This is a subject I'm rather interested in: long-term recovery. Much of the research on recovery focuses on the acute phase of treatment--and, to some extent, rightly so. If you can't start getting better, than figuring out how to stay better is somewhat secondary. Except there are a lot of people who have crawled their way out of the hellhole of the eating disorder and are now focusing on staying well.
So what do we know about how to stay well from an eating disorder?
Answer: not a whole lot. Continuing nutrition, obviously. Management of co-occurring mental and physical disorders. Therapy as needed.
But these are all very vague things. Everyone is different, and so getting too prescribed in terms of treatment isn't super useful, either.
However, a group out of the University of Iowa and Harvard University followed women with AN or BN for 10 years, and found that "worse psychosocial function and overconcern with weight or shape demonstrated statistical significance in increasing the risk of relapse." The researchers found that approximately one-third of women whose eating disorders had gone into remission ultimately relapsed, and rates were the same regardless of initial diagnosis. And regardless of whether the person presented with the restricting subtype of anorexia, the binge/purge subtype of anorexia, or bulimia nervosa, most people relapsed into binge/purge behaviors.
Several interesting points:
the researchers defined remission as "having a period of 8 consecutive weeks in which no or minimal symptoms of the syndrome were present," which doesn't seem like a super long time to define something as ephemeral as 'recovery' or 'remission.' Then again, that also would seem to imply a relative freedom from body image issues and other ED thoughts, which is pretty indicative of significant progress towards recovery.
only ONE THIRD of the women presenting with a diagnosis of anorexia nervosa even achieved an eight week period of remission. If that doesn't signal the need for better treatments, I don't know what does.
The authors say that
Women with poor psychosocial function may be less equipped to cope with life stressors. Thus, stress coupled with poor coping may lead to a return of symptomatic behaviors...In addition, poor psychosocial function among recovered patients may contribute to the emergence of such stressors. Such a pattern may explain why interpersonal psychotherapy has demonstrated efficacy in the treatment of bulimia nervosa at follow-up.
As a solution, the authors say that "Thus, the combination of poor psychosocial function and increased concern about weight and shape may trigger the return of full eating disorders. Teaching patients to cope effectively with psychosocial stressors and to accept their bodies may help prevent relapse into eating disorders."
It's an older study (from 2005), but it does provide some useful information on an area that's not well-researched. If only the authors hadn't thrown that "food is something sufferers can control..." stuff into the last paragraph. Oh well.