"The outcome of anorexia nervosa is predicted by body mass index (BMI), physical risk, age and illness duration."
In other words the chance of recovery isn't determined by by "cause" or by "treatment modality" or by "motivation to change." It's successful intervention - catching it early, getting them healthy, keeping them in treatment.
We have to stop hiding from the fact that "Recovery from anorexia nervosa becomes much less likely the longer the illness has persisted."
The first three years are your window after which the chances of recovery are small. Really small. NO therapy has good rates of success after the illness has been in place for a while. Older patients do worse in Family-Based Maudsley and ALL treatments because they've been ill longer.
I say this not to depress or deter those who have not been able to intervene early, or whose first attempts at treatment were not successful - but to try to catch as many families as early as possible and beg them to act assertively and not delay. Don't whine, don't flinch, don't watch and wait. And don't settle for snake oil.
Parents new to this diagnosis: your chance of finding appropriate and effective treatment the first place you look is really quite small. The chance that you already know most of what you need to know is nil. When your loved one has an eating disorder your regularly scheduled life is cancelled, or should be, radically and for a long, long time. Anyone who tells you otherwise is not your friend. Will it be forever? No, unless you fail. And yes, parents CAN fail. Fail to act, fail to trust the right people, fail to do our own homework, fail to make the best decisions, fail to maintain the stamina to do what needs to be done.
I hear it all the time. "I wish I'd acted sooner." "I wish I'd known." These are really tragic stories, people. These are the same people who six months or two years earlier thought I was exaggerating and that their child wasn't that sick. They thought their local provider "connected" with their child or that it would "kill" their son or daughter to miss school or "I just can't bear to make her gain weight."
We don't say that about a tumor and we shouldn't say it about an eating disorder. I know that analogy offends people but until I find another one that will work to help people see that the early symptoms of an eating disorder are an OPPORTUNITY to intervene and not a milder form, I'm going to keep using it.
Does this mean give up on patients ill longer than three years? Hell no. These patients deserve even MORE urgency, not hopelessness or palliative care.