What is Eating Disorder Relapse?
For those in recovery from an eating disorder, it can be difficult to realize that your recovery is starting to slip. The eating disorder relapse can be very subtle and sneaky, slowly working it’s way back into your life before you realize that you have taken a number of steps backwards. For anyone in recovery, it is important to talk in depth both with yourself and with your team about the “red flags” that the eating disorder may be creeping back in. Below is a list of common indicators that someone’s recovery may be at risk.
1. Increased Obsessiveness About Food or Eating
The first sign of an eating disorder relapse is an increased obsessiveness about food or eating. No matter how your eating disorder presents, whether you overeat or you undereat, you spend a tremendous amount of time thinking about food. When someone is truly in recovery, food takes it’s appropriate place in your life. While it may be a source of enjoyment and pleasure, it is not something that requires a lot of thought in between meals. When disordered thoughts about food start to increase, you may find that you are making detailed plans about how you will restrict at your next meal, thoughts about eating in a more dietetic way, or you may make plans for your next binge including where you will buy the foods and what you will eat.
A big clue as to whether or not these food thoughts are disordered is if the thoughts make you feel momentarily more calm or in control. Remember that the eating disorder, as problematic as it is, is also a coping mechanism, one that has been utilized over and over. So under stress or in the right circumstances, you may find yourself automatically going back to this maladaptive coping strategy as a way of soothing yourself. But remember, the eating disorder, including obsessive thoughts about eating, is a good short term strategy but really bad long term strategy. This does not mean one should aspire to have disordered thoughts. What it means is that you are able to momentarily quell your eating disorder’s fears when you think this way or ease your tension in the moment when you have these thoughts. In the long run, you are reinforcing the eating disorder and only making it harder to get it out of your mind and out of your life. These thoughts can be quite intense and it can feel like the only way to make them go away is to act on them but this is a very dangerous cycle. Practicing other forms of self-soothing, ones you have identified in your treatment as helpful in the past, become essential during these moments to move your mind off of these thoughts.
2. Engaging in Eating Either in Secret or Separate From Your Family
The second sign of an eating disorder relapse is engaging in eating either in secret or separate from your family
One of the most destructive features of eating disorders is the way it isolates and separates people from their families and those closest to them. This plays out in a macro level in the sense that the more rigid and disordered one becomes around food, the less likely one is to join in meals with others. So you are literally be separated from your support network by the eating disorder. It happens on a micro level as well because the foods you are eating are separate from every one else. That may be because you are bingeing in secret when you can be alone or because you want to eat foods that are different.
Because of the rituals and anxiety that come with eating, people with eating disorders tend to want to engage in the behaviors in private in order to avoid scrutiny and shame. If you are finding that you need to have your own, special foods, you have become more uncomfortable with eating the meal prepared by someone else in the family, or you wait until after a meal with others to go purchase your binge foods to eat alone, this may be a sign that you are gravitating back towards the rules and regulations of your eating disorder.
A good question to ask yourself in any circumstance is, “Am I willing to eat this or eat this way in front of someone who knows I am in recovery for an eating disorder?” In recovery, as in life, if you aren’t willing to share with someone that you are doing something, you probably shouldn’t be doing it.
3. Increase in Negative Body Image
The third sign of an eating disorder relapse is an increase in negative body image.
Negative body image is probably the most common symptom to precipitate a relapse. It generally is the last symptom to go away in recovery and the first to come back during a relapse. The intensity of the negative body image often gets worse in the beginning of recovery because of all the changes in your body, in the way you are managing food, and because you no longer have the eating disorder behavior available to you to soothe uncomfortable emotions. What I always tell clients is that negative body image is as much a symptom of the eating disorder as restricting, bingeing or purging is. It must be taken seriously and it is an indicator that the eating disorder is “just waiting around the corner” to entice you back into it’s web of lies.
While a certain amount of negative body image is actually considered normal in our culture, known as Normative Discontent, those without eating disorders can move on quickly from these thoughts. They cause small amounts of distress and do not impact one’s ability to function or impair one’s self-esteem. If you find yourself constantly comparing your body to other people’s bodies, feeling like you can’t get dressed, feeling like you don’t deserve to be seen in public, or are turning down invitations because you feel so uncomfortable in your body, this is a very strong sign that your negative body image is reaching a disordered level and requires attention. These thoughts can quickly turn into eating disorder behaviors if you are not being honest with yourself and your therapist that this is happening. There are numerous strategies that can help you reduce these thoughts and fight the urge to engage in eating disorder behavior.
4. Worsening of Your Depression or Anxiety
The fourth sign of an eating disorder relapse is worsening of your depression or anxiety.
For many people with eating disorders, they also struggle with a mood disorder or anxiety disorder. In the course of treatment, what you may have discovered is that your mood or anxiety disorder requires just as much clinical attention as your eating disorder. Mood and anxiety disorders can worsen for a variety of reasons. Generally, they respond to stress so if you have recently experienced some kind of set back or stressor in your life, it would not be unusual for your mood or anxiety disorder to increase in severity. Medications do not make these disorder go away completely so it is normal for there to be fluctuations in your symptoms.
What many people realize is that the mood or anxiety disorder actually pre-dates the onset of their eating disorders and that the eating disorder actually helped them cope with the mood or anxiety disorder, as strange as that may sound. The eating disorder can often help soothe painful or uncomfortable emotions by just helping one to numb out or be distracted by obsessive thoughts about food or weight. So the mood or anxiety disorder can be viewed almost as the “engine” of the eating disorder. It’s at the core of the eating disorder. So if you are noticing a worsening of your mood or anxiety symptoms, it is important to acknowledge this and work quickly to address it so that your eating disorder does not take advantage of an already difficult situation.
5. Rationalizing That a Small Change in Your Eating or Exercise Behavior is “Normal” or “Okay”
The final sign of an eating disorder relapse is rationalizing that a small change in your eating or exercise behavior is “normal” or “okay.”
This particular behavior is very sneaky because it happens so quickly and so quietly in your own mind, without anyone being aware of it. Sometimes situations present themselves by chance that encourage you to deviate from your meal plan. For example, perhaps you have to travel and you can’t eat on your normal schedule. Or perhaps you get a stomach virus and can’t eat for a few days. These situations happen all the time and if you are a bit shaky in your recovery, your eating disorder will really capitalize on these situations. It might say to you, “Well you skipped you last snack when you were travelling and you seem to be just fine.” Or it could say, “You know you are so much more comfortable in your body now since that stomach flu, you don’t need to go back to eating all that food.” Other examples include, “My nutritionist doesn’t know what she’s talking about, that is way too much food for me, “ or, “That really is not healthy so it’s OK to skip it.” Or, perhaps you have gone through a stressful experience and engaged in some eating disorder behaviors and you told yourself that you “deserved” to be able to do this because you were feeling so badly. Or perhaps you were eating with a family member who is monitoring your intake and he or she did not realize that you ate less than what is required by your meal plan and you tell yourself, “Well if Dad didn’t tell me I needed to add that component then I guess it’s OK not to eat it.” There are millions of ways that we can dismiss the significance of an eating disorder behavior, no matter how small. These small victories for the eating disorder only embolden the eating disorder and it will ask for more the next time. This is a slippery slope and it’s important to verbalize these thoughts to yourself and your team so that you are more aware of the ways you give yourself permission to undermine your own recovery.
Finding Help To Avoid An Eating Disorder Relapse
Many of these warning signs happen at the same time and build upon each other. Most people who are struggling with some kind of set back in their recovery will report most, if not all of these experiences. If you have been working diligently on your recovery, chances are you already know some very effective strategies that can help you address these behaviors. If you feel that the symptoms are starting to overwhelm you, please reach out for help and find someone who has experience treating individuals with eating disorders.
I look forward to helping you heal and find your path to recovery.
I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in eating disorder treatment (all types including anorexia treatment, bulimia treatment, and binge eating treatment) and other long term conditions, including addictions, bipolar, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, cognitive behavioral therapy, anxiety treatment, depression treatment, and much more.
I look forward to helping you obtain a brighter tomorrow.