1. There Is No One Definition of ‘Recovery’
“I think the eating disorder field is pushing for full recovery for everyone, and yet we’re still not defining what that actually means,” Tarpley says.
The DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the guidebook clinicians use to diagnose and classify mental conditions) says a person has fully recovered once they no longer meet any of the criteria for an eating disorder for a sustained period.
While writing her book, Tarpley asked more than 700 people with lived experience with an eating disorder whether they identified with her concept of the middle place, and about 85 percent said yes. “I described it as this liminal, gray space between acute sickness and full recovery, where you’re trying to make progress, but you still slip, and your recovery is imperfect,” she says. “I realized how this middle place is so prevalent, and yet we don’t talk about it,” she says.
Just as eating disorders look different for everyone, recovery does, too, says Rachel Goldberg, a licensed marriage and family therapist and an eating disorder and infertility therapist in Los Angeles. “Factors like the type of eating disorder, how long someone has struggled, family dynamics, age, and where they are physically and emotionally all shape the process,” she says.
2. Recovery Is Fluid
The way full recovery was often presented to Tarpley early on made it feel like a finish line to cross. In reality, she’s found it to be more fluid. “It’s about trying to make progress, but knowing it’s imperfect,” she says.
Goldberg agrees. “There are periods when progress feels harder, old behaviors resurface, or recovery shows up in new ways.” This fluidity isn’t an obstacle, but part of the journey.
Tarpley says she hopes that defining and talking about this “middle place” of eating disorder recovery helps make healing more doable for others.
Setbacks are absolutely part of the healing process, Goldberg says. If you’re working with a therapist during eating disorder treatment, for example, Goldberg says they can try to help you understand how to respond differently moving forward.
A mental health care provider can help you evaluate where you are on your journey and develop an inclusive, holistic, and supportive approach for continued progress.
3. Relapse Is Common
Research suggests more than a quarter of people with eating disorders worldwide will experience a relapse. As with complete recovery, there’s no standardized clinical definition of a relapse. But it is widely used to indicate a return to acute illness after an apparent recovery.
Tarpley considers relapses to be different from slips, lapses, or collapses, defining these terms as follows.
- Slip An unplanned, one-time deviation from the treatment plan
- Lapse A more significant engagement in eating disorder thoughts and behaviors over a period of time
- Relapse A repetitive pattern of eating disorder thoughts and behaviors with an inability to get back on track
- Collapse A worsening relapse that requires higher levels of care
Destigmatizing the middle place in recovery could reduce the risk of slips and lapses becoming relapses and collapses, she says.
She titled her book Slip for exactly this reason. “So often we tell people slips shouldn’t happen in an ongoing way, and yet so many people continue to struggle,” she says. Denying that setbacks happen as a natural, common part of recovery perpetuates stigma and shame, she adds, noting that this can make people more self-critical and less likely to ask for help.
One of the best ways to lessen stigma around slips is to stop calling them relapses, Goldberg says. “That word often carries a sense of failure or wrongdoing,” she says. “Periods of struggling with eating, food, or body image happen even to people without eating disorders. Expecting that all unhealthy thoughts or habits will disappear forever is unrealistic.”
If you’re looking for support during any challenging moment in recovery, Golderberg suggests reaching out to someone you trust to respond nonjudgmentally. “That might be a parent, a school counselor, or a therapist,” she says. You can also call an eating disorder hot line.
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