Stages of Change
The Stages of Change model is a guide to understanding the five different stages on the way to recovery, although some people may skip back and forth between these stages, especially in cases where relapse is common.
This model seeks to understand a person’s motivation towards achieving change and recovery. From a carer or support perspective, it can also be used to understand how to approach and care for someone with an eating disorder.
Stage 1: Pre-Contemplation
In the Pre-Contemplation stage, a person with an eating disorder will most likely be in denial that there is a problem.
While others around them may have noticed some of the warning signs, the person with the disorder will have little or no awareness of the problems associated with their disordered eating. Instead, they may be focused on controlling their eating patterns.
A person with an eating disorder in this stage may not be willing to change or disclose their behaviour and may be hostile, angry or frustrated when approached. This is because the person’s eating disorder is currently serving as a way to control or avoid strong and unpleasant emotions. The person may be unwilling or afraid to let go of these behaviours.
To approach someone in the Pre-Contemplation stage:
- Stay calm and try to see things from their point of view
- Show compassion and understanding
- Take the focus off their disordered eating; instead, talk about their interests, goals in life and the things they may be missing out on as a result of the eating disorder
Stage 2: Contemplation
A person with an eating disorder in the Contemplation stage will have an awareness of their problems. They may be considering the benefits of changing some of their behaviour.
However, their attitude may also fluctuate between wanting to change and wanting to maintain their disordered eating habits. This can be difficult and confusing, both for the person with the eating disorder and for their loved ones.
You can manage the Contemplation stage by:
- Encouraging the person to voice their thoughts, feelings and concerns
- Demonstrating that you are listening to what they are saying and that you understand their struggle. You can even reinforce what they are saying by repeating it back to them; e.g. ‘I hear you saying that part of you feels like you want to change, while another part of you feels scared of changing...’
- Showing them you respect their ideas, particularly the ones in favour of change
- Trying to boost their self-esteem and confidence; this will help them believe they can change
- Letting them know you are pleased that they have shared their feelings with you and that you are willing to support them through the process of change and recovery.
Stage 3: Preparation and determination
In this stage, the person with the eating disorder has decided they want to change their behaviour and is preparing to make these changes in order to recover. This can be a very stressful and anxious time for the person with the disorder, as well as for others who are supporting them. In most cases, help from a doctor, clinician or eating disorder professional is necessary.
As a carer or support person, you can help by:
- Being informed. Learn as much as you can about the steps you and the person you are caring for need to take in order to recover
- Working with the person to identify their goals and develop a detailed approach of how you will manage the changes together
Stage 4: Action
A person with an eating disorder in the Action stage will be taking the first steps towards recovery and is focused on completing the recovery process.
They require strong support and encouragement to get through this stage. The person can move backwards and forwards in their development during this stage and relapse can be common.
Supporting someone in the Action stage often means:
- Acknowledging how difficult it is to change and recover from an eating disorder
- Supporting the person through challenges and letting them know you believe in them; this will help build their confidence
- Focusing on the benefits of change, rather than the difficulties in changing; being encouraging and positive
- Letting the person know that you are willing to support them throughout this stage and that they are not alone
- If relapse occurs, explain to the person that relapse is normal and common and assist them in coping with the relapse and achieving recovery
Stage 5: Maintenance
In the Maintenance stage, a person with an eating disorder will have changed their behaviour and may be focusing on maintaining their new, healthier habits. They are also learning to live without the eating disorder.
This stage takes time and ongoing commitment, both from the person with the disorder and his/her support network. It is still possible for a person with an eating disorder to relapse at this stage. However, full recovery from relapses and recurrences is also entirely possible.
To assist in the Maintenance stage and help maintain recovery:
- Work together with the person to identify triggers that may impact their recovery
- Put systems and strategies in place to help avoid relapse
- Show care, patience and compassion
- Remain positive about their recovery
The Care Team
Eating disorders are complex and multifaceted. While the minimum treatment team is a medical practitioner and a mental health professional, input from practitioners from a range of disciplines is often necessary for comprehensive care. Family and supports are integral to the care team.
Barriers to Care
Vital access to treatment and recovery can be hampered by a limited availability of care or lack of care in remote areas, by stigma, poor professional skills and poor understanding of the pathways to care.
It's different for everyone, but recovery from an eating disorder involves overcoming physical, mental and emotional barriers in order to restore normal eating habits, thoughts and behaviours.
Relapse & Recurrence
Relapse can be a common part of the recovery process; many people with eating disorders experience a relapse or recurrence as they recover from their disorder and learn to manage their eating habits.