More than an outcome: a person-centered, ecological framework for eating disorder recovery

Abstract

Background Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. Body In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual’s level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.

Exploring the relationship between clinical and personal models of recovery in anorexia nervosa: A mixed methods study

“…The findings of this study broadly support the hypothesis that there is agreement between personal and clinical models of recovery in AN, in line with proposed frameworks (Kenny & Lewis, 2023; Wetzler et al., 2020). Most participants who self‐defined as fully recovered met clinical criteria for full recovery, and those who met criteria for full recovery scored significantly higher on personal recovery measures compared to the not recovered group.…”

“…Thirdly, the findings of this study, particularly the diversity of opinions expressed in the qualitative section, emphasise that whilst a universal criterion‐based approach to defining recovery from AN is vital for ongoing research and clinical work in this field, it will inevitably have limitations on an individual level. This is in line with concerns raised by researchers in this field who suggest that recovery may best be captured using a flexible, individualised, and non‐linear approach (Kenny & Lewis, 2023). For example, the presence of co‐occurring conditions may complicate the measurement of ongoing behaviours: previous research on the overlap between autism and AN has highlighted that autistic individuals may experience disordered eating unrelated to AN which persists following recovery (Kinnaird et al., 2019).…”

“…Whilst previous research recommends that BMI should be used in combination with psychological and behavioural indices, the results of this study go further in suggesting that clinicians should consider additionally adding personal recovery tools to support a more holistic exploration of what recovery means to an individual (Bardone‐Cone et al., 2010). For example, Kenny & Lewis' (2023) proposed recovery model includes a worksheet to aid clinicians in exploring their proposed domains with patients, and there is some research highlighting the benefits of using individualised goal‐based measures of treatment outcomes in this population (Austin et al., 2020). Finally, given the poor agreement between self‐defined and clinically defined recovery identified in this study, particularly regarding understandings of partial recovery, clinicians should be sensitive and consider curiosity around the fact that their understanding of their patient's recovery status may not be shared with that individual.…”

“…This framework highlights the core domains of supportive relationships, hope, identity, meaning and purpose, empowerment, and self‐compassion, all theorised to exist in a positive relationship with a reduction in clinical symptoms. More recently a second recovery framework has been published (Kenny & Lewis, 2023). Whilst this model posits recovery domains (including physical stability, quality of life, and psychosocial functioning), its core argument is that recovery is individualised, ongoing and non‐linear, and that the domains are therefore “starting points” that may or may not be relevant to individuals.…”

Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality

“…This absence is particularly notable given that there is no singular definition of recovery, nor complete agreement amongst individuals with lived experience, clinicians, and supporters about what recovery means–or whether the term is preferred relative to other terms (e.g., healing or remission). For decades, researchers have been working to establish a consensus definition of ‘recovery’ from an ED [ 28 – 30 ], but such a definition remains elusive. Increasingly, questions are emerging about the potential outcomes of a universalised definition of ED recovery when applied to a phenomenon that shows up differently depending on each individual’s identities and experiences [ 31 ].…”