If you are experiencing an eating disorder relapse, it is important to address it quickly. Try not to let feelings of shame or embarrassment keep you from reaching out for support.
Relapse does not mean failure
Relapse is common and even expected on the road to recovery. When my patients relapse, I remind them of this: “The tools that worked in the past are no longer effective.” Then we work together to figure out:
What was working
What stopped working
What never worked
What has not been tried yet
If you work with your support system and your treatment team, you can overcome this latest challenge.
The definition of relapse
Eating disorder experts agree that there isn’t one single definition of relapse. Most describe relapse as the reemergence of significant eating disorder thoughts or behaviors after a period of improvement.
Defining lapse, slip and collapse in recovery
From the field of addiction work come the helpful terms lapse, slip and collapse.
A lapse is a temporary slip—one isolated behavior. Lapses are common. If a lapse happens, acknowledge the lapse, identify what might have triggered it and figure out how you might handle the next situation differently. With support, a lapse can be addressed quickly. I like to tell my patients, “Do the next right thing.”
A collapse is a serious or long-term relapse. This means that a full return to eating disorder behaviors and symptoms has occurred. If this happens, you may require a higher level of care, such as inpatient treatment, residential treatment or a partial hospitalization program (PHP).
What is the anorexia relapse rate?
Around one-third to one-half of those with anorexia nervosa relapse within the first year or two after treatment.[1-3] The risk of relapse is high in the first few months after being discharged from treatment. The risk is particularly high if an individual leaves treatment prior to full nutritional and weight restoration and before they see a significant reduction in eating disorder symptoms. Relapse rates appear similar for males and females.[4]
The good news? Recovery can build over time!
People with anorexia nervosa often deepen their recovery more than 10 years after treatment. About a third of folks recover within nine years after discharge.[5] After 22 years, nearly two-thirds have fully recovered.[5] Those who recover earlier (at a younger age) may have an increased chance of long-term recovery, pointing to the importance of early, intensive treatment.[5]
What is the bulimia relapse rate?
Bulimia nervosa relapse rates range from 25% to 45% within the first year.[6-8] After the first year, about a third of individuals will relapse.
A large European study found that 37% of individuals with bulimia relapsed within 2.5 years after many symptoms had improved.[2]
Another study showed that two-thirds of those with bulimia nervosa recovered within nine years after discharge.[5]
At the 22-year mark, two-thirds of those with bulimia nervosa had recovered.[5]
When is the risk of eating disorder relapse highest?
A study of 655 individuals with anorexia nervosa and bulimia nervosa found that relapse was most likely to occur six to seven months after achieving partial remission.[2] (Partial remission is when eating disorder symptoms have significantly improved but some behaviors remain).
Additional factors can increase the risk of relapse, as I discuss later in this piece, but there is no way to predict who will relapse and who won’t.[9] The transition from a structured treatment program to independent living can be a vulnerable time and symptoms may return during this transition.
Eating disorder relapse in adults
At Eating Recovery Center (ERC), we often see adults struggling with relapse more than younger patients. There are so many complex factors that we face in adulthood that can impact our mental health, raise stress levels and make recovery more difficult.
Being responsible for children, a career, finances, and other caregiving or household duties can all impact recovery and even lead to burnout. Reaching out to your care team or returning to treatment early offers the best chance for continued healing.
Eating disorder relapse in children and teens
When parents and caregivers are fully engaged in treatment and recovery, we see lower relapse rates. If you are a parent, work closely with your child’s treatment team. Recovery is often strongest when the whole family is supported.
At ERC, we also encourage caregivers to seek help for:
Untreated mental health conditions
Unaddressed substance abuse problems
Relationship or marital issues
There is no judgment here. Recovery is hard enough when everyone is at their best. If a parent is struggling, a child’s recovery can become even more difficult.
Find eating disorder resources for families here.
What increases the chance of relapse?
Relapse is more likely to occur when people leave treatment before behaviors improve and full nutritional and weight restoration is achieved.[10] Other factors increasing the risk include:
Struggling with an eating disorder for many years or having more severe symptoms
Developing an eating disorder at an older age
Excessive or compulsive exercise as an eating disorder symptom
Increased concern with weight and body image/shape/size
Struggling with self-esteem or relationships
Experiencing a trauma or stressful event(s)[11]
When speaking about anorexia specifically, these factors may increase the risk of relapse:
Limiting food groups or types of food eaten
Reducing calories
Desiring to lose weight
Having lower body fat even after weight restoration[11]
We also see certain psychological and emotional factors increasing the risk of relapse:
Traits like perfectionism, rigid thought patterns, “black and white” thinking
Fear of weight gain and/or poor body image
Low social support
Struggles with emotion regulation
Low levels of self-compassion
Those who have co-occurring mental health conditions along with the eating disorder, like depression, anxiety, obsessive-compulsive disorder (OCD) and substance abuse, also face an increased chance of relapse.
What are the signs of an eating disorder relapse?
If you or someone you care about is struggling in recovery, pay attention to these possible signs of a relapse. These “red light” warning signs can indicate a relapse:
Not completing one’s meal plan
Taking a longer time to finish meals
Skipping meals or shrinking portion sizes
Eliminating individual food items or groups of foods from one’s diet
Avoiding discussions about eating disorder recovery; being less open to talking about recovery; refusing to believe that recovery is possible
Experiencing weight loss or unexpected/unaccounted for weight changes
Eating alone or avoiding mealtimes
Delaying nighttime snack until very late
Locking the door to the bedroom or bathroom after meals
Becoming more irritable with noticeable surge in anxiety and depression
Refusing to eat or hiding food
Eating alone or avoiding mealtimes with others
Exercising in secret
Unexpected weight changes
Experiencing sleep loss, including insomnia
Being unable to manage food noise
If you spot these signs, reach out to the treatment team. If you don’t have a treatment team at the moment, make an appointment with a licensed therapist or registered dietitian that specializes in eating disorders.
Who is at risk for a relapse?
Relapse is not always predictable—but certain factors can increase the risk:
Distress tied to one’s body image
Feeling that one’s self-worth is tied to appearance
Lack of a strong social support network
Low motivation or thinking that recovery is not possible
Intensified eating disorder thoughts and behaviors at time of discharge
Discharge at a medically unstable weight
Rapid weight loss following treatment
While these factors may raise the risk, relapse is never inevitable. Find out how to reduce the risk of eating disorder relapse here.
There is always hope for recovery
We want you to experience life free from the eating disorder. These illnesses can be sneaky, manipulative and tricky. When a relapse occurs and eating disorder symptoms worsen, you may lose hope for recovery. I tell my patients to learn from it and seek help. Remember: Early intervention is key. Many who relapse return to recovery stronger and more committed than before. With support, structure and self-compassion, healing continues.
If you are seeking additional support for you or a loved one, please reach out to our compassionate admissions team. You can fill out this brief form or call us today at (866) 622-5914. Recovery is within reach!
Relapse FAQs
Will I ever recover from my eating disorder?
Eating disorders are treatable conditions and recovery is always possible. You may feel like you can’t recover or that you’ll never overcome this illness, but that’s not true. What is true is that listening to your treatment team matters—they know the path forward.
As providers, we’re not looking for you to get a little bit better, but to experience complete freedom from your eating disorder. Yes, recovery takes work, energy and time, but the commitment is worth it for a lifetime of healing and freedom.
Is weight restoration related to relapse?
For those who need weight restoration in treatment, being fully weight-restored is tied to a lower risk for relapse. Adolescents, especially, are more likely to relapse when discharged at lower body weights.[13] Having said that, there is still a chance of relapse in those who have fully weight-restored.
I’m really struggling with relapse. What can I do?
Eating disorder recovery often comes with ups and downs. You go to treatment and come out in a better place. Before long, the eating disorder might creep in, little by little, escaping detection until a relapse is fully underway. Life gets busy quickly after treatment. Relapse can sometimes take hold before you realize it; I’ve seen it happen to thousands of patients.
The more momentum the eating disorder picks up, and the longer it goes undetected, the more difficult it can be to confront and treat. This is why early intervention is so important. If you’re struggling, please reach out for support. Fill out this brief form or call us today at (866) 622-5914 if you need help. Recovery is always within reach.