Understanding Stages of Change – Recovering from an Eating Disorder
“I first realized that I needed help when I was about 18 years old, which was approximately six years into my eating disorder” Wendy Hughes explains, “and over the next few years I battled some of the hardest days, weeks and months of my life.”
The road to recovery is often a long and frustrating one, but it can also be a time of great hope and relief. This process requires not only a qualified team of professionals, but the support and love of family and friends as well. It is not uncommon for someone who is suffering with an eating disorder, or any addiction or illness for that matter, to sometimes feel uncertain when beginning their treatment process.
Flora Svinarenko, a psychotherapist specializing in eating disorders notes, “the difference between the medical model and the Stages of Change model or other current approaches to treatment of eating disorders, comes from viewing eating disorders as much more than straightforward diagnosis.” Knowing more about the Stages of Change model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.
There are five Stages of Change that occur in the recovery process: Pre- contemplation, Contemplation, Preparation, Action, and Maintenance.
Pre-Contemplation is the beginning stage where an individual suffering with an eating disorder will not even consider that they need to change their behaviours. Although other people involved, such as family and friends, might be able to pick up on the symptoms the individual will deny the need for help.
Wendy reflects on her emotions and thoughts prior to recognizing her need to seek help. “Not until three years into my eating disorder did I realize how serious it had become, and for the next eleven years I tried time and time again to break free from my eating disorder, always believing that I could do it on my own.”
The Contemplation Stage occurs when the individual is ready to admit that they have a problem but might not be open to receiving help. The fear of change can become very strong and the thought of having to give up your coping strategy can be extremely overwhelming. During this stage it is important for others to recognize the person’s readiness for change and support with them accordingly.
It is not unusual for some individuals to spend years in the contemplation stage, which professionals easily recognize by “yes, but…” statements. Validation, support and encouragement are necessary during all stages, but especially when individuals are struggling with ambivalence and doubting their ability to accomplish a change in their lives.
“The thought of seeking help for my eating disorder was almost as terrifying as the thought of living with it for the rest of my life” reflects Wendy, “seeking help meant breaking my silence, announcing to the world that I was not the person everyone thought I was, and I believed, letting everyone down.” It is important that individuals struggling with an eating disorder reach out and gain support. Being surrounded with people who love you can become a huge attribute to your commitment to recovery.
Wendy was overwhelmed by the reactions she received from her family and friends when she opened up about her eating disorder, “instead of being made to feel like I had let them down, I received praise for my strength in coming out about my struggles. I had people telling me they were proud of me, and that I could accomplish anything I put my mind to, including overcoming my eating disorder.”
The next stage is Preparation, when an individual begins making goals and preparing to make specific changes in their behaviours. An individual, with the support of others, will begin to establish specific coping skills such as ways of dealing with triggers or negative eating disorder thoughts and emotions. This can also be the stage where a treatment team as well as the individual and family members can develop a plan of action.
An individual may then be ready to implement the Action Stage where they can use their strategies and confront the eating disorder behaviours head on. Although the individual may be willing to try new ideas and face their fears in order for change to occur they still need support. As Flora describes, “the individual can be at advanced stages of recovery addressing their behaviours, but still need more support about healthy coping with their emotions.”
This is where the Maintenance Stage can begin to evolve. During this period an individual has usually maintained their goals for approximately six months or longer and is now practicing their new behaviours and ways of thinking. Parts of this stage also involve revisiting triggers in order to prevent lapses or get back on track if an individual has a slip.
Wendy shares that “since the completion of my last hospital treatment I have not relapsed, although I have had slips and expect to have slips for a long time to come.” It is important to understand that a slip in the recovery process does not equal failure and that during the maintenance stage learning ways to manage a slip will help get the individual back on track.
Wendy explains if a slip occurs or she feels like she may be at risk she utilizes the supporters and coping mechanisms she now has in place and “strips the eating disorder of its strength before it has a chance.”
Every individual will experience their journey of recovery in a unique way and therefore it is important that we begin to consider recovery not as a linear, all or nothing approach but as a multidimensional process. As Flora suggests, “recovery from an eating disorder is about redeveloping a healthy relationship with food, learning to accept that perfection doesn’t exist, and rebuilding trusting relationships with oneself and others.” Recovery will not be a simple process and individuals will experience many barriers, but the important thing is to turn these experiences into an opportunity to learn and have the strength to fight back.
On your journey of recovery you will experience good days and bad days. Recovery takes a lot of time and hard work. It is important that if you recognize the warning signs of relapse that you have a support team you can turn to. It can be difficult to admit to those helping you that you are experiencing a slip or lapse for fear that you may disappoint them or that they may feel angry with you. It is always important to keep in mind that if you have people who love you they will appreciate your honesty and help you overcome those feelings of guilt and shame.
“My first hospitalization was not successful and I relapsed immediately after being released. Part of me believes that this was not the right treatment approach for me, but a stronger part of me believes that even though I had started seeking treatment, I just wasn’t yet ready to let go of my eating disorder” describes Wendy. Although relapsing can cause overwhelming feelings of shame you do not have to work through those struggles alone.
As Flora explains “it is important to remember that a few steps back doesn’t mean complete failure. It can be turned into a learning experience that can provide you with the strength to fight back. You need to try different approaches, therapists, and groups to learn what your needs are and what will be helpful for you.” It takes a lot of strength to recognize your own warning signs, as they will be different for each of us. Take this opportunity as a learning experience and remember that this is all part of your journey towards recovery.
After five years of being in recovery from her eating disorder, Wendy shares her story in an attempt to stress to others facing similar struggles that “although the road to recovery is long and hard, the longer you commit to the fight, the brutal days will become less and less and farther and farther apart.”
Stages of change model. (2011). Patient Education Management, Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/902391639?accountid=13631
Brotsky, Sarah. (2009). Understanding stages of change in the recovery process. Eating disorders recovery today, 7(4).
Sullivan, Victoria., & Terris, Charlotte. (2001). Contemplating the stages of change measures for eating disorders. European eating disorders review, 9(1), 287- 291.
Bio About the Author:
Alannah Sheridan is a third year Bachelor of Social Work student at Ryerson University. She is currently at Eating Disorders of York Region as a placement student working towards completing her undergraduate degree. Her research focus is in the area of mental health and she is passionate about promoting recovery and wellness.