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Three Essential Steps to Recovery

Three Essential Steps to Recovery

By Suzanne Dooley-Hash, MD, FAED

When I was first thinking about writing this article I was a little overwhelmed by the thought of boiling eating disorder (ED) recovery down to three steps. Thinking back over years of treatment, relapse and recovery, so many different things came to mind. A few have been constants throughout my journey, though. The first and arguably most important step is to show up. This might sound overly simplistic, but it can be surprisingly difficult at times. Eating disorders have high rates of treatment dropout for a reason – working on recovery is hard. While taking the first step by reaching out or asking for help is often thought to be the hardest, other steps along the way are pretty tough, too. Some days just showing up is all you can do. And that’s ok. Once, after I’d unceremoniously left the third or fourth treatment center I’d been in that year, my therapist told me how great it was that I kept showing up to her office despite feeling pretty hopeless at the time. She said that was all I needed to do right then and as long as I kept showing up I was taking steps in the right direction. At that time, showing up was all I could do. Her telling me I was doing that one thing right made all the difference in the world. And I kept showing up.

The next essential step is finding support. Eating disorders thrive on isolation. Recovery from one is very much about connection and support. That support can come in many forms and serve different purposes. For me, I know I would not be here if it weren’t for the support of my husband. He and I never really talked much about ED, but he has always had my back. He kept our household running when I was away or too ill and he always loved me no matter how crazy things got with ED. His unwavering support even when I was at my most unlovable has gotten me through some rough times and he continues to be my stabilizing force today.

Clinical support has also been crucial as well. This has looked different at different stages. Sometimes this was in an inpatient or residential setting and other times it was an outpatient team consisting of therapist, dietitian, and physician. Consistently, I’ve found I work best with an experienced ED therapist who is familiar with ED’s tricks and who has abundant patience as I’ve often been slow to grab the rope.

One thing related to support people I would like to point out is not everyone has to be a confidant for things related to ED. Many of the other people that have supported me in recovery likely never knew they were doing so. Having family and friends in my life who accept me for who I am, that I enjoy spending time with, and who help stave off ED’s isolation is huge even if I never talk about ED with them. Ranting about work with work friends, laughing about our crazy world with others, and other “normal” things can get overtaken by ED. Having supportive people to help bring them back into my life has been key to regaining the normalcy ED had stolen.

Lastly, I also credit my non-human supports with playing extremely important roles throughout my life and recovery. I never feel more grounded than when I am caring for a horse or cuddling with a kitten. As Temple Grandin has said, “Animals make us human.” I’d add they also take me to a place where ED is irrelevant.

As for my third essential step in recovery, learning to listen, especially to myself, has been perhaps the hardest thing to do. As many with ED’s are, I’ve long been a master at ignoring internal cues, both physical and emotional. Working past exhaustion, putting everyone else’s needs ahead of my own, denying my body its basic needs, are all things that have allowed ED to keep me stuck. I won’t say I’m great at it yet, but I’ve slowly learned if I listen carefully, I can hear my body saying it needs a break from my usual hectic pace or my mind telling me it doesn’t want to take on the next new project. By recognizing those cues and responding appropriately, I find I am actually happier and more productive. I also find there is less room for ED in my life when I’m paying attention to what actually matters. Win, win.

Listening to that little voice in my head is also critical for helping me find things I care about more than I care about ED. When I was at my absolute worst I found myself not caring about anything or anyone. That came as a complete shock and I think it was somewhat of a turning point for me. For someone who has spent a lifetime caring, often too much, it was unfathomable I suddenly was indifferent to pretty much everything. Ironically, I had to learn to listen to that voice and to care about myself before I could rediscover what else really mattered to me. Just listening has opened a whole new world of possibilities and allowed me to rekindle old passions and discover new ones, all of which I find are more important than ED.

A closing disclaimer – these are just a few of the things that have helped me along the way. Just like no two people are alike, no two eating disorders or recoveries are either. What has helped me may or may not be helpful for others. Honestly, no one thing has been helpful for me at every point in time. Recovery is a journey; an imperfect, often messy journey. Everyone’s journey is a little different, but the destination is always the same – freedom from ED. May you journey in peace.

About the author:

Suzanne Dooley-Hash, MD, FAED: I am currently an Associate Professor of Emergency Medicine at the University of Michigan in Ann Arbor, Michigan. I also have more than seven years of experience providing medical care for individuals with eating disorders (ED’s) at the Center for Eating Disorders and as a consulting physician for the Eating Disorder Recovery Program, both also in Ann Arbor. Since 2014 I have taught a graduate level course, Medical and Physiological Aspects of Eating Disorders, at Plymouth State University in Plymouth, New Hampshire. I have presented on several topics related to ED’s and medical education nationally and internationally and have published more than 30 papers and book chapters on these topics. My current research interests include screening for ED’s in medical settings, and improving standards for medical treatment of ED’s. Personally, I have decades of experience with ED’s as an individual with an ED as well as through being the child, parent, sibling and friend of others with ED’s.


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