Eating disorder resources for current and previous clients

It’s Ok, Eating Disorder Relapses Happen

First things first – relapses happen. Someone who has gone through eating disorder treatment (or even someone who’s about to go in for the first time) may think of a relapse as a failure of some kind, and that’s natural. After an enormous effort to grow in personal, behavioral, and emotional ways, a person might feel that returning to old behaviors is a setback.

However, as they say in eating disorder treatment circles, “Recovery is not a straight line.”

Most professionals in the treatment community recognize this and consider relapses as normal parts of the eating disorder recovery process. They stress to their clients, both those in treatment and those in aftercare, the importance of recognizing the signs of a potential lapse in the recovery program and reaching out for help.

Even if they don’t, and fall back into disordered eating behaviors, people who relapse shouldn’t feel guilty or as though they’ve failed in their recovery; it’s an opportunity to learn more about the underlying causes of their disorder. 

Relapses can also prove an opportunity to learn new coping mechanisms that will eventually strengthen the foundation for a long-lasting, recovered life.

In this article, we’ll review the risk factors for relapse and the telltale signs and symptoms that a relapse is on its way. It’s not just for people with the eating disorders themselves – family and close friends play a vital role in recovery as well. 

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Why Do Eating Disorder Relapses Happen?

It’s an imperfect analogy, but eating disorders are in many ways similar to addictions. The disordered eating behaviors provide emotional relief and a sense of control over negative emotions. Many disordered eating behaviors even cause the release of dopamine and serotonin into the brain, just like intoxicants or exercise. And just like addictions, continued disordered eating behaviors cause alterations to the way the brain works – necessitating cognitive retraining techniques like Cognitive Behavioral Therapy (CBT) to counteract.

Stress Can Be an Eating Disorder Relapse Trigger

Aside from the cognitive/psychiatric cases of relapses, certain emotional and stress-related factors can make a relapse more likely. One of the major known causes of eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder, and others is the presence of past trauma and PTSD. Psychiatrists and other eating disorder treatment professionals have heard countless personal tales about post-traumatic stress playing an integral part in starting to use disordered eating behaviors to cope. It’s no different after a person has gone through treatment. A resurgence of the negative emotions caused by PTSD can easily re-spark disordered eating behaviors even if they have been eliminated during treatment. For this reason, many treatment centers employ Cognitive Processing Therapy (CPT), a step-by-step dialectic therapy that was designed specifically to treat trauma.

These underlying causes of relapse are certainly very common, but usually, when a relapse occurs, there is a specific trigger that prompts the resumption of disordered behaviors. This is most often stress of some sort. This stress doesn’t always have to be negative; many major life changes can cause stress, and many are happy occurrences. Positive or negative, stress is the most prominent trigger for relapse; a study done in 2011 showed that a group of people with bulimia nervosa who suffered significant life events relapsed at a much higher rate than those who had not.

Some examples of major life events that can cause stress include:

• Getting a failing grade
• Abuse, physical or emotional
• Being in a car accident
• Getting married
• Graduating from school or college
• Being fired or laid off
• Getting a promotion or a new job
• Being robbed or burglarized
• Achieving a goal
• Having to give a speech or other public speaking
• Spending the holidays with family
• Having a child
• Having an abortion
• Losing a friend or family member

There are as many potential causes for stress as there are major life events. Following one of these events, a relapse may occur. At times, the relapse will come on slowly, with some small behaviors leading to the re-emergence of classic behaviors associated with eating disorders such as purging, binge eating, and calorie restrictions. At other times, a stressful event can spark a relapse quickly. Next, we’ll look at some of the signs that a person is inching back toward disordered eating and exercise behaviors.

What Are the Signs of a Potential Eating Disorder Relapse?

Every kind of eating disorder has its own unique symptoms, so there will be different warning signals for each. However, some changes in thinking patterns and behavior indicate a relapse might be coming among all eating disorders. During treatment, many of these behaviors were replaced with positive coping mechanisms, but they can lay low for months or years afterward. Very often, when a relapse is imminent, a person will experience one or two of these, and then a few more, and so on until the disorder has completely come back.

Here are a few signs that a person’s recovery has become at-risk:

1. Increase in negative body image or self-criticism

Body image distortions are central to eating disorders; they’re one of the first things addressed at both residential and day treatment centers. Learning to love and accept your body is also part of most treatment programs, with daily affirmations and mindfulness exercises that can be used during aftercare. When negative body image encroaches after eating disorder treatment, it’s a clear sign that a relapse may be coming. 

Some indications include an increase in self-criticism, i.e. “I feel fat,” beginning to wear baggy or less-revealing clothes to hide their body shape or even a general feeling of being dissatisfied with your body. Negative body image, especially when it centers on weight, can prompt behavioral changes designed to lose weight – a slippery slope for a person in recovery.

2. Changes in eating patterns

A major part of treatment is establishing a regular eating pattern with nutritious meals that provide nourishment as well as a renewed sense of enjoyment when eating. When a person in recovery starts to change these eating patterns, it might mean they are inching towards a relapse. The most obvious is when a person goes on a diet that requires calorie counting or cutting out entire food groups – any fad diet, in fact. 

A person in recovery from an eating disorder should avoid food restrictions, of course, but they might begin to justify small changes in their eating, which can turn into a relapse. Other changes might include a reluctance to eat in public or discomfort at family meals or when out with friends at a restaurant. An increase in private eating is also an indicator of a relapse, especially for a person in recovery from binge eating disorder or bulimia nervosa. 

Some other signs of a potential relapse are chewing more gum and increasing caffeine intake, especially black coffee or diet colas.  These aren’t the only eating changes that can be a warning sign – any sudden changes in the way a person eats can be a red flag.‍

3. Looking back on the disorder with fondness

Even after a successful period in eating disorder treatment, a person may not like the way they look or be completely happy with their weight. It can take a concentrated effort to promote self-love and body positivity. If a person in recovery is feeling nostalgic for the body shape their eating disorder brought on, they may resume those disordered eating behaviors. Commonly, they will look back at these perceived “positives” and ignore the myriad negatives that come with an eating disorder.

4. Worsening of depression or anxiety

Co-occurring disorders, i.e. another mental health condition in addition to a person’s eating disorder, are completely normal. These disorders are much more common in people with eating disorders than in the general population; they can be both contributing factors and results of an eating disorder. The negative emotions brought on by depression and/or anxiety can prompt disordered eating behaviors as a kind of relief – as mentioned before, the “feel-good” brain chemicals released by binge eating, purging, or restricting are often a disordered coping mechanism. If you notice a worsening of these symptoms in yourself or a loved one, it’s time to reach out for help – it’s a clear risk factor for a relapse.

What to Do if You Notice an Eating Disorder Relapse

When an eating disorder relapse occurs, remember it’s not a failure or something to be ashamed of. It’s a natural part of the recovery process. That’s why eating disorder treatment centers provide alumni support groups and other alumni services – to prepare for exactly these circumstances. 

When a relapse is coming, or when it has struck, it’s imperative to reach out for help. If you’re the person in recovery, you might want to speak to a family member or close friend, or if that’s uncomfortable for you, talk to a professional therapist or even place a call back to your eating disorder treatment center. If your loved one is in recovery and facing a relapse, you may want to have a compassionate talk with them. Make sure you ask how you can help and if they feel supported. A relapse can be scary – but it can also be treated.

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This week, one of our Primary Therapists discusses maintaining recovery during the summer holiday. Read on to learn some strategies to support your recovery.

How Summer Vacation Can Impact Eating Disorder Recovery

For most, summer holidays are full of excitement and pleasure. People often count down to summer for as long as they can remember. They begin preparing for the event weeks ahead by going shopping for a new outfit, picking out a recipe to cook, and reaching out to friends and family to coordinate plans. 

However, if you are someone currently in recovery from an eating disorder or disordered eating, a summer celebration might make you uncomfortable.

You might currently be experiencing an absence of joyful emotions for the last several weeks, months, or even years. All of your previously enjoyed activities that used to bring you joy might feel as if they have completely escaped you. Because of this, you might question whether you will be able to have fun or enjoy yourself by attending a 4th of July celebration, a family BBQ, or a friend’s pool party.

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Eating Disorders and Summer Depression

Depression can increase your desire to engage in your action urge (the urge that appears to protect you), which results in withdrawal and isolation from others. Opposite action asks you to question whether this specific urge to isolate makes sense in the moment or whether acting oppositely could be more beneficial. 

If you have already decided that you are not going to attend the celebration, this is the time to reflect on whether isolating is more harmful than attending. If you decide that the benefits of going to the event outweigh the potential consequences of avoiding the celebration, there are certain ways to plan ahead to make sure you are as comfortable as possible.

4 Strategies to Aid Summer Eating Disorder Recovery

1. Identify an ally: Choose a family member or friend that can be your go-to person. Have a plan about how long you’re going to stay at the event and how often you might need to check in with one another to assess how you’re feeling. Think about creating a code word/phrase to share when you need additional support away from the group.
2. Meal plan: Decide whether you are going to bring your own food or whether you are going to eat what the host has prepared. Do not allow this to be an excuse for engaging in eating disorder behaviors due to being unaware of what food will be available. Call the host or ask your friend/family to do this ahead of time if necessary.
3. Prepare for social interaction: Reintegrating back into a social group after a period of isolation can be anxiety producing. Your family and friends are most likely excited to spend time with you. They may have several questions in regards to how you are and what you have been doing. They might even unintentionally make a comment about your appearance with the belief that they are complimenting you. Be prepared. Brainstorm safe topics that you can discuss if you’re uncomfortable talking about treatment or your recovery. Role-play with someone prior to the event in order to explore how you will respond to certain questions. Ask yourself how much information you’re willing to share and with whom you feel comfortable sharing that information with. Think of a statement to use if you need to remove yourself from a conversation that is no longer beneficial.
4. Set an intention: On your way to the celebration, set an intention. What is the reason that you are attending this party? What is the desired outcome? Repeat this intention to yourself over and over until it resonates with you. When your eating disorder begins to distract you from this intention with attempts to engage you with thoughts related to food or body, challenge it by repeating this intention. Remind yourself of the initial purpose.

A Plan Can Ease Eating Disorder Recovery in Summer

Managing summer vacation celebrations while being in recovery can often feel extremely overwhelming if you are without a plan. Take the time to recognize any obstacles that may arise in order for you to cope with potential eating disorder urges. While you are challenging your eating disorder over time, you will soon be able to return to enjoying fireworks, bonfires, and BBQs as a means for celebrating the milestones in your life.

Need more support? Check out our alumni resources or reach out today.

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There’s no question that letting go of an eating disorder is one of the hardest things a person can do. Each individual will follow their own unique path to ED recovery. While there is no magic wand to wave away all the stress, challenges, and difficult moments, we'll try to provide the next best thing.

Here are suggestions shared by individuals who have had success with their ED recovery journey.

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1) Practice self-compassion.

Decide that you are worthy of eating disorder recovery and living a joyous life, which means full of ups and downs. Forgive yourself when you have a bad day. Acknowledge when you are tired and need rest. And keep reminding yourself that you are doing the best that you can.

2) Feed your soul.

If your body and brain are being deprived, you are less likely to reap the benefits of therapy or your mindfulness practice. Regardless of body shape or size, malnourishment increases the risk of medical complications, co-morbid psychiatric symptoms, and distorted thinking. 

Consider ways to nourish yourself beyond just the physical piece. Look at ways to feed your soul. That might be through journaling, creative expression like art or poetry, or playing an instrument or listening to music. We nourish our bodies with food, and our minds and hearts with knowledge and love.

3) It takes a village.

One person can’t give you the keys to eating disorder recovery. Rather, it takes a team. One who holds you accountable and provides the knowledge and skills you need for recovery. 

A dietitian specialized in eating disorders helps navigate your food rules and ultimately normalize eating. A medical doctor or nurse practitioner monitors for medical complications and can provide a reality check regarding the seriousness of your illness. A therapist who you genuinely connect with will be your ally to help you better understand yourself and your eating disorder. 

While it isn’t unheard of for people to recover on their own, it is immeasurably easier with a strong team of professionals by your side.

4) Look forward to future fun.

You have your clinical team, but remember your squad. Don’t let your eating disorder isolate you from those you care about and those who care about you, too! As one recovery pro said,

“Think about your friends who want to do things with you to help keep you out of your head and nudge you to go to meals. Eventually, the future fun with your friends will outweigh the fear of eating. Your friends can also provide a good model for more normalized eating patterns.”

5) Don’t forget that honesty is the best policy.

Many recovered individuals will stress that honesty is key to success. Because an eating disorder thrives in secrecy, being honest is a way to defy eating disorders and stake a claim on recovery. In addition, being open with your family and friends can be a great motivator to keep going on your recovery journey.

6) Use your eating disorder recovery tools.

An eating disorder is an incredibly effective coping mechanism…until it isn’t. And while this is an oversimplification of a very complex disease that can involve genetics, temperament, trauma, and a host of other contributors, it is undeniable that the use of eating disorder behaviors meets a very immediate need to dull or distract from unpleasant feelings or things. 

You cannot take away a coping mechanism, whether it is maladaptive or not, without replacing it with something else. How about adding healthy coping skills to your toolkit? This is where all those hours of DBT are going to come in handy. Other skills can be mindfulness, meditation, art or yoga. Have your pick.

Furthermore, the key to internalizing skills is to practice them often throughout the day. Repetition and time will help the brain form new neural pathways, and slowly but surely, these habits will replace the old, unhealthful ones.

7) Rediscover your sense of self.

Eating disorders are often ego-syntonic, or in other words, consistent with one’s sense of self. When you make the decision to pursue eating disorder recovery, it can feel like giving up a part of your identity, maybe one that you have held on to for a long time.

In the same way you must add new ways to self-regulate when you begin to abstain from your eating disorder behaviors, rediscovering your sense of self is key to maintaining your recovery. A journal can be a great way to do this, especially if you use writing prompts.

Thought starters for journaling throughout eating disorder recovery:

• What defines you outside of your eating disorder?
• Explore your relationship to others in your life, as a child, parent, spouse or friend.
• What are you passionate about?
• What subjects do you like best in school, or what is your favorite thing about your job?
• What makes you feel connected?
• What are your pet peeves?
• What’s your idea of the perfect day?

As the eating disorder identity fades away, make sure that YOU are there to take its place.

Ongoing change is achieved by building a life that has meaning to you, as an individual. Be open and willing to try anything, stick with what works, be kind to yourself and never forget:

Eating Disorder Recovery is possible.

We know finding care can be tough. Monte Nido is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out to us.

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