Recovering from an eating disorder can be long and complex.

Treatment typically focuses on reducing the unhelpful behaviours and thoughts that characterise these disorders. These include extreme dieting, binge eating, purging, negative body image, and – in some (but not all) cases – having a very low body weight.

But when recovery focuses on a clinical checklist of symptoms, such as reaching a healthy weight, it may ignore other important aspects of getting better.

Eating disorders are not just physical. They are complex mental health conditions that severely disrupt people’s relationship with themselves, their bodies and other people. So the psychological aspects of recovery, and the way people feel about it, also plays an important role.

Our new research shows when people’s broader wellbeing improves – such as developing a sense of self-acceptance or hope – they are more likely to report a “personal” recovery from an eating disorder, even if they still have some clinical symptoms.

How is recovery measured?

There is no one definition of eating disorder recovery.

But most research has focused on clinical symptoms. This means an absence of diagnostic criteria (for example, no binge eating or purging) over a specific timeframe, such as a 12-month period, to meet the definition of recovery.

Emerging research points to the importance of “personal recovery” meaning that dimensions of psychological wellbeing are essential.

For example, a 2020 review of studies focusing on perspectives of people with eating disorders showed supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion were central to their recovery process.

People with eating disorders also report that including these as goals (rather than just focusing on clinical symptoms) feels relevant and empowering, while emerging research shows this can improve long-term outcomes and improve quality of life, meaning people may be less likely to relapse.

But there still hasn’t been much research on how both personal and clinical aspects can be incorporated into treatment and recovery.

Understanding how to include these aspects in treatment is urgent, given eating disorders are among the most life-threatening psychiatric disorders, and recovery is often slow.

What we did and what we found

Our new study surveyed 234 adults who have lived through or are currently experiencing an eating disorder. Most identified as female (89%), and the average age was 28.

Overall, we found less than a quarter of participants (22.6%) met the criteria for clinical improvement, meaning many were still dieting or preoccupied with food and body image.

But more than half (52.1%) felt they had achieved personal recovery. This included experiencing self-acceptance, positive relationships, personal growth, reduced eating disorder behaviours, resilience and greater autonomy.

Clinical improvement in symptoms did make personal recovery more likely. But nearly two-thirds (63.9%) of those who self-identified as personally recovered did not meet the clinical definition, meaning they still experienced some eating disorder symptoms.

This points to a possible disconnect between definitions of recovery that focus on symptoms and what recovery actually means to the people living it.

We also explored whether personal recovery looked different depending on someone’s eating disorder diagnosis.

All participants had a past or current diagnosis of anorexia nervosa (68.4%), bulimia nervosa (8.5%) or binge eating disorder (8.1%).

But, we found no meaningful differences in personal recovery rates across these diagnoses. This suggests the experience of personal recovery may be broadly similar regardless of the specific eating disorder a person has faced.

Why does this matter?

When treatment success is measured almost entirely through symptom checklists and clinical criteria, we risk missing – and failing to celebrate – the progress that may matter the most to the person in front of us.

We suggest people seeking recovery from an eating disorder should be asked early on about what recovery looks like to them, not just what the clinical guidelines say it should look like. This might also improve the currently low rates of people seeking help for eating disorders. It may help clinicians set goals that are meaningful and better reflect the psychological nature of eating disorders, not just the physical aspects.

If there’s something that feels important to your recovery, it’s worth raising with your treatment team. Recovery can look different for everyone, and your personal goals matter.

For example, wellbeing goals could involve reconnecting with relationships, rebuilding a sense of identity, or simply feeling more in control of daily life, alongside improving clinical symptoms.

This is also significant because funding for eating disorder services and policy decisions still often lean heavily on clinical benchmarks. If these don’t capture aspects of personal recovery, we are likely underestimating how many people are getting better, and potentially designing services around a narrower picture of recovery than the evidence actually supports.

If you have a history of an eating disorder or suspect you may have one, you can contact the Butterfly Foundation’s national helpline on 1800 334 673, or via online chat.

Catherine Houlihan, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast; Andrew Allen, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast; Dan Fassnacht, Associate Professor in Psychology, University of the Sunshine Coast, and Kathina Ali, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.

There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.

But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.

These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.

There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.

A new vision for general practice

I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.

But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.

The future of primary care is one involving more use of the range of health professionals, in addition to GPs.

It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.

This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.

How about pharmacists?

An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.

This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.

But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.

Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.

GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.

Who pays for all this?

Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.

Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.

This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.

In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.

In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.

The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.

Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.