You’ve been doing well and maybe even thought that your eating disorder was tucked away, but lately stress has gotten to you and you’ve started to revert to old habits. Weighing yourself daily…counting every calorie…refusing to eat a single carb…skipping a meal or two. It doesn’t take long before you know you’re in the danger zone: Other people are noticing that you’re dropping pounds.
Eating disorder relapses happen, and they can sneak up on you. The highest-risk period for an eating disorder relapse is within about two years of treatment, but they can occur at any point. In fact, the longer you’ve lived with an eating disorder, the greater the chance of experiencing a relapse.
Here are steps you can take to prevent relapses…and other steps that can stop a relapse in its early stages…
Stay connected, or get reconnected, to your original support source. Whether that’s your therapist, medical treatment team or a support group of fellow patients, this support source helped you before—and there’s no reason or advantage for you to go it alone now or ever.
Review your journal. Keeping a journal was probably part of your original recovery. If so, periodically go over it alone or with your therapist to preemptively identify triggers that could bring about a relapse and come up with healthy coping strategies. Relapses most often occur during times of stress, such as after a death or a traumatic breakup, because a return to old, familiar habits makes you feel safer and more comfortable and can lead you to think you’re in control.
Activate your coping mechanisms. Relapse prevention is an important part of treatment and recovery. If you didn’t already develop a strategy to put in place when confronted by a trigger, make a list of action steps that helped you during your recovery and take them, one by one. They might include attending a support group meeting, checking in with your treatment team or confiding in a family member or friend. Also, check to see whether you’re really sticking to your meal plan and nutritional guidelines—draw up a meal schedule and eat with other people for accountability. Part of the plan should be to engage in specific activities that bring you joy, such as joining a book club, hiking or taking a painting class.
Quickly acknowledge any return to destructive behaviors. For people recovering from anorexia, warning signs of a relapse might be eliminating specific foods from your diet, being preoccupied with thoughts of food, engaging in food rituals such as eating foods only in a certain order and/or obsessing about weight. For people recovering from binge eating, it might include hiding food (or the food wrappers after eating). For people who are recovering from bulimia, it could be starting to overexercise or reach for a laxative again. As soon as you recognize familiar, destructive thought patterns and behaviors, acknowledge what’s happening and restart your former care plan.
Let your loved ones into your life, and listen to what they have to say. Family members and close friends may notice your red flags before you do. Let them be your eyes and ears. Trust that they have your best interests at heart, and listen when they tell you that they see signs that concern them.
Ask about additional treatment. Depression and anxiety often travel with eating disorders and can usher in a relapse. If you are feeling sad, hopeless or overly agitated, talk to your doctor or therapist to make sure you’re doing everything that you can to take care of your mental health. This might include taking medication even if only temporarily.
Understand that significant weight gain is sometimes fine—even healthful. There are times in life when significant weight gain occurs naturally, such as during pregnancy or as a side effect of certain medications, and is not a big health threat. Attempting to lose weight can be a slippery slope when you have a history of an eating disorder. Engage a dietitian as well as your therapist to help you lose weight safely when losing weight is truly necessary. It’s also important to acknowledge that weight gain isn’t a concern unless it brings medical complications with it. Remember that your goal is health at every size.
Ditch the scale. If you’re weighing yourself constantly at home, get rid of the scale to stop this behavior. Constantly weighing yourself gives in to the obsession with food and weight and allows you to focus on that instead of healthier coping mechanisms. You can have periodic weigh-ins done at your doctor’s or therapist’s office instead.
Be kind to yourself. Recovery is a lifelong process, and you want to take it one day at a time. Rather than berate yourself for having a relapse, think about how far you’ve come in the past. Setbacks happen—the key is to forgive yourself as you take action to prevent it from becoming a full-blown relapse.