Eating Disorders: Recovery IS Possible! Understanding Relapses as Steps on the Journey

Introduction: Debunking the toxic myth of incurability

"You never really recover from an eating disorder." How many times have I heard this sentence in my Parisian practice? Sometimes spoken with fatalism by exhausted healthcare providers, repeated like a desperate mantra by discouraged patients after yet another relapse, echoed by resigned families who have lost hope after years of struggle. This belief, deeply rooted in our medical and social culture, is not only false - it constitutes one of the main obstacles to recovery itself.

Let me be crystal clear from the start: the scientific data from 2024-2025 speaks volumes. A transdiagnostic meta-analysis covering more than 88,000 patients reveals that 46% of people with eating disorders achieve complete recovery, and this figure rises to 67% with 10-year follow-up. Anorexia nervosa, often considered the most resistant and deadliest disorder, shows a remission rate of 62.8% at 22 years of follow-up. Binge eating disorder can achieve up to 77% complete recovery. These figures are not empty promises or manipulated statistics - they are documented clinical realities, published in the most prestigious medical journals.

So why does this belief in incurability persist with such force? Because we have collectively confused several fundamental concepts. We have confused the complexity of the recovery process with the impossibility of recovering. We have interpreted relapses as definitive failures rather than normal stages of the journey. We have seen human adaptation to suffering as permanent pathology rather than a temporary survival mechanism that can be transformed. As an English-speaking dietitian-nutritionist specializing in eating disorders support in Paris, with consultations in the 6th, 17th arrondissements and Le Raincy, I observe daily how this myth sabotages care pathways, destroys hope and unnecessarily perpetuates suffering.

Understanding eating disorders as intelligent human adaptations

The spectrum of human functioning: we all exist on continuums

To truly understand the nature of eating disorders and why recovery is possible, we must first recognize a fundamental truth about the human condition: we all exist on spectrums of functioning. There aren't "normal" people on one side and "sick" people on the other. This binary vision is not only scientifically false but deeply harmful therapeutically.

The modern transdiagnostic approach, developed notably by Fairburn and colleagues at Oxford, shows us that eating disorders themselves exist on a dynamic continuum. Between occasional dietary restraint (which 80% of the population experiences) and severe anorexia nervosa, there exists a whole spectrum of more or less optimal adaptive behaviors. This perspective reveals that eating disorders are not incomprehensible anomalies arising from nowhere, but adaptive strategies that, at some point in the person's life, allowed them to psychologically survive an intolerable or unbearable situation.

Let's take a moment to explore these different spectrums on which we all function. Our personality traits naturally oscillate between introversion and extraversion, between rigidity and flexibility, between impulsivity and control. No one is fixed at a single point - we all move along these continuums according to contexts, life periods, encountered stresses. Our psychometric abilities vary considerably by domain and time. Someone can excel in spatial intelligence but struggle with emotional intelligence, shine intellectually in the morning but collapse cognitively by day's end. Our functioning schemas, these patterns learned in childhood to navigate our specific family environment, activate differently depending on situations. The abandonment schema can lie dormant for years then activate brutally during a breakup.

Our multiple heritage profoundly shapes our vulnerabilities and resources. Genetic heritage predisposes us to certain neurobiological sensitivities - some are born with a more reactive nervous system, a natural tendency toward anxiety, vulnerability to addictions. Traumatic heritage, sometimes transgenerational, influences our stress responses - epigenetic studies show that food traumas can be transmitted over three generations. Economic heritage determines our access to resources, our relationship with abundance or scarcity. Narrative heritage - the family stories we're told about who we are - shapes our identity. Social and cultural heritage transmits specific norms, values, and food prohibitions.

This dimensional vision reveals a liberating truth: eating disorders are extreme expressions of mechanisms we all possess. The difference is not qualitative but quantitative. This is why recovery is possible: it's not about eliminating something foreign to our nature, but about rebalancing natural mechanisms that have become dysfunctional.

The vicious cycles of sub-optimal adaptation: understanding to better transform

An eating disorder rarely begins suddenly and arbitrarily. In most cases, it emerges as a creative solution to an apparently unsolvable problem. Imagine a teenager overwhelmed by exam anxiety, family conflicts, social pressure. She discovers that controlling her food intake gives her a sense of mastery in a chaotic world. Initially, this strategy works remarkably well: anxiety decreases, she receives compliments on her "willpower," her parents worry less about her academic results and more about her eating (thus displacing the problem), she finds an identity in this control.

But here's where the trap closes: the more she uses this strategy, the more dependent on it she becomes. This is what I call the negative reinforcement mechanism. The brain, through cognitive economy, favors strategies that have worked in the past. Every time she feels anxiety, the restriction reflex triggers automatically. Gradually, what was a solution becomes THE sole management mode for all difficult emotions. The more she restricts, the more her body demands biologically (increased ghrelin, decreased leptin, growing food obsessions). The more the body demands, the more she must reinforce control to maintain restriction. The more she reinforces control, the less she develops other emotion regulation skills. The vicious cycle is established, progressively creating a loss of adaptive flexibility - the hallmark of all psychological disorders.

2024 neuroplasticity research, notably McGill team's work on acetylcholine deficits in anorexia, shows us that these patterns literally create neural grooves in the brain. Like a river carving its bed, repeated behaviors trace preferential paths in our neural networks. The brain, always seeking energy efficiency, automatically takes these well-worn paths rather than exploring new routes.

But - and here's the extraordinary news - this same neuroplasticity that maintains the disorder can also enable recovery. Recent epigenetic studies from the Pasteur Institute show that genetic modifications induced by eating disorders are reversible with appropriate treatment. Our brain retains its ability to create new neural pathways throughout life. With patience, repetition, and adapted support, we can literally rewire our brain to develop new, healthier adaptive strategies.

The destructive impact of the incurability myth on all stakeholders

For patients: when hope is murdered in its cradle

How can you mobilize the monumental energy needed for change when you're told your final destination doesn't exist? Imagine being asked to climb Everest while being told the summit is an illusion, that at best you can only reach temporary base camps before inevitably relapsing back to the valley. Who would undertake such a journey?

In my clinical practice, I see daily the spectacular difference between patients who believe in their capacity for recovery and those who have internalized the incurability myth. The former arrive at consultations with a light in their eyes, even in their darkest moments. They speak of "when I get better," not "if I got better." They see relapses as bumps in the road, not confirmation of their condemnation. The latter arrive already defeated. Their discourse is peppered with "anyway," "it's pointless," "I'm just like this." They've developed what Martin Seligman calls learned helplessness - that psychological state where, after repeated failures, one stops even trying to change their situation.

The incurability myth generates what I call a particularly pernicious negative self-fulfilling prophecy. If I believe I cannot recover, why would I make the terrifying effort to face my food fears? Why would I accept weight gain if it's to remain eternally sick? Why would I invest time, energy, and money in therapy doomed to failure? This belief sabotages motivation for change, yet identified by Prochaska and DiClemente's transtheoretical model as one of the main predictive factors for therapeutic success.

Even more insidiously, this belief directly affects the neurobiology of healing. Psychoneuroimmunology research shows that hope is not just a pleasant mental state - it's a powerful biological modulator. Hope activates the brain's reward circuits, facilitates neuroplasticity, improves immune function, regulates stress hormones. Without hope, the body itself resists change.

For healthcare providers: exhaustion facing the wall of impossibility

On the healthcare professionals' side, this belief in incurability is equally devastating. How can you maintain the necessary therapeutic engagement when you think you're supporting patients condemned to chronicity? I've seen too many brilliant colleagues burn out in this fatalistic vision, become cynical, progressively lose their capacity for wonder at the daily small miracles of recovery.

When a caregiver believes their patients cannot truly recover, their support unconsciously becomes emotional palliative care. We manage crises, limit damage, maintain a stable state, but no longer aim for deep transformation. This attitude, even perfectly unconscious, transmits to the patient through a thousand micro-signals: the resigned tone when speaking of goals, the absence of enthusiasm for progress, excessive surprise when something goes well, systematic preparation for relapse rather than success.

Worse still, I've observed particularly problematic avoidance strategies. Some caregivers completely avoid making the eating disorder diagnosis to "protect" the patient from this supposedly indelible label. Others literally abandon their most chronic patients, referring them to colleagues or specialized structures not out of concern for better care, but out of discouragement. Yet research on therapeutic alliance is clear: the quality of the caregiver-patient relationship is the most powerful predictive factor for therapeutic success, more important than the technique used or the therapist's experience. A 2024 Italian meta-analysis shows that the therapist's belief in the possibility of recovery directly influences outcomes, with an effect size of 0.68 - huge in statistical terms.

For families: generational learned helplessness

Families, already upset and often traumatized by their loved one's illness, find themselves trapped in an impossible position when they integrate this belief. How do you support without hope? How do you maintain necessary boundaries (not becoming complicit in the disorder) while remaining present if all efforts seem in vain? How do you invest the considerable family energy required to support a loved one with eating disorders if it's for a lost battle?

I regularly observe families oscillating between two equally toxic extremes: anxious overprotection ("since they'll always be sick, might as well protect them from all stress") and resigned detachment ("we've tried everything, now it's their problem"). These two positions, humanly understandable, deprive the patient of the balanced support they need: loving presence AND expectations of progress, acceptance of the present moment AND faith in possible change.

This belief also generates a terrible transgenerational guilt that I frequently encounter in family consultations. Parents wonder what they "broke" irreparably in their child, searching their history to find THE original trauma that triggered everything. Siblings anxiously anticipate the transmission of this supposedly genetic and incurable "defect." Partners question their ability to live with someone "condemned" to illness, the possibility of having children who might inherit this curse.

The healing process: learning, neuroplasticity and profound transformation

Developing a diverse repertoire of adaptive skills

Recovery from an eating disorder is not a return to a mythical previous state where everything was fine - it's an evolution toward a new equilibrium, richer and more flexible. Human beings continuously construct themselves through adaptation to their environment, preferentially developing the skills most necessary for maintaining their psychological and physical balance. When this environment is traumatic, chaotic, or invalidating, we develop survival strategies that may seem dysfunctional from the outside but have deep adaptive logic.

The eating disorder often testifies to an overly restricted skill repertoire in the face of emotional, relational, and identity challenges encountered. If restriction is your only way to manage anxiety, what happens when anxiety increases? You restrict more. If food is your only source of emotional comfort, what do you do when facing intense distress? You eat, even without hunger. These behaviors are not "willpower failures" - they are the only tools available in a dramatically limited toolbox.

Therapeutic work therefore consists of considerably enriching this adaptive repertoire. It's an active learning process, not simple symptom suppression. With my patients, we explore together a range of new strategies: emotion regulation techniques (coherent breathing, mindfulness, EMDR), relational skills (assertive communication, conflict management, asking for help), resourcing activities (creativity, intuitive movement, nature connection), identity construction beyond the disorder (rediscovering values, passions, life projects).

This learning process relies on our extraordinary neuroplasticity capacity. Recent discoveries by the McGill-INSERM team on acetylcholine deficits in anorexia open promising pharmacological perspectives to facilitate this plasticity. But even without pharmacological help, our brain retains throughout life its ability to create new synaptic connections, develop new neural networks, literally reconfigure itself. Each time a patient uses a new strategy rather than the problematic eating behavior, they strengthen a new neural pathway. With repetition, this new path becomes more easily accessible, until becoming the preferential path.

The therapeutic alliance: much more than a simple helping relationship

One of the most powerful and underestimated factors in recovery remains the therapeutic alliance. It's not simply having a "good relationship" with your therapist - it's a space of profound transformation where the patient learns, often for the first time, what it means to be in a healthy relationship with another human being and, by extension, with themselves.

In the therapeutic space, something extraordinary happens. The patient often arrives with a deeply devalued self-image, convinced of being "too much," "not enough," "broken," "incurable." They expect to be judged, abandoned, rejected as they perhaps were in the past. But instead, they encounter a constant benevolent gaze, unconditional acceptance of their person (not their destructive behaviors), unwavering faith in their capacity for change.

This new relational experience acts as an emotional corrective experience. The concept, developed by Franz Alexander, describes how a new relational experience can literally repair old attachment wounds. When I treat my patients with compassion and respect, when I maintain hope even in their darkest moments, when I celebrate their smallest progress with authentic joy, I'm not just "treating" them - I'm showing them that another way of being in relationship is possible.

This positive contagion is at the heart of the healing process. Gradually, the patient begins to internalize this benevolent voice. They begin to speak to themselves with the words I use, to look at themselves with the gaze I have for them, to treat themselves with the respect I show them. It's a slow process, sometimes invisible from the outside, with advances and setbacks, but of extraordinary transformative power. Neuroscience shows us that this internalization is not just psychological - it literally modifies the brain circuits of attachment and emotional regulation.

Relapses: essential stages of the journey, not returns to zero

Let's speak frankly about relapses, this taboo subject that terrifies patients and families. A relapse is never, I repeat never, a return to square one. It's an extraordinarily precious learning opportunity that informs us about remaining vulnerabilities, skills still to develop, risk contexts to better prepare.

When one of my patients relapses after a period of improvement, we explore together what happened with a scientist's curiosity, not a tribunal's judgment. What triggered the symptom resumption? Often, we discover a specific unanticipated stress: a professional change, a romantic breakup, grief, a move, sometimes even positive events like a promotion or new relationship that upset the established balance. What warning signs did we miss? Retrospectively, the patient often identifies precursor signs: disrupted sleep, increasing irritability, progressive isolation, rigidification of routines. Which skills were still insufficiently developed? Perhaps stress management strategies worked well daily but proved insufficient in the face of major stress.

Data on relapse predictive factors enlighten us considerably. A 2024 systematic review identifies the main factors: unmanaged stress (present in 78% of relapses), social isolation (65%), unsoftened rigid perfectionism (71%), unaccompanied major life changes (82%). Each relapse informs us about the patient's specific vulnerabilities and allows us to considerably refine the therapeutic plan. It's like a GPS system recalculating the route - we don't abandon the destination, we simply find a better path.

In my practice, I observe that patients who go through and overcome relapses often develop superior resilience to those who have never experienced them. Why? Because they learn experientially that relapse is not fatal, that they can get back up, that they have developed resources that allow them to climb back faster each time. A patient recently told me: "Before, a relapse took 6 months of my life. The last one, I climbed back up in 3 weeks. That's my real victory."

Toward a truly humanistic and hopeful approach

Individualizing pathways: honoring each story's uniqueness

There doesn't exist, and will never exist, a universal protocol for eating disorder recovery. Why? Because each eating disorder is inscribed in an absolutely unique story, woven from millions of unique threads: particular genetics, specific family history, unique traumas, personal resources, cultural context, individual values, personal dreams.

The transdiagnostic approach offers us an extremely useful conceptual framework for understanding common mechanisms, but it's in fine personalization that real therapeutic effectiveness plays out. With some patients, the priority will be work on early traumas that fragilized the attachment system - we'll then use EMDR, ICV, or other trauma-informed approaches. With others, the urgency will be emotion regulation - we'll develop mindfulness skills, distress tolerance, emotion surfing. Some will need deep work on body image, others on interpersonal relationships, still others on identity construction.

This individualization must also take into account each person's unique rhythm. Some patients progress through spectacular leaps followed by plateaus, others through slow but constant progression. Some need a very structured framework, others great flexibility. Some flourish in group therapy, others require the intimacy of individual follow-up. The therapeutic art consists of co-constructing with the patient a pathway that makes sense for them, that respects their values, their rhythm, their resources and current limits.

Advances in personalized medicine now allow us to further refine this individualization. Epigenetic biomarkers inform us about specific biological vulnerabilities. Neurobiological profiles (brain imaging, hormonal assays) guide toward certain approaches rather than others. Microbiota analyses reveal specific dysbioses to correct. But let's never forget that behind this data, there's a unique person with their story, their suffering, their hopes, their extraordinary courage to want to heal.

Cultivating and maintaining active hope: the fuel of transformation

Hope is not that passive and naive thing we sometimes imagine - it's an extraordinary mobilizing force that must be actively cultivated. In my Parisian consultations, I practice what I call "active hope cultivation": the deep conviction that recovery is possible, coupled with concrete engagement in the actions necessary to achieve it.

This hope first anchors in factual reality. I regularly share with my patients encouraging research data, not as abstract promises but as proof that others have traveled this path before them. I present them with (anonymized) testimonies from recovered patients, not to create comparisons but to show the diversity of possible paths. I keep in my office what I call a "victory notebook" where, with their permission, I note my patients' successes - not just the big victories but especially the small ones: "I ate with pleasure today," "I refused to weigh myself this week," "I accepted a restaurant invitation."

Active hope also means radically accepting the uncertainty of the journey while maintaining course. We don't know how long recovery will take - it could be a few months or several years. We don't know what challenges will arise along the way - new life situations, unforeseen stresses, sometimes difficult self-discoveries. We don't know exactly what life "after" will look like - because recovery profoundly transforms, you don't become who you were before, you become a richer and wiser version of yourself.

But what we know with certainty is that the path exists. Millions of people have traveled it before us. Science shows us the mechanisms of healing. Clinical experience offers us increasingly refined tools. And above all, each small step in the right direction, however tiny, is living proof that change is underway.

Conclusion: Yes, you can recover - and this truth changes everything

So yes, I affirm it loud and clear from my clinical experience of almost10 years and thousands of patients supported: you can recover from an eating disorder. Not by erasing this experience from your story as if it never existed, but by transforming it into a source of strength, compassion, and wisdom. Not by returning to an idealized previous state, but by evolving toward a more complete and authentic version of yourself.

Eating disorders reveal our vulnerabilities, it's true. But they also reveal our incredible capacity for adaptation, our creativity in the face of suffering, our determination to survive even in the most difficult conditions. The healing path is not linear - it's made of ups and downs, surprising turns, difficult passages and magnificent views. Relapses are not failures but demanding teachers who teach us what we still need to learn.

Research confirms it, clinical experience demonstrates it, testimonies from thousands of recovered people prove it: recovery is not just hope, it's a real, documented, accessible possibility. It requires courage, patience, adapted professional help, a supportive environment. It requires believing in yourself even when everything seems lost, getting up after each fall, celebrating each victory however tiny.

If you're reading these lines while suffering from an eating disorder, know that your recovery is not just a distant dream - it's an achievable destination. If you're a loved one, your hope is justified and your support precious. If you're a caregiver, your faith in your patients' recovery is not naive, it's therapeutic. Together, we can deconstruct the toxic myth of incurability and open the path to recovery for all who suffer.

Living and eating are two sides of the same coin. Lighten your relationship with food and free yourself from what doesn't serve you!

📚 SOURCES AND REFERENCES

Recovery path illustration eating disorders through seasons journey Paris