Relapse does not define you
Eating disorder relapse is common and even expected in recovery. Yes, relapse is painful, but it’s not the end of the story.
- Relapse does not determine your long-term recovery.
- It does not define what your ultimate level of success will be.
- Relapse does not determine whether you can live a rich, full life, free of your eating disorder.
- And relapse does not mean that you will never recover.
- It is simply a common experience in a very complex mental health condition.
In this piece, I will show you how to make a relapse prevention plan. If you're unfamiliar with eating disorder relapse, review common signs of eating disorder relapse here.
What leads to an eating disorder relapse?
Some of the best-known risk factors for relapse include:
- Leaving treatment without full nutritional and weight restoration
- Leaving treatment before addressing all eating disorder thoughts and behaviors
- Having untreated co-occurring mental health concerns (e.g., depression, anxiety, substance abuse, obsessive-compulsive disorder)
Multiple factors can increase the risk of eating disorder relapse. Major life transitions are also a prime time for relapse. When you get off your normal routine or are creating a new routine, it can be hard to stick to your meal plan or remember the coping skills you learned in treatment. You may find yourself tempted to use disordered eating or other behaviors as coping mechanisms, which can put you into a relapse.
Common eating disorder relapse triggers
Common life transitions that could trigger a relapse include:
- Starting/ending school or college
- Starting/ending a job
- Starting/ending a relationship
- Moving to a new residence
- Becoming pregnant
- Having a baby/becoming a parent
- Experiencing a trauma or loss of a loved one
- Weight changes associated with physical health, aging or pregnancy/postpartum/menopause
- Physical injury or lessened mobility
It is totally normal for anyone to struggle, at any age, with the life transitions listed above. During these difficult times we encourage our patients to seek additional support from friends, family and their treatment team.
How can I reduce the risk of relapse?
I recommend the following:
- Try to reduce your workload and responsibilities at home
- Get enough sleep and manage your meal plan
- Decrease time spent on sports and extracurricular activities
- Take fewer rigorous classes
- Monitor yourself for signs of recovery burnout
Since relapse is common, and even expected, I would first encourage you to commit to the full course of treatment recommended by your treatment team. Then, you can slowly ramp up your activities while monitoring your mental health, self-care, meal plan and therapy. This may be hard in the short term, but it’s not forever and it’s so worth it.
What else reduces the risk of eating disorder relapse?
Factors that can reduce the risk of relapse include:
- Restoring and maintaining one’s fully adequate weight
- Successfully challenging and changing cognitive distortions
- Addressing and treating any co-occurring disorders[12]
To boost recovery, work on developing the following protective factors:
- A strong and encouraging support network (family, friends)
- Checking in with your treatment team regularly
- Identifying and participating in meaningful activities that you value (work, school, creative hobbies)
It’s important to believe that you can recover—and stay motivated.
Can I prevent a relapse?
I’m sometimes asked if it’s possible to prevent eating disorder relapse. Here’s what I tell my patients and their concerned family members:
- First, be prepared for relapse. It is quite common.
- Plan ahead. Identify any action steps you would take in case you do relapse.
- Write down these action steps and create a relapse prevention plan. (I’ll show you how below).
- Share the plan with appropriate friends, family members and your treatment team.
Above all, maintain hope. Recovery is possible!
Creating a relapse prevention plan: 7 tips
I tell all my patients that no matter what your personal situation is, you must acknowledge that relapse is a risk and prepare for the possibility by following the old Boy Scout motto: Be prepared. Think about what might have led to the relapse as you make your plan.
1. Reach out for help
If you’re currently going through a relapse or are close to it, please reach out to your dietitian and therapist. Your treatment team and support system are going to be some of the biggest helpers to you during this challenging time. We also invite you to attend our free virtual eating disorder support groups. This is a great way to get recovery tips from peers and professionals who understand what you’re going through.
2. Reflect on what's been going on lately
If you’re struggling with eating disorder thoughts and behaviors, take some time to explore your internal state. Consider journaling as you explore the following questions:
- Did something specific cause this relapse?
- Has there been a significant change in your life recently?
- Have you been under more stress or experiencing more anxiety?
- Have you started a new job, school program or other activity?
- Has there been any change at home with your family or significant other?
- Has something been upsetting or bothering you?
- If you have a trauma history, has something triggered you or reminded you of your trauma?
- Have you been experiencing more eating disorder thoughts, including food noise?
When you meet with your treatment team, discuss what you’ve learned through this journaling exercise. If journaling is not your thing, talk through these questions with someone.
3. Write up your plan
If you have not yet made a plan with your treatment team, try it now. The plan can include:
- A list of warning signs that indicate a higher risk of relapse for you
- Steps you can take to reduce this risk
- Steps others can take to reduce this risk
Keep the list handy and refer to it during times of increased stress or transition. Update it over time. Your plan can:
- Be modified throughout treatment and after discharge
- Include the factors that might show up if and when you are struggling
- Be shared with loved ones to provide support and accountability
- List action steps to take if a slip, lapse or full relapse occurs
If you’ve journaled about your experience, use those insights to help you make your plan. Review any resources you found helpful during treatment and use those to shape your plan. And get creative; use art, colorful pencils, pens or markers, and other tools to make it personal and meaningful for you.
4. Share your plan
Share your relapse prevention plan with your support system (friends, family members, treatment team members). This provides you both the support you need right now and accountability for the future. Always let your loved ones know when you’re struggling, and remember that recovery is within reach.
5. Focus on recovery
When you leave treatment and return to your daily life, you are going to be tempted to return to the life you lived before you started treatment. But that life may not have worked so well for you.
You may be driven to move up in your field, have all A’s or star in the school play. You are certainly talented and smart enough to do all of these things! But if you drop yourself into the life you were living before you entered treatment, it’s going to be too much for you to manage along with recovery. I also predict that it will be very difficult to stay on your meal plan. Once you aren’t getting enough sleep or are off your meal plan, you may find yourself returning to the behaviors that led you to treatment in the first place.
I can’t say it enough: Focus on recovery. Rest, self-care, sleep and nutrition should be top priorities.
6. Try recovery-focused self-talk
Positive self-talk is a skill that can build self-compassion. With greater self-compassion, you create a relationship with yourself that is kind and forgiving. Ultimately, it can help you stay aligned with your goals, including a continued focus on recovery. Try saying these to yourself and notice how you feel. Keep these self-talk examples nearby in difficult times:
- “I wish I had been better prepared for that situation. I see what I need to do differently next time. And I won’t wait as long to reach out for help.”
- “I am disappointed that I used a behavior when I felt stressed/upset. I will now focus on the next best recovery-focused decision.”
- “Slips and lapses are bound to happen in recovery. Overall, I am doing much better than before treatment and that feels hopeful.”
Hope is not lost. Recovery is possible!
7. Watch for eating disorder “slips” or “lapses”
Let’s say that you have had a slip or lapse, meaning you’ve had a momentary return to eating disorder behaviors. You might be tempted to say, “Well, there I go again. I’ve really blown it. See, I knew I hadn’t changed. I guess all that treatment was for nothing. My friends and family are going to be really disappointed when they hear about this one.”
Instead of being helpful, this kind of negative and self-critical talk could steer you to feel bad about yourself, possibly leading to eating disorder behaviors again. While it may seem counterintuitive, shame can lead you to continue harmful behaviors, rather than preventing the behavior from happening again.
Words matter. And remember that slips and lapses are part of a normal and healthy eating disorder recovery.
We can help.
No matter what you are going through, you have the strength within you to get through this. One of our top recommendations for our alumni who are struggling with relapse is to attend regular eating disorder support groups.
Find an eating disorder support group here.
If you are looking for more intensive support, please reach out to one of our compassionate, master’s-level admissions team members. Call (866) 622-5914 or fill out this form today.
Eating disorder relapse FAQs
Do I need to go to treatment to prevent relapse?
I don’t really consider it an eating disorder relapse unless you have gone through a full course of treatment (see my next response) or experienced demonstrable recovery. If you haven’t gone through a full course of treatment, as recommended by your treatment team, you might get better, but recovery will be that much harder.
What is a full course of eating disorder treatment?
A full course of treatment looks different for each individual because each person has different needs. If you achieve the goals that you set with your treatment team prior to moving to a new level of care, and then achieve your final goals for discharge, you will have completed a full course of treatment.
The truth is, nobody can recover from an eating disorder if they are undernourished or inconsistently nourished. The brain’s recovery follows the body — and the brain can sometimes take a while to catch up. Until your body is fully and consistently nourished and physiologically stable, your brain will not be able to do what is needed to be in and sustain recovery. Every journey to recovery is different.
Do I need to go to IOP and PHP?
Going to a partial hospitalization program (PHP) may be the hardest thing you will ever do, but if it is hard, it means that you needed that level of support to do the work necessary to recover.
If your team recommends PHP, it will be difficult, but it will be important. PHP is likely to be a big factor in helping you develop the skills and the supports you need to keep moving toward a sustainable recovery, avoiding relapse.
If you complete PHP and start an intensive outpatient program (IOP), you’re going to have the support of your full outpatient team and have an additional nine hours of support each week.
If you complete IOP before moving on to outpatient care, you’re going to be better prepared for recovery for life.