-7b5b5bca666c But many experts consider BMI to be inaccurate and unreliable as a measure of weight management.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297bc3ba41-57f2-45fb-89b7-88a4b8844bd8 Plus, it’s unhelpful in cases of atypical anorexia, where people with average or above-average BMIs exhibit disordered eating behaviors.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915535f26-8fe7-4963-8193-d82c31ad47cc Others measure it more subjectively, on the basis of someone’s body image , relationship with food, self-esteem, social relationships, and outlook on the future.e60dc2a1-f33c-4a05-9b50-8e3e8e59762972dd81cb-4a07-4726-ab55-aa29c327e715 “I think the eating disorder field is pushing for full recovery for everyone, and yet we’re still not defining what that actually means,” Tarpley says. The DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the guidebook clinicians use to diagnose and classify mental conditions) says a person has fully recovered once they no longer meet any of the criteria for an eating disorder for a sustained period.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299e391541-5d48-4fa6-8ab5-52186cfcafb9 While writing her book, Tarpley asked more than 700 people with lived experience with an eating disorder whether they identified with her concept of the middle place, and about 85 percent said yes. “I described it as this liminal, gray space between acute sickness and full recovery, where you’re trying to make progress, but you still slip, and your recovery is imperfect,” she says. “I realized how this middle place is so prevalent, and yet we don’t talk about it,” she says. Just as eating disorders look different for everyone, recovery does, too, says Rachel Goldberg , a licensed marriage and family therapist and an eating disorder and infertility therapist in Los Angeles. “Factors like the type of eating disorder, how long someone has struggled, family dynamics, age, and where they are physically and emotionally all shape the process,” she says. If you’re not sure what recovery might look like for you, you can begin by speaking with your primary care physician. They can refer you to a qualified mental health professional , such as a psychologist, psychiatrist, or clinical social worker.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290a08a444-53db-4e83-b69b-7b8041cc5538 2. Recovery Is Fluid The way full recovery was often presented to Tarpley early on made it feel like a finish line to cross. In reality, she’s found it to be more fluid. “It’s about trying to make progress, but knowing it’s imperfect,” she says. Goldberg agrees. “There are periods when progress feels harder, old behaviors resurface, or recovery shows up in new ways.” This fluidity isn’t an obstacle, but part of the journey.e60dc2a1-f33c-4a05-9b50-8e3e8e59762987e3a24f-ebad-4bf6-9890-657fe501d572 Tarpley says she hopes that defining and talking about this “middle place” of eating disorder recovery helps make healing more doable for others. Setbacks are absolutely part of the healing process, Goldberg says. If you’re working with a therapist during eating disorder treatment, for example, Goldberg says they can try to help you understand how to respond differently moving forward. A mental health care provider can help you evaluate where you are on your journey and develop an inclusive, holistic, and supportive approach for continued progress.e60dc2a1-f33c-4a05-9b50-8e3e8e59762992e48a67-9740-4621-b057-34a50900a0b5 3. Relapse Is Common Research suggests more than a quarter of people with eating disorders worldwide will experience a relapse. As with complete recovery, there’s no standardized clinical definition of a relapse. But it is widely used to indicate a return to acute illness after an apparent recovery.e60dc2a1-f33c-4a05-9b50-8e3e8e59762934c57d4c-4935-476e-bd35-1d2c8292d448 Tarpley considers relapses to be different from slips, lapses, or collapses, defining these terms as follows. Slip An unplanned, one-time deviation from the treatment plan Lapse A more significant engagement in eating disorder thoughts and behaviors over a period of time Relapse A repetitive pattern of eating disorder thoughts and behaviors with an inability to get back on track Collapse A worsening relapse that requires higher levels of care Destigmatizing the middle place in recovery could reduce the risk of slips and lapses becoming relapses and collapses, she says. She titled her book Slip for exactly this reason. “So often we tell people slips shouldn’t happen in an ongoing way, and yet so many people continue to struggle,” she says. Denying that setbacks happen as a natural, common part of recovery perpetuates stigma and shame, she adds, noting that this can make people more self-critical and less likely to ask for help. One of the best ways to lessen stigma around slips is to stop calling them relapses, Goldberg says. “That word often carries a sense of failure or wrongdoing,” she says. “Periods of struggling with eating, food, or body image happen even to people without eating disorders. Expecting that all unhealthy thoughts or habits will disappear forever is unrealistic.” If you’re looking for support during any challenging moment in recovery, Golderberg suggests reaching out to someone you trust to respond nonjudgmentally. “That might be a parent, a school counselor, or a therapist,” she says. You can also call an eating disorder hot line.e60dc2a1-f33c-4a05-9b50-8e3e8e59762936d9d9ad-3307-4829-8d18-02bcb5b03c38
If you or a loved one is struggling with an eating disorder, call 888-375-7767 from 9 a.m. to 9 p.m. CST, the helpline of the National Association of Anorexia Nervosa and Associated Disorders (ANAD).If you or a loved one is experiencing significant distress and needs immediate support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7.For more help and information, see these Mental Health Resources and Helplines.