For many people, eating disorder recovery will be a life-long journey full of ups and downs. While the ups of recovery tend to increased self-esteem and positive emotional states, the downs of recovery, although discouraging to most, can also provide valuable experiences. A well-thought-out aftercare plan or program can help you successfully maneuver every experience in recovery, whether good or bad, and keep you moving forward. Most eating disorder treatment facilities recognize that aftercare is a major contributor to long-term success in recovery and will incorporate aftercare planning into their overall treatment approach.
Many people believe they can recover from an eating disorder on their own, but research shows that anywhere from 10% to 50% of people dealing with an untreated eating disorder will relapse.1 Furthermore, many eating disorders can lead to death if left untreated.1 Investing in your treatment and recovery can prevent relapse and reduce the psychological and physical ailments associated with eating disorders.
Benefits of an Aftercare Program
In general terms, aftercare describes everything that you do upon discharge from an intensive eating disorder treatment program. More specifically, it means the various elements you put in place to support your long-term recovery, including:
- Medication management to treat mental health disorders, such as anxiety and depression, that either exist concurrently with the eating disorder or that arise after treatment.
- Individual therapy to help you gain an ongoing and deeper understanding of your eating disorder.
- Group therapy to continue to support you and to expand your internal and external resources to maintain recovery.
- Nutritional counseling to help you overcome dysfunctional relationship dynamics with food and provide guidance with everyday challenges around your eating disorder.
- Lifestyle changes to help you derive a stronger sense of purpose and satisfaction in your life overall.
Incorporating each of these aspects of aftercare into your plan can help you remain encouraged, motivated, and accountable in your recovery. With every small success in your recovery comes a boost, whether small or great, to your overall wellbeing and self-esteem. Each one will be proof that you are capable of achieving your goals and remaining on your recovery path.
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A solid aftercare plan will increase the chances of a sustained recovery from your eating disorder. Without one, the odds of relapsing are quite high. Focusing on the core issues related to your eating disorder should be the focus of any aftercare program that you choose.1 Seeking out providers who focus on these issues will likely increase your chances of success.
Several core issues related to eating disorders are:1
- Obsessive thoughts. Anxiety often drives obsessive thoughts which then leads to compulsive, maladaptive behaviors—all of which can greatly interfere with your ability to function in a healthy and productive way.
- Perfectionism or a need for order and symmetry. Perfectionism often drives relapse, causes low self-esteem, and increases your interpersonal conflict.
- Rigidity or inflexible thinking. Inflexibility can result in self-limiting thoughts and behaviors and increased conflict with others.
- Over-compliance with perceived authority figures. This often results in passivity and a disregard for your own needs, which can lead to negative cognitive and emotional states, as well as potential relapse.
- Inhibition of emotion. If left unchecked, bottling up emotions can drive further eating disordered behaviors, which act as a way to release pent-up feelings.
- Social anxiety, phobia, and introversion. Avoidance and isolation may drive feelings of depression, triggering disordered eating.
In addition to these common core issues related to eating disorders, weight gain and substance abuse may be additional factors that emerge as you move further into recovery.2 Finding a therapist or a program equipped to handle each of these issues will be essential to staying healthy.
To increase your odds of staying abstinent from your eating disorder long-term, your aftercare treatment team should include the following clinicians, each specially trained to treat people with eating disorders:
- A psychiatrist or psychiatric nurse practitioner (NP). Many people recovering from eating disorders suffer from depression, anxiety-related disorders, and substance abuse.1,2 Psychiatric healthcare professionals can help you deal with these common symptoms. This is important because untreated co-existing mental illnesses can trigger an eating disorder relapse. It can also interfere with your ability to follow your aftercare plan. Medications are not a permanent method in recovery for everyone, but when needed, having access to it in the acute stages of recovery may help you stay focused and optimistic.
- An individual therapist. Individual therapists should be knowledgeable and experienced in dealing with eating disorders. It’s also best if they are trained in cognitive behavioral therapy (CBT) for eating disorders, since this modality has proven successful in treating eating disorders.3 CBT provides structured, evidence-based therapy to help you identify what is driving your eating disorder, as well as what patterns and triggers are associated with it.3
- Group therapy. Group therapy is important, but it may have to be incorporated after you have made some progress in individual therapy. Many people who are recovering from an eating disorder deal with some level of social anxiety, which could result in avoidance, isolation, and even depression.1,2 Group therapy can help you move past these feelings and build interpersonal trust that can eventually extend beyond the group setting. Group therapy also provides an environment where others understand what you are dealing with and will not judge you, but rather support you during your recovery. The National Eating Disorder Association (NEDA) can provide more information about support groups in your area.
- A nutritionist. Learning healthy nutrition is crucial for anyone recovering from an eating disorder. Often, thoughts and feelings around food are inaccurate or distorted and must first be dealt with in therapy. A nutritionist can help you slowly incorporate nutritionally dense foods into your diet and help you to experiment with food in ways that you may not be able to do on your own.
Support groups have helped millions of people achieve long-term recovery, so a good aftercare plan should incorporate a support group of some type because:
- It helps you realize that you are not alone, and that if other people can achieve successful recovery, you can too.
- It provides a safe place that is free from judgment and full of ongoing support from others who understand exactly what you have been through.
- It can provide you with various techniques that others have successfully used in their own recovery.
- It provides resources to other professionals who are experienced in helping people get through eating disorder recovery.
- It often provides sponsors who are available whenever you are feeling discouraged or triggered. Mentors and sponsors are usually people who have been in recovery a long time and who have experienced the many thoughts and feelings that you will experience in your own journey.
- It provides free or low-cost options to continue on your recovery path.
Like all other types of aftercare, there are groups that are helpful and groups that may actually make you feel worse. Part of recovery is finding what works best for you and committing to those things. In the process of finding a group, it is important to find a facilitator and group that you feel you would be most successful in. Do not be afraid to try many groups before settling on one that is most helpful to you; and don’t be discouraged if this process takes some time. In the end, the effort that you put into your recovery will be reflected in your recovery success.
Inpatient treatment is hard. However, the real work will begin once you leave the treatment facility and get back to living your everyday life. Treatment facilities provide a safe and structured environment where you are focusing exclusively on healing from your eating disorder and you have 24/7 support. Leaving this setting can be a fear- and anxiety-producing event, but planning everyday-life support can help to ease the transition by shifting it to a time of optimism and excitement instead.
Most facilities have you begin thinking about your aftercare plan days or weeks prior to your discharge date. These facilities will structure your daily schedule to include nutrition, therapy, groups, and other stress-reducing activities to aid in your continued recovery. Typical everyday factors you may want to include in your aftercare plan include:
- Employment. Finding employment may be a stressor, or it may be something that helps keep you on track. You must start by asking yourself if you are ready to take on a job at this time. Consult with your treatment team, and if you collectively agree that you are ready, returning to your old job or finding employment can boost your self-esteem by using your talents and skills with the tangible result of monetary benefits. Some insurance companies provide caseworkers who can help you with the process of creating a resume and applying for jobs. If you are uninsured and cannot afford this type of service, there should still be a local job agency that is free and open to the public. It is important to find a job that will not add undue stress and will contribute to your life satisfaction while you are in recovery.
- Therapy. Setting up individual, group, and nutritional therapy before you are discharged will increase your chances of success. Most facilities will have a list of recommended therapists, nutritionists, and groups in your area. This is a good place to start and can streamline the process.
- Recreational activities. Discovering new activities and hobbies is important for your mental, physical, and spiritual well-being in recovery. It is not enough to simply have follow-up care, it’s important to begin deriving pleasure and satisfaction from your life. There are so many activities to choose from, but remaining open to experiences and seeking the support of a friend or loved one when experimenting will be important. Some suggested stress-relieving activities include yoga, meditation, tai-chi, Zumba, hiking or walking, being out in nature, swimming, massage, acupuncture, Reiki, or any other activity that helps you to relax, rejuvenate, and center yourself. Find something you can enjoy without triggering your eating disorder, and then do that activity on a regular basis.
- Social/community involvement. Sometimes the best medicine is helping others, which takes the focus off of your own problems or worries, opening up your heart to feel compassion and love for others. Ask yourself what you are passionate about (such as helping animals, children, or the elderly) and find a cause you can invest a couple of hours into each week. If you already know what you are passionate about, you can start at Volunteermatch.org.
When developing your everyday aftercare plan, try not to overwhelm yourself by completely over-booking your schedule. This can sabotage your recovery. Start small and then build as your confidence and energy grows. Your health and happiness are the two most important things, so keep yourself in mind and honor where you are during every moment.
- Srinivasagam, N. M., Kaye, W. H., Plotnicov, K. H., Greeno, C., Weltzin, T. E. & Rao, R. (1995). Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. American Journal of Psychiatry, 152(11), 1630–1634.
- Fairburn, C. G., Cooper, Z., Doll, H. A., Norman, P. & O’Connor, M. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57(7), 659–665.
- Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T. & Kraemer, H. C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57(5), 459–466.