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 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. Read on to learn more about eating disorders and relapses.
Why Do 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.
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 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:
- 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.
- 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.
- 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.
- 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.
If You Notice These Symptoms, Reach Out to an Eating Disorder Treatment Professional
When a 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 aftercare and alumni groups – 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 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.