Differences in coping across stages of recovery from an eating disorder.

Individuals with eating disorders generally evidence deficits in coping,1 and in some cases, the disordered eating behavior can be conceptualized as a maladaptive coping behavior (e.g., binge eating or extreme food restriction as a way of coping with negative affect). Furthermore, therapists and patients have identified developing healthier coping skills as an especially important component of the treatment of eating pathology.2 These findings compel us to better understand what coping looks like as individuals recover from an eating disorder. Can someone fully recover without improved coping skills and thus experience persistent deficits in coping? Or is full recovery closely linked to the development of healthier coping skills, perhaps to the level of healthy controls? The current study seeks to understand how different dimensions of coping compare across different levels of eating disorder recovery encompassing physical, behavioral, and psychological indices. Coping refers to the thoughts and behaviors that people engage in so as to manage, tolerate, or reduce internal or external demands that are appraised as exceeding an individual’s resources3 and is typically thought of as a factor that mediates the relation between stress and the onset of psychiatric illness.4 Coping is often depicted as a multidimensional construct, including task-, emotion-, and avoidance-oriented skills. Broadly, task-oriented coping involves efforts aimed at solving the problem or altering the situation, emotion-oriented coping involves reactions that are self-oriented, such as emotional responses and self-preoccupation, and avoidance-oriented coping describes activities and shifts in mental focus aimed at avoiding the stressful situation.5 Generally, task-oriented coping is seen as adaptive, while emotion- and avoidance-oriented coping are viewed as maladaptive.1 Because the types of stressors reported by individuals with eating disorders appear to fall within the normal range of experience,4 it seems likely that the ability to manage stress effectively (i.e., via healthy coping skills) has something to do with the likelihood of developing an eating disorder and its maintenance. Indeed, researchers have found that individuals with eating pathology tend to have more difficulty coping with stress than controls and that this deficit is likely related to their disorder (e.g., poor coping skills may worsen subclinical eating disorder symptoms and lead to the development of a diagnosable disorder).6 Ball and Lee found that coping skills differed between eating disordered individuals and controls in all of the studies examined in their review.1 Individuals with anorexia nervosa (AN), bulimia nervosa (BN), or significant eating disorder symptomatology were inclined to demonstrate more avoidance- and emotion-oriented coping when compared to controls. In contrast, healthy controls demonstrated more active coping techniques (e.g., problem-oriented, social support-seeking).1 Regarding a recovery perspective, some work has found that decreases in eating pathology are related to the use of less avoidant coping strategies, and in patients with BN, recovery was actually associated with the development of coping strategies almost identical to those with no eating disorder history.7 However, much less is known about the relation between recovery and coping compared to the relation between the presence of eating pathology and coping, and what is known generally relies on recovery defined using physical and behavioral criteria, but not psychological criteria. In the present study, we examined coping skills across stages of eating disorder recovery, with particular interest in the coping skills of those recovered according to physical, behavioral, and psychological indices. Those fully recovered were compared to individuals currently diagnosed with an eating disorder, individuals partially recovered (only physical and behavioral recovery), and a healthy control group. We proposed that individuals who were fully recovered would have better coping skills (i.e., more task-oriented and less emotion- and avoidance-oriented) than either those who were partially recovered or those who met criteria for an eating disorder and that they would use these skills at levels comparable to healthy controls.