Understanding the stages of change in the recovery process

Recovery from an eating disorder can be a long process that usually requires not only a qualified team of professionals, but also the love and support of family and friends. It is not uncommon for someone who struggles with an eating disorder to feel uncertain about their progress or for their loved ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress and treatment drop out. Therefore, knowing about the Stages of Change Model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.

The Stages of Change in the process of recovery from an eating disorder are a cycle rather than a linear progression. The person may go through this cycle more than one time or may need to revisit a particular stage before moving on to the next. They may also go through the stages for each individual eating disorder symptom. In other words, if they are recovering from anorexia, they could be in the Action Stage for restrictive eating (e.g., eating three meals a day along with snacks, engaging in social eating, and utilizing support system) while, at the same time, they could be going through the Contemplation Stage for body image and weight concerns (e.g., becoming aware of how body image is tied to self-esteem and self-worth, defining oneself as a body or number, and identifying the negatives of striving for the “perfect body”). This is precisely why recovery from an eating disorder is complex and individualized.

The following is a general breakdown of the Stages of Change for someone who is recovering from an eating disorder. If you are a parent, partner or friend of someone struggling, you no doubt struggle right along with them, so it is crucial for you to pay attention to your own needs as well as be present for your child or friend during her recovery process (NEDA, 2021).

What are the stages of change?

There are five Stages of Change that occur in the recovery process: Precontemplation, Contemplation, Preparation, Action and Maintenance.

Precontemplation stage

The Precontemplation Stage is evident when a person does not believe they have a problem. Close family, partners and friends are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape and appearance even before the individual admits to it. They may refuse to discuss the topic and deny they need help. At this stage, it is necessary to gently educate the individual about the devastating effects the disorder will have on their health and life, and the positive aspects of change.

Do not be in denial of your child, partner or friend’s eating disorder. Be aware of the signs and symptoms. Avoid rationalizing their eating disordered behaviours. Openly share your thoughts and concerns (NEDA, 2021).

Contemplation stage

The Contemplation Stage occurs when an individual is willing to admit that they have a problem and are now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the individual in discovering the function of their eating disorder so they can understand why it is in their life and how it no longer serves them. This, in turn, helps the individual move closer toward the next stage of change.

Particularly if your child is under the age of 18, be more proactive in encouraging them to seek professional help from a qualified eating disorder specialist. Educate yourself about the disorder. Be a good listener. Do not try to “fix” the problem yourself. Seek your own encouragement from a local eating disorder support group for family and friends (NEDA, 2021).

Preparation stage

The person transitions into the Preparation Stage when they are ready to change, but are uncertain about how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. Potential barriers to change are identified. This is usually when a plan of action is developed by the treatment team (i.e. psychotherapist, nutritionist, and physician), as well as the individual and designated family members. This generally includes a list of people to call during times of crisis.

If supporting a loved one in their recovery, identify what your role is in the recovery process. Explore your own thoughts and beliefs about food, weight, shape and appearance. Ask your child, partner or friend and the treatment team how you can be best involved in the recovery process and what you can do to be supportive (NEDA, 2021).

Action stage

The Action Stage begins when the person is ready to implement their strategy and confront the eating disorder behaviour head on. At this point, they are open to trying new ideas and behaviours, and are willing to face fears in order for change to occur. Trusting the treatment team and their support network is essential to making the Action Stage successful.

Follow the treatment team’s recommendations. Remove triggers from your environment: no diet foods, no scales and no stress. Be warm and caring, yet appropriate and determined with boundaries, rules and guidelines. Reinforce positive changes without focusing on weight, shape or appearance (NEDA, 2021).

Maintenance/Relapse stage

The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, they actively practice new behaviours and new ways of thinking as well as consistently use both healthy self care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live their life in a meaningful way.

Applaud the individual’s efforts and successes. Continue to adjust to new developments. Redefine the boundaries at home as necessary. Maintain positive communications (NEDA, 2021).

A possible sixth stage

The Termination Stage and Relapse Prevention. Relapse is sometimes grouped with the maintenance stage since recovery in nonlinear and it is not uncommon to return to old behaviours during the overall recovery process. So, how do you know when it is time to discontinue treatment? With the understanding that this decision is best made in consultation with your treatment team, ask yourself the following questions:

Have I mastered the Stages of Change in the major areas of my eating disorder? Do I have the coping skills necessary to maintain these changes? Do I have a relapse prevention plan in place? Am I willing to resume treatment in the future if necessary?

To prevent relapsing do not forget to ask for help, communicate your thoughts and feelings, address and resolve problems as they arise, live a healthful and balanced life, and remember that you would not have made it this far if it were not for your strong determination and dedication toward recovery (NEDA, 2021).