When you’re trying to recover from an eating disorder, setbacks can happen. In fact, relapses are quite common. But the key is to use them as learning opportunities, adjust your treatment, and try to move on. Sometimes, you may be able to prevent a relapse.
For more information on relapse and what individuals can do, I spoke with Pam Cleland, MS, LPC, an aftercare coordinator at the Eating Recovery Center. Below, she provides valuable insight into how people can prevent and minimize relapses.
Q: How do you define an eating disorder relapse?
A: An eating disorder relapse can be defined as occurring when a patient in recovery begins resorting to his or her old methods of coping (i.e., eating disorders symptoms begin to reappear). Specific harmful behaviors such as binge/purge cycles, restricting, over-exercising, using laxatives/diuretics can enhance and accelerate the relapse.
Q: What are several ways that individuals recovering from an eating disorder can prevent relapse?
A: First and foremost, consistent, regular visits with your outpatient treatment team (therapist, dietitian, psychiatrist) are crucial.
It’s also important to follow your meal plan or dietary routine as designed by your nutritionist and creating a relapse plan, which can be revised as needed, to build and provide empowerment.
Surrounding yourself with a support network of friends and family who understand and will not judge you can help with preventing relapse.
Continue working on internal values, which will help improve the “selfs,” self-esteem, self-worth, self-confidence and self-awareness.
Q: If a person does experience a relapse, what are the best ways to deal with it?
A: Seek support from a therapist, friend, family member, etc. Many relapses, if identified early, can be arrested so that the relapse becomes a “slip” and doesn’t become a full-blown relapse lasting weeks or months.
Explore your feelings before the slip or relapse occurred. Remind yourself that just because a relapse is looming or in process, it does not mean that you have failed.
Q: How do you help patients who’ve experienced a relapse at your center?
A: Prior to discharge at Eating Recovery Center, patients complete a Wellness Plan, a tool for the patient’s dedication to wellness, as well as acknowledging and accepting help from others.
Reminding our patients of their values and how those values do not align with eating disorders behaviors or the long-term goals of the patient is vital to the prevention of relapse.
Additionally, negative self-talk statements are exposed and turned into positive self-talk affirmations.
Q: I’ve read that setbacks in recovery are common but the key is to learn from them. What are your thoughts on using relapse as a learning opportunity for recovery?
A: It is not always possible to avoid slips and relapses, as this is a very difficult disease to treat and manage. The eating disorders population tends to be very hard on themselves if relapse occurs.
Therefore, it’s important to remember that no one can recover “perfectly”; a learning opportunity in and of itself that defines the notion that perfection does not exist.
Acceptance of that can be powerful during or after the relapse.
Q: I’ve also read that patients with histories of excessive exercise should not return to exercise because it significantly raises the risk of relapse. But movement is also critical to one’s emotional and physical health. So what can these individuals do?
A: It is unrealistic to expect a patient to completely let go of any and all exercise. After all, exercise is healthy for you! The difference is that eating disorders patients exercise because of their eating disorder.
The goal for the patient is to incorporate a healthy “movement plan” into his or her relapse prevention or Wellness Plan. The patient’s dietitian can – and should – be very helpful in working with the patient to create a managed, calorically balanced meal plan with appropriate exercise. Exploring the implications of excessive exercise with the patient is vital.
Q: Anything else you’d like readers to know about relapse and getting through it?
A: Remember to…
- Be kind to yourself and give yourself time to recover.
- Refer often to your values and strive to live by them.
- Work on self-approval, which is not dependent on weight.
- Accept your personal limitations.
- Create an environment of respect, optimism, trust and honesty with yourself and others.
- Know that “failure” neither dooms nor defines you. You are just a person who is willing to take on challenges.
- Practice, practice, practice!
Over a year ago, I interviewed eating disorder expert and psychologist Sarah K. Ravin, Ph.D, who also revealed important information about relapse. In our interview, she said:
This is a very important question because relapses are quite common in eating disorders. In order to prevent relapse, it is essential that the client and their family understands the brain disease model of eating disorders. While full recovery is possible, the underlying biological and temperamental predisposition will always be there.
People who have recovered from eating disorders must be very conscientious with their self-care, always ensuring good nutrition, maintenance of a healthy body weight, plenty of sleep, and regular exercise. They must be careful to manage any other mental disorders or physical illnesses they may have, as these can trigger relapse. They should be mindful of living a low-stress life and surrounding themselves with supportive people who are aware of their eating disorder history and prepared to intervene if necessary. Ongoing psychotherapy can be very helpful as a means of self-care and stress management, and can help the client spot early signs of relapse and fix them right away.
Many recovered persons believe that they will not relapse because they don’t want to relapse, or because they no longer have a drive for thinness. This belief is understandable because many people first fall into an eating disorder through dieting during adolescence. Nevertheless, it is possible to relapse unintentionally, without ever going on a diet.
Granted, dieting is a terrible idea for anyone, especially those with eating disorder histories. However, some people relapse into eating disorders as a result of emotional stress or unintentional malnourishment (e.g. due to illness, surgery, depression). Any amount of malnourishment, even one skipped meal, is dangerous for someone with an eating disorder history.
I recommend that clients and their families have a specific, written plan in place to deal with any future relapses. Fortunately, clients who have been through successful treatment are less likely to relapse and are more likely to get help immediately at the first sign of struggle. For these clients, relapses are usually shorter and less severe than the initial episode.
If you’ve struggled with a relapse, what helped you overcome the setback? What have you found to be helpful in preventing a relapse? What things were key in your recovery?