Imagine that someone you barely know offers to take you traveling to a country that you’ve never even heard of, and they don’t tell you any details about the destination.  You have no idea what to expect or how to prepare.  For all you know, the country could be extremely dangerous and with few people who speak your language. Without such clarity, you may find that you’re actually apprehensive about this trip and may not want to go.

For someone who is struggling with anorexia nervosa, the journey of recovery can feel this way.  Without an idea of what to expect during this process, you may experience similar feelings of fear, confusion, and apprehension which can interfere with willingness to recover.  Instead of blindly jumping into the process, you can benefit from knowing what to expect, how to prepare, and what type of support you might need.

Many therapists view the process of anorexia recovery through stages of change that are not necessarily linear, but cyclical (DiClemente & Prochaska, 1998).  Below you will find this layout of anorexia recovery, and hopefully with some clearer expectations about this process, you will feel more prepared and willing to begin your journey.

Pre-Contemplation Stage

Someone with anorexia who is in pre-contemplation is in denial about having an eating disorder.  Even if they clearly exhibit symptoms of anorexia, such as restrictive eating and a preoccupation with their weight, they may refuse to recognize that they are struggling. For someone in this stage, part of their recovery is to learn (from professionals and/or loved ones) the debilitating effects of anorexia on their health and functioning, and how recovery can bring them positive change.

Contemplation Stage

During this stage, the individual accepts that they have anorexia and are open to some type of treatment.  This does not mean they are willing to give up their eating disorder; in fact, the idea of surrendering the disorder can be terrifying.  A therapist is crucial in helping the individual determine the role and purpose of their eating disorder and how while it may have provided some protective function in the past, it no longer helps them.  This will hopefully make the individual more inclined to continue recovery.

Preparation Stage

In this stage, the individual feels ready to recover but does not know how.  Again, having a treatment team (therapist, physician, dietician, psychiatrist, and trusted loved ones) is essential to equip the client with tools and support.  Therapy can help the client develop and implement adaptive coping skills, learn appropriate boundary-setting, and create a plan to challenge anorexia-related thoughts and feelings.  Think of this stage as a means of scaffolding to ready the client for challenges that may surface during the remainder of the process.

Action Stage

The client is now prepared to confront specific eating disorder behaviors. This includes making explicit changes to their meal plan in order to challenge their restrictive eating, such as being required to eat three meals per day with snacks and/or supplements.  During this stage the client has to face their eating disorder fears head on, and with their treatment team will challenge other behaviors that fuel the eating disorder, like using scales and diet foods, and recognize and navigate eating disorder triggers, such as stress or family dynamics.

Maintenance Stage

After a sustained time and clear progress in the action stage, the client focuses on continuing to implement their new behaviors and coping skills, such as eating according to their meal plan and challenging themselves with new foods and social situations. The individual and treatment team refer back to the client’s potential triggers and how to manage them to prevent relapse.  The client also begins to focus on and enrich their life outside of the eating disorder, including goal-setting and meaning-making. 

Termination Stage & Relapse Prevention

During the recovery process, small lapses or relapse may occur.  Should this happen, the client should focus on strengthening their team of support, and utilize them to determine why they are using their eating disorder and prepare again for taking action to tackle behaviors. (i.e. going through the cycle of stages again). Termination depends on the individual’s progress and goal fulfillment, use of coping skills, commitment to their recovery and future treatment as needed, and their plans moving forward. 

By learning about the different stages of anorexia recovery, I hope that you are able to take away that it is a process, and not something that is expected to be completed overnight.  Each stage strengthens and prepares you for the next phase in challenging your eating disorder and creating the life you deserve, all with the help of a team that supports you.