Anorexia Nervosa (AN) is an eating disorder (ED) marked by distorted body image, intense fear of gaining weight and restriction of food leading to dangerously low body weight (American Psychiatric Association, 2013). It is the mental health condition with the highest mortality rate, potentially due to its high relapse rates (Solmi et al., 2024). As such, understanding factors that can facilitate recovery is paramount to reducing chronicity.
Despite the impact AN is having on our population, there is currently a lack of consensus in how AN ‘recovery’ should be defined, leading to difficulties in understanding factors that may predict relapse and recovery. Previous approaches have defined recovery as a medically healthy weight (also known as weight restoration) and remission of disordered eating behaviours such as food restriction (Glasofer et al., 2020). This adds to the wider issue of individuals not seeking treatment even though they are struggling psychologically as their weight is deemed ‘not low enough’ (read Lucy’s blog about barriers to accessing treatment). However, there is now a move towards not just defining recovery in terms of absence of disordered behaviours and physical recovery (weight gain), but in relation to psychological symptoms (Bardone-Cone et al., 2010). This can include disordered thoughts such as shame about one’s body.
To aid this new approach, Ferreira and colleagues (2025) sought to understand from the perspective of those with lived experience of anorexia nervosa and the mental health professionals that support them, how they define recovery and what factors may hinder it.
Understanding factors that facilitate recovery and prevent relapse from the perspective of those with lived experience is paramount so that we can create systems that foster recovery and protect against the pressures of relapse.
Methods
Fifteen individuals with lived experience of anorexia nervosa (aged 18-55 years; n = 14 cisgender female) and seven mental health professionals that support those with AN (n = 7 cisgender female) were recruited via social media, university posters, and emails to relevant groups. All participants were at least 18 years old and lived in the UK. All individuals with lived experience completed an eating disorders examination questionnaire (Fairburn, 2008); those who scored higher than 2.88 were excluded and sign posted to support resources, in line with the Bardone-Cone et al. (2010) model of recovery. A total of six focus groups and one interview were conducted, with sessions lasting around 60-90 minutes. Reflexive thematic analysis was used to analyse the data.
Results
Analysis generated three themes that explore how individuals with lived experience and mental health professionals conceptualise anorexia nervosa recovery:
1) Recovered, yet still recovering: the paradox of anorexia nervosa
Recovery was defined in both groups as having two distinct processes: cognitive and behavioural, with the former taking longer to reach.
However, there were differences in how professionals and lived experience individuals conceptualised recovery. Professionals defined full recovery as living well despite residual symptoms and suggested recovery is about managing disordered thoughts. Conversely, those with lived experience viewed recovery as an absence of disordered thoughts and symptoms and felt that due to the persistence of disordered thoughts, they are perpetually “in recovery” and being “recovered” was unattainable.
Additionally, lived experience individuals suggested factors such as societal views on food impacted their ability to recover. Lived experience individuals advocated for better aftercare to prevent relapse, but professionals thought that this would be difficult due to limited resources and that it may foster dependency.
2) Disentangling recovery and weight gain
The importance of weight gain as a marker of recovery was viewed differently by the two groups of participants. While professionals discussed weight as a way to quantify when it is safe to discharge service users, individuals with lived experience did not tend to reference weight gain as a marker for recovery and only brought it up in relation to what they felt their care team focused on.
Professionals did recognise that there was likely a discrepancy between their views and service users’ and cautioned against the overemphasis on weight as a marker. They felt that factors such as psychological wellbeing and social functioning should be considered, too. This was echoed by individuals with lived experience, who described the focus on weight restoration in recovery as demoralising, and were concerned that it could overshadow other progress they may have made, such as being able to eat without distress.
3) The role of others in recovery: a motivator or a hindrance?
Lived experience individuals and professionals agreed that social support is a key motivator for recovery; professionals were often tentative to discharge people without these support systems in place. Yet, professionals also emphasised the need for internal motivators in recovery, particularly to prevent relapse during stressful times. This view was shared by some lived experience individuals, as they highlighted that social support systems may not always be present. However, this was not always echoed in the lived experience group, which may point to an overreliance on external motivation. Additionally, although social support was often suggested to be a positive motivator, both groups suggested that the social environment can be a hindrance (e.g., when people make triggering comments about food). Professionals suggested that providing loved ones with psychoeducation and support is key to sustained recovery.
An overemphasis on weight as a recovery marker for anorexia may disincentivise service users away from weight gain, as they may be concerned about losing support.
Conclusions
Overall, Ferreira et al. (2025) concluded that how anorexia nervosa recovery is conceptualised differs between individuals with lived experience and mental health professionals, yet there are clear areas of overlap. For example, both groups recognised that cognitive recovery takes longer than behavioural recovery and that social support plays an important protective and motivational role. That said, the differences in opinion in relation to residual symptoms and the focus on weight restoration led the authors to suggest that it:
may be hindering therapeutic alliances and ultimately recovery progressions. We urge clinical decision makers and researchers to show greater attempts at including [lived experience] perspectives in definitions of recovery.
There are key differences in how individuals with lived experience and mental health professionals conceptualise recovery from anorexia, such as the emphasis put on weight restoration.
Strengths and limitations
A strength of this qualitative design is that it captures a dual perspective from professionals and individuals with lived experience. By comparing two viewpoints, the study is able to reveal conceptual asymmetry that exists between the groups, such as opposing opinions of using weight as a marker for recovery. Bridging the gap between clinical and lived experience individuals may help to create a collaborative approach to improving treatment. To further develop this collaboration, future research could focus on using co-production with lived experience individuals to create treatment protocols that support recovery outcomes meaningful to the patient.
The study’s inclusion of older adults enhanced generalisability beyond the typical focus of ED research on young white women. Research often overlooks older adults’ perspectives, even though these individuals may face discrimination within ED services (Scholtz et al., 2010). There is a suggestion that older adults may focus on symptom reduction and quality of life over total symptom eradication during treatment (Maine & Kelly, 2016). Therefore, how they define recovery may be different to how young adults define recovery.
However, more research is needed to explore how recovery from anorexia nervosa is conceptualised across genders and in non-Western cultures, as this study primarily included cisgender white females. The levels of awareness around EDs and access to treatments differs across cultures (Lee et al., 2021) and could contribute to individuals’ perceptions of recovery if they feel they are unable to vocalise their ED related thoughts due to feelings of shame. Furthermore there may be differences in how EDs present across genders, with females exhibiting more residual symptoms (Strober et al., 2006); therefore, how gender may impact individuals conceptualisations of recovery should also be explored.
A final limitation of this study is the lack of data regarding diagnosis timing and treatment history, factors that may influence recovery perception. For example, those transitioning from inpatient care may define recovery as maintaining progress without surveillance (Smith et al., 2016). Equally, individuals with long term AN may prioritise a state of functional recovery over total symptom eradication (Cummings et al., 2023). Research should investigate how nuances such as illness duration and treatment experiences may shift recovery goals away from rigid clinical markers. Incorporating these perspectives will aid in the creation of an inclusive framework of recovery in anorexia nervosa.
More research is needed to understand how recovery from anorexia is defined across diverse groups, including those from underserved groups and non-Western cultures.
Implications for practice
This study suggests that there may be some core differences in how individuals with lived experience and mental health professionals define recovery. There may be a discrepancy between lived realities and what is practical; for example, individuals with lived experience highlighted a need for aftercare, whereas professionals suggested this may not be feasible. Both groups agreed that psychological markers such as disordered thoughts about body image or food consumption should be used as indicators for recovery. This is in line with previous research that looked at a range of EDs and also suggests psychological markers are the best indicators for ED recovery from the perspective of those with disordered eating (Richmond et al., 2020). However, mental health professionals suggest there is still a need to account for behavioural and physical components to get the full picture. Social support systems should also be considered when examining factors that help individuals to achieve recovery.
To translate these findings into practice, researchers should consider further exploring self-guided tools for individuals to continue supporting them after they have reached the benchmark for recovery. This could be a way of getting integrating aftercare into treatment plans without placing added stress on the NHS. Self-guided tools may help to target a core relapse factor, which is cessation of structured support (Heal-Cohen et al., 2025). Furthermore, treatment plans may benefit from taking a person-centred approach not only to understand how the symptoms affect the individual (NICE, 2017), but to actively incorporate the individual’s definition of recovery. Using co-production to design tools and incorporating individuals’ conceptualisations of recovery ensures that treatment plans resonate with service users’ lived realities.
More emphasis should be placed on psychological markers for recovery such as disordered thoughts around food and weight.
Statement of interests
Holly Myers has no conflicts of interest to declare.
Edited by
Dr Nina Higson-Sweeney
Links
Primary paper
Ana Julia Ferreira, Leda Blackwood, Manuela Martinez-Barona Soyer, Graeme Fairchild, & Melissa Atkinson (2025). How do people with lived experience of Anorexia Nervosa and mental health professionals working with people with eating disorders conceptualise recovery? Journal of Eating Disorders, 13(1), 247. https://doi.org/10.1186/s40337-025-01432-6
Other references
American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596
Bardone-Cone, A. M., Harney, M. B., Maldonado, C. R., Lawson, M. A., Robinson, D. P., Smith, R., & Tosh, A. (2010). Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behaviour Research and Therapy, 48(3), 194–202. https://doi.org/10.1016/j.brat.2009.11.001
Cummings, M. P., Alexander, R. K., & Boswell, R. G. (2023). “Ordinary days would be extraordinary”: The lived experiences of severe and enduring anorexia nervosa. International Journal of Eating Disorders, 56(12), 2273–2282. https://doi.org/10.1002/eat.24058
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
Glasofer, D. R., Muratore, A. F., Attia, E., Wu, P., Wang, Y., Minkoff, H., Rufin, T., Walsh, B. T., & Steinglass, J. E. (2020). Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa. Journal of Eating Disorders, 8(1), 69. https://doi.org/10.1186/s40337-020-00348-7
Heal-Cohen, N., Allan, S. M., Gauvain, N., Nabirinde, R., & Burgess, A. (2025). Relapse in eating disorders: A systematic review and thematic synthesis of individuals’ experiences. Clinical Psychology & Psychotherapy, 32(4), e70101. https://doi.org/10.1002/cpp.70101
Hyam, L. (2023). Barriers to help-seeking for eating disorders: which factors impact early intervention? The Mental Elf.
Lee, Y., Kuo, B. C. H., Chen, P.-H., & Lai, N.-H. (2021). Recovery from Anorexia Nervosa in contemporary Taiwan: A multiple-case qualitative investigation from a cultural-contextual perspective. Transcultural Psychiatry, 58(3), 365–378. https://doi.org/10.1177/1363461520920327
Maine, M., & Kelly, J. (2016). Pursuing perfection: Eating disorders, body myths, and women at midlife and beyond. Routledge. https://doi.org/10.4324/9781315710099
National Institute for Health and Care Excellence. (2017). Eating disorders: Recognition and treatment (NICE Guideline NG69). https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813
Richmond, T. K., Woolverton, G. A., Mammel, K., Ornstein, R. M., Spalding, A., Woods, E. R., & Forman, S. F. (2020). How do you define recovery? A qualitative study of patients with eating disorders, their parents, and clinicians. International Journal of Eating Disorders, 53(8), 1209–1218. https://doi.org/10.1002/eat.23294
Scholtz, S., Hill, L. S., & Lacey, H. (2010). Eating disorders in older women: Does late onset anorexia nervosa exist? International Journal of Eating Disorders, 43(5), 393–397. https://doi.org/10.1002/eat.20704
Smith, V., Chouliara, Z., Morris, P. G., Collin, P., Power, K., Yellowlees, A., Grierson, D., Papageorgiou, E., & Cook, M. (2016). The experience of specialist inpatient treatment for anorexia nervosa: A qualitative study from adult patients’ perspectives. Journal of Health Psychology, 21(9), 1833–1844. https://doi.org/10.1177/1359105313520336
Solmi, M., Monaco, F., Højlund, M., Monteleone, A. M., Trott, M., Firth, J., Carfagno, M., Eaton, M., De Toffol, M., Vergine, M., Meneguzzo, P., Collantoni, E., Gallicchio, D., Stubbs, B., Girardi, A., Busetto, P., Favaro, A., Carvalho, A. F., Steinhausen, H.-C., & Correll, C. U. (2024). Outcomes in people with eating disorders: A transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry, 23(1), 124–138. https://doi.org/10.1002/wps.21182
Strober, M., Freeman, R., Lampert, C., Diamond, J., Teplinsky, C., & DeAntonio, M. (2006). Are there gender differences in core symptoms, temperament, and short-term prospective outcome in anorexia nervosa? International Journal of Eating Disorders, 39(7), 570–575. https://doi.org/10.1002/eat.20293
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