Untreated recovery from eating disorders

Adolescence, Summer, 2004 by Susan Woods

Eating disorders are the third most common chronic condition among adolescent females in the United States (Fisher et al., 1995). It is estimated that 1% to 3% of adolescent females suffer full syndrome anorexia or bulimia nervosa, and up to 20% of high school and college age females have partial syndrome eating disorders (Sands et al., 1997). Eating disorders are associated with devastating physical, psychosocial, and financial consequences, and have the highest mortality rate of any mental health disorder (Fisher, 2003; Rome et al., 2003).

After two decades of research, there remains limited understanding of the eating disorder recovery process. Approximately 50% of patients do well after inpatient treatment; 20% do poorly; and 30% do reasonably well but continue to have symptoms (Fisher, 2003). These recovery outcome results, however, have been based on studies of patients in specialized treatment centers. Schoemaker (1998) notes, "We don't know in how many cases eating-disordered patients may improve or even recover without professional treatment" (p. 204). The present exploratory study was designed to examine the experience of recovery from an eating disorder without clinical treatment.

METHOD

Instruments

Based upon a review of literature and input from four undergraduate student research assistants, a qualitative, open-ended, electronic email survey was developed for this study. This format allows respondents to describe events, perceptions, and experiences in their own words. The survey questions were reviewed by a panel of four experts in eating disorder treatment and research, and was revised based upon panel suggestions. Following human subject research approval, eight survey questions were made available on the study e-mail address: (1) When did your eating disorder symptoms begin/emerge? (2) How did they start? (3) What factor(s) led to the development of your behavior? (4) What behaviors did you engage in? (Please list or describe all behaviors.) (5) Was there a key turning point in the initiation of your recovery? (6) Did you see/consult with any of the following: physician(s) therapist(s) or dieticians(s)? If yes, please describe: Who was consulted? How often? Length of treatment? (7) Do any physical and/or psychological aspects of your eating disorder persist? Please describe. (8) What and/or who do you find most helpful in keeping you from your former behaviors?

The survey cover page contained the study purpose, an explanation of confidentiality, a short demographic section, instructions on paper mail-in for anonymity assurance, and a statement thanking the participant for his or her time and generosity. Respondents were given information on obtaining study results, and were encouraged to contact the researcher by e-mail, or faculty telephone, with any questions, suggestions or thoughts.

Procedure

Several hundred survey flyers were placed on bulletin boards throughout the campus. The bold headline, "Recovery from Eating Disorder Study," was followed by, "If you have recovered from an eating disorder without extensive outpatient or inpatient clinical treatment, and would assist with a study on your experience of recovery, please contact (e-mail address). This eight-question e-mail study is confidential and can be answered anonymously. Your input is important and greatly appreciated." At the bottom of the survey were tear-off e-mail address tab strips. Throughout the semester student assistants monitored and replaced the flyers. Surveys were collected for three months.

Design

Ground theory (Glaser & Strauss, 1967) was employed to sort through themes and connections in the data. This qualitative process attempts to discern the mechanisms and pathways of experience, and the understanding of phenomena in the generation of theory.

RESULTS

Demographics

Twenty-two respondents completed the e-mail survey. Four respondents had been in hospital and inpatient treatment programs prior to recovery. The recovery following inpatient treatment surveys were reviewed as a comparison group, but are not included in the main analysis. Of the 18 respondents who reported recovery without treatment, 16 were female (89%), and 2 (11%) were male. Seventeen of the respondents were white, and one female respondent was Black. All respondents were 18-21 years of age and full-time students at one midsize, midwestern university. All respondents met the DSM-IV (American Psychiatric Association, 2000) diagnostic criteria for full syndrome anorexia nervosa or purging type bulimia nervosa prior to recovery. Eight females and one male (50%) reported suffering from purging type bulimia, six females and one male (39%) reported restricting type anorexia, and two females (11%) reported binge-eating/ purging type anorexia nervosa. All respondents reported regular or intermittent excessive exercise throughout the duration of their disorder.

The respondents began their disordered behavior between the ages of 12 and 17 (modal age = 15). All respondents were competitive high school athletes in the following sports: gymnastics/cheerleading (10 females), elite junior level figure skating (1 female), cross-country/ track (4 females, 1 male), softball (1 female), and football (1 male).