What is an eating disorder relapse?
In general, an eating disorder relapse refers to someone in recovery reverting to old, unhelpful eating behaviors. This can look very different from person to person and eating disorder to eating disorder, and often, the signs of an eating disorder relapse will be subtle.
Some people further break down this experience into different "types" of relapse, including:2
- Lapse: A temporary backsliding of behavior
- Relapse: A longer return to disordered eating behaviors
- Collapse: A complete return to disordered thoughts and behaviors
As recovery from an eating disorder is often a lifelong commitment, these various phases of relapse are common. One study found that relapse occurred in 36% of people with anorexia nervosa and 35% of people with bulimia nervosa.1
Rather than focus on the progress that has been "lost," it can be helpful to reframe relapses as a temporary bump in the road. Patients should also look at how far they've come in their recovery journey rather than think that treatment didn’t work or that they have failed.
Warning signs of a relapse
Eating disorder relapses are often subtle, especially at first. Because so many of these conditions impact mental health and the way someone thinks or feels, someone may struggle with thoughts related to their eating disorder long before these unhelpful patterns manifest physically. However, keeping an eye out for signs of an eating disorder relapse can be a helpful way to ensure the issue gets promptly addressed.
Some possible warning signs of a relapse include:5
- Regularly checking weight
- Skipping meals or occasions involving food
- Regularly eating alone
- Engaging in excessive exercise
- Seeming ashamed or guilty after eating
- Justifying small slips or lapses from a recovery plan
- Isolating themself from friends and family
- Repeatedly checking their appearance in the mirror
- Seeming irritable whenever food is discussed
- Appearing sad or depressed
- Wearing loose-fitting clothing
- Hiding information from loved ones or treatment team members
- Appearing stressed or anxious
- Sleep disturbances
If you are worried that your loved one is at risk of relapsing, you can help enact their relapse prevention plan. Encourage your loved one to seek extra support, whether that be additional therapy sessions or attending more frequent support group meetings. In the event of full collapse, you can empower your friend or family member to re-enter an eating disorder treatment program.
Eating disorder relapse triggers & risk factors
Eating disorder relapse is possible at any time along the recovery journey, which is why eating disorder relapse prevention is so important.
One study found that the highest risk period for eating disorder relapse was between four and nine months after completing treatment.3 However, some situations can act as particularly powerful eating disorder relapse triggers, and other risk factors may increase the eating disorder relapse rate.
The risk of relapse is particularly evident during times of stress or significant life transitions. Some major eating disorder relapse triggers include:5
- Moving to a new city or state
- Starting a new job
- Going through a divorce
- Becoming a new parent or giving birth
- Experiencing infertility
- Going through menopause
- Receiving a serious medical diagnosis
- Experiencing the death of a loved one
- Going away to college
- Experiencing financial issues
Additionally, some situations can increase the risk of experiencing a relapse, including:2,3
- Consuming a low-energy diet
- Eating a limited variety of foods
- The desire to be a lower weight
- A lower percentage of body fat in patients who have recently recovered weight
- A decrease in motivation, either during or after treatment
One study found that poor body image and psychosocial functioning also increased the risk of relapse for people in recovery from anorexia nervosa and bulimia nervosa.1 Psychosocial functioning refers to a person’s ability to engage in healthy social relationships and perform the activities of daily living. So, if you notice your loved one seems to be struggling with their day-to-day tasks or relationships, this could be a sign they need additional care or support.
The importance of finding help after a relapse
Again, relapses are common occurrences and can happen at any stage of eating disorder recovery. It's important to address these situations with grace and acceptance and a measure of action toward getting back on track. Resumed disordered behaviors can take a toll on emotional, mental, and physical health and often get worse as time goes on.
Adopting a nonjudgmental mindset is key for those in recovery—and their caretakers. Part of a nonjudgmental view on relapse is honesty. It's important for everyone involved to be clear and honest about the symptoms they've observed or experienced during this time and to report those symptoms honestly to healthcare providers or treatment team members.
Healthcare providers can also help someone initiate their eating disorder relapse prevention plan or recommend the next best steps. These can—and should—be made with a patient's individual needs in mind. Don't be afraid to ask questions about the recommended course of action or about making appropriate adjustments to a recovery plan.
How to support someone in eating disorder recovery
It’s natural to want to help your family member or friend during their recovery from an eating disorder, but it can also be intimidating or scary. If you’re feeling overwhelmed or are unsure where to start, here are some things you can do to support them while also taking care of yourself:
- Research their eating disorder
- Ask how you can provide them with support
- Focus on your loved one as a whole person; they are not their eating disorder
- Remind them of how far they’ve come
- Express how proud you are of their progress
- Attend support groups with them if they request you to
- Change the way you talk about body image and weight, being sure to be educated about the impact of weight stigma and the destructive influence of diet culture
- Model a body-positive attitude
- Provide your loved one with a safe space to vent
- Validate their feelings when they confide in you when appropriate
- Encourage your loved one to stay gentle with themselves
In general, it's good for caretakers to offer support, encourage more open communication, and assist with finding more professional help. If the patient has an eating disorder relapse prevention plan in place, help them institute or follow it when appropriate. Otherwise, if the person in recovery seems unwilling or unable to reach out for help themselves, you can reach out to a mental health professional for advice on the next steps.
It's also important to take care of yourself, especially if you're the primary caregiver for someone with an eating disorder. You may want to create a self-care plan and ensure you tend to your needs. Although we all want to help our loved ones—pouring from an empty cup is impossible.
What to do if a loved one relapses
Relapse is a common part of the recovery process and should be treated as such. Someone in eating disorder recovery who has relapsed is likely feeling extremely ashamed and guilty about it—the worst thing you can do is add to that shame and guilt by blaming them or catastrophizing the experience.
It's essential to make sure your loved one gets the extra help, support, and care they need during this time. Once that's taken care of, you can express your own support for your loved one by being available to and open for them. Encouraging them to practice self-compassion during this vulnerable time can also be a huge help. Research shows that self-compassion reduces eating disorder symptoms and body image issues and is associated with greater positive body image.4
Lastly, if your friend or family member is struggling to return to their recovery plan, you may want to encourage them to re-enter an eating disorder treatment program where they will receive the structured support they need to get back on track.
The most important thing to remember is that relapsing does not mean your loved one has failed or that eating disorder treatment didn’t work. It simply means that they need some extra support right now. It may be stressful or upsetting to deal with in the moment, but in time, it all becomes part of a deep, rich process of understanding and healing.
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