An Overview of Conceptualizations of Eating Disorder Recovery, Recent Findings, and Future Directions

Abstract

A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.

Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta‐analysis

“…dance with similar recommendations(Ackard, Richter, Egan, Engel, & Cronemeyer, 2014;Tomba, Offidani, Tecuta, Schumann, & Ballardini, 2014;Fava & Bech, 2016;de Vos et al, 2017;Bardone-Cone et al, 2018). Moreover, in line with neuropsychological literature which underscores the importance of including neuropsychological tasks in treatment, for example, to improve set-shifting and cognitive flexibility(Vall & Wade, 2015), we suggest considering such areas of functioning in defining remission and recovery in EDs as well.…”

“…Remission from EDs, which also has been found to vary in definitions and to be inconsistently applied across studies , appears to not differ greatly from recovery criteria (Bardone-Cone et al, 2018). However, remission studies frequently do not clearly state the required duration (Bardone-Cone et al, 2018). However, remission studies frequently do not clearly state the required duration (Bardone-Cone et al, 2018).…”

“…Data suggest that the presence of residual symptoms, defined as the perseverance of symptoms and signs despite meeting remission or recovery criteria, are frequent after completion of drug or psychotherapeutic treatment in various psychiatric illnesses such as schizophrenia, unipolar depression, bipolar, panic, substance use, and EDs (Cosci & Fava, 2013;Fava, 1996). Indeed, partial remission is the most common ED outcome after treatment, whereas full remission or recovery is quite rare (Bardone-Cone et al, 2018;Kordy et al, 2002).…”

Variability in remission in family therapy for anorexia nervosa

“…Appropriate attention to such detail is urged whether interpreting individual study results or findings across the AN treatment literature, or when utilizing such information to inform clinical care. Our findings also have implications for the broader eating disorder treatment outcome literature in that there are as many definitions of remission as there are published studies, regardless of diagnosis (Bardone‐Cone et al, ). Gaining consensus in this broader field about the definition of remission is of critical importance in prospectively creating a cohesive storyline as this body of research evolves.…”

“…Given the fragility of partial clinical improvement (Khalsa, Portnoff, McCurdy‐McKinnon, & Feusner, ), and the high risk of chronicity in AN (Eddy et al, ; Fichter, Quadflieg, Crosby, & Koch, ; Herpertz‐Dahlmann et al, ), it has been argued that the bar for clinical efficacy in AN RCTs should be set high. In this earnest effort, aptly highlighted by Bardone‐Cone, Hunt, and Watson (), the broader eating disorder community is urged to reach consensus on how to define recovery, and that this definition includes at least three key criteria; physical, behavioral, and psychological well‐being. Presently, however, there is still no consensus as to precisely what constitutes clinically significant change over a course of treatment for AN.…”