Eating disorders, although they don’t always feel like it, happen in stages. These stages look a little different within each individual’s recovery process, but the basic outline remains the same. It's important to remember that people may go back and forth between the different stages, particularly those who have experienced relapse.

Why is being aware of the stages of change helpful?

It is beneficial to understand the stages of change as it helps people understand where they or others may be in their road to recovery. It shows the journey ahead and gives people “permission” to experience relapse, and move back and forth in their recovery process. It also challenges the idea that an eating disorder is permanent part of the person’s life.

What are the stages of change?

Pre-contemplation

In this stage an individual is unable to acknowledge problematic behaviour and has no intention to change. A person with an eating disorder may deny there is a problem. Friends and family may pick up on some of the warning signs and symptoms (e.g. restrictive eating, overeating, overexercising, purging or a pre-occupation with weight and appearance). During this stage, the individual may exhibit hostility, anger or frustration if approached by someone who is concerned.

Contemplation

In this stage, an individual is aware of the problem and beginning to think about getting help. They may be considering some of the benefits of changing their behaviours but be hesitant about the idea of doing so. Consequently, there is no concrete commitment to change during this stage (e.g. “Yes my weight is a concern for me, but I’m not willing or able to begin gaining weight within the next month”). The eating disorder often plays an important role as a coping mechanism for the individual when dealing with the stress and challenges in their life.

Preparation

In this stage, an individual has intention to change and is planning how this might happen. They may begin to engage in ‘change talk’, for example - “my weight concerns me; I’m clear that the benefits of change outweigh the drawbacks, and I’m planning to start within the next month”.

Action

In this stage there is a change in the behaviour, environment and thoughts of an individual. This stage requires commitment to change and to continue to practice new behaviours (e.g. sticking to meal plan, restricting amount of exercise). The person will be trying new is willing to face fears in order for the change to occur.

Maintenance

In this stage, there is a focus on relapse prevention and building on gains and positives from change (e.g. improved health and long-term happiness). In this stage, more stable behavioural changes are observed. The person is proactively practicing new behaviours and new ways of thinking as well as consistently using both healthy self-care and coping skills. This requires continued commitment and support (e.g. from family, friends and loved ones, support groups, health professionals such as a GP or psychologist) to sustain the new behaviours and support the person as they navigate their pathway to ongoing recovery.

Relapse

Relapse can also be considered a stage of change, where there is a return to some old patterns of thought or behaviours. Relapse can be an important stage during recovery to see what works well for the individual and what triggers arise. Although relapse can be stressful, it is very common and often helpful to gain insight into patterns of the eating disorder for future management. 

What can people with an eating disorder do to help themselves throughout the stages?

It can be useful for a person recovering from an eating disorder to remind themselves that there is hope and that recovery is possible for everyone. It is important to realise everybody is different and everybody’s experience with an eating disorder is as individual as they are.