What is an eating disorder relapse?
To better understand an eating disorder relapse, it may help to first understand what eating disorder recovery looks like. The recovery journey is usually tracked in three main areas:1
- Psychological recovery: Progress in understanding and moving away from disordered thoughts around food, eating, body image, and self-worth. This is often considered the most difficult area in which to achieve recovery.
- Behavioral recovery: The reduction or elimination of unhelpful behaviors around eating, working out, binging and purging, or other actions related to the disorder.
- Physical recovery: Healing, restoring, or normalizing any physical complications caused by the disorder, including weight restoration, rebalancing hormones and electrolytes, and addressing other potential physical issues.
An eating disorder relapse occurs when progress in these areas is stalled or reversed. Some professionals further distinguish between "lapses," short-term setbacks, and "relapses," longer-term setbacks.2 A full-blown relapse is generally thought to be a return to the disordered behaviors and thoughts that maintain an eating disorder.
Again, recovery is hardly ever a straight line. Patients may experience stalls, lapses, or relapses in some of these areas even after experiencing progress in others. Full recovery can take months or years, so it's vital to have patience and compassion for yourself during this time.
Relapse triggers
Eating disorder relapses are common, with one study estimating the probability of relapse at 43%.3 One reason that the rate is so high is the number of events that can act as eating disorder relapse triggers.
While eating disorders can and do develop from a number of factors, stress or trauma is a very common element. Many of the disordered behaviors or thoughts involved in these conditions can manifest as maladaptive coping mechanisms. When something stressful happens during the recovery process, it could potentially trigger a return to these disordered eating behaviors.
Some stressful life events that can act as eating disorder relapse triggers include:4
- Moving to a new town or away from home
- Death of a loved one
- Pregnancy, giving birth, or having trouble conceiving
- Experiencing menopause or perimenopause
- Getting married, getting divorced, or experiencing marital difficulties
- Going away to college
- Being diagnosed with a chronic disease
- Starting a new job
- Experiencing financial stress
Other issues can trigger eating disorder relapse, as well, including exposure to unhelpful social media accounts or other misinformed or harmful content around food, weight, diet, and eating. Environmental triggers, such as peer pressure, may also play a role. Some biological factors, such as a low body fat percentage in recently weight-restored women with anorexia nervosa, can also increase the odds of a relapse.2
If you're currently in eating disorder treatment and are experiencing or anticipating some of these issues, you may want to discuss your concerns with your treatment team and examine potential treatment interventions. There are several things you can do to help insulate your recovery and build a recovery culture that supports you.
Signs of eating disorder relapse
Even though an eating disorder relapse generally means a return to eating disorder symptoms, the warning signs can be rather subtle, especially at first. People who are struggling may feel ashamed of their setback and go to great lengths to hide their relapsed behaviors.
Some signs to look out for that may indicate an eating disorder relapse include:4
- Increased anxiety, depression, or perfectionist tendencies
- Issues with sleeping
- Skipping meals or avoiding events involving food
- Making more attempts to eat alone
- Generally becoming more socially isolated
- Checking oneself frequently in the mirror
- Weighing oneself outside of treatment
- Irritability around the topics of food or eating disorders
- Return to a fixation on food, eating, nutrition, or related topics
- Justifying small lapses or slips in their treatment regimen
- Hiding information from loved ones or treatment team members
Relapse can also happen to any eating disorder patient at any time during the recovery process. However, certain factors may put certain people at a higher risk of experiencing a relapse, including:2
- Experiencing an eating disorder for a long time before seeking treatment
- Having a later age of onset
- Experiencing low self-worth or self-esteem, or high self-criticism
- Consuming a low-calorie diet or one with a limited variety of foods
- Participating in vigorous workout routines
If you notice these signs in you or a loved one, it may be time to turn to a support system or seek additional help.
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Eating disorder relapse prevention
Most formal eating disorder treatment will, at some point, frankly discuss the possibility of relapse. Because this is such a common occurrence, many patients have an eating disorder relapse prevention plan in place.
If you or a loved one is experiencing an eating disorder relapse, it's important to speak to a trusted treatment team member who can help you activate or create this plan. That could mean spending additional hours in therapy or other treatments, reevaluating your meal plan, readjusting medication levels, or taking other steps to assess what's going on and refocus on recovery.
Another helpful option during a relapse is to lean on your support network. You may want to attend more support group meetings or identify the people who support you and reach out. Having a group of trusted loved ones can make a big difference in how supported and cared for you feel during this difficult time.
Perhaps the most important thing to do during an eating disorder relapse, however, is not to beat yourself up. Eating disorder recovery is a long and hard process, and it takes courage to even start that journey. Remember all the work you've already put in and the progress you've already made, and remember that, just as one good day doesn't equal recovery, one bad day doesn't equal failure. Even if you experience a setback, recovery is always possible.
What to do after an eating disorder relapse
If you or a loved one is experiencing signs of an eating disorder relapse, it's important to seek out help. Relapse is common, but these behaviors should still be addressed by a mental health professional.
Contact a trusted member of your treatment team about what happened. They will be able to help you reevaluate your current treatment plan, identify any vulnerabilities to the eating disorder, and develop strategies for returning to recovery progress.
Some mindfulness practices can also help you recenter and refocus your efforts. And practicing self-care can help reinforce the idea that you're still worthy of love and health, even if you've experienced a setback.
If you need further help, you can also contact us. Our team of experts understands that eating disorder recovery is a multidimensional process, and we can help develop a personalized recovery plan that addresses your various needs for sustained recovery.
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