First off, let's normalize relapse in eating disorder recovery. Relapse happens, and you can still be okay (more than okay!). It doesn't mean you've failed or that you're back to square one. In fact, research shows that approximately 40% of those in recovery from an eating disorder will relapse at some point in their lives. Relapses can be approached as a detour on one’s road to recovery. Sometimes, despite your best efforts, you may find yourself slipping back into old patterns. What matters most is how you respond to these times and what you learn from the experience.
Before we dive a bit deeper into this, let's clarify some terminology. Though the literature isn’t always clear on operationalizing the term “relapse”, it can be helpful in clinical work to distinguish between a lapse, a relapse, and a collapse. Think of a lapse as a brief slip or temporary return to disordered behaviors. It's like hitting a speed bump on the road – jarring but manageable. A relapse is when these behaviors become more sustained and intense, requiring more effort to overcome. A full-on collapse could be described as when things seem to spiral out of control, as though you are losing your grip on recovery. (For purposes of simplicity, I’ll refer to all forms of relapse by the umbrella term relapse for the rest of this post.)
Here are some of the most common risk factors for relapse. Everyone's journey is certainly unique, but I’ve seen these issues come up time and time again in my clinical practice (and research highlights these risk factors as well):
1. Stressful Life Events: Major life changes, such as moving, starting a new job, becoming pregnant, adjusting to a new baby, or experiencing relationship difficulties, can trigger old patterns of coping through disordered eating. I frequently work with clients on “safeguarding” their recovery when a time of transition is approaching. Being prepared and taking the shame and judgment out of the equation can make all the difference.
2. Negative Body Image: In today’s toxic beauty and fitness culture, if you are not actively cultivating a positive, empowered relationship with your body, this could put you at risk for relapse. I say “actively cultivating” because I believe the current climate in which we live bombards us with anti-body acceptance messages to such an extent, that we truly have to work so hard to stand against these pressures.
3. Lack of Support: Having a strong support system is crucial for recovery, especially when you consider the journey it entails. Without adequate support, individuals may feel isolated and overwhelmed, increasing the risk of relapse. It’s important to have people in your life who speak the “language” of recovery (or at least try really hard to understand it). This means people who understand the impact of triggering environments, who value emotional intelligence and regulation, and who prioritize healthy boundary-setting and self-care.
4. Dietary Restraint/Restrictive Food Mentality: Research demonstrates that individuals with high levels of dietary restraint (i.e., highly controlling their food intake) are at greater risk for eating disorder relapse. This might sound obvious, but here are the subtle ways this can emerge in eating disorder recovery: an insistence on “clean eating”, forms of mental restriction that often fly under the radar (“I won’t eat that type of food after certain times of the day” or “If I eat this, I won’t allow myself that”), or even using intuitive eating as a form of weight-control or diet.
5. Lower Weight at Pre & Post Treatment: Studies shows that individuals at lower weights at both pre- and post-treatment could be at greater risk of relapse as well. This emphasizes the importance of both early intervention, as well as achieving weight restoration (or an optimal weight for your unique body) in recovery. Many individuals leave treatment too early, before their bodies have had the chance to fully heal and recover. For many folks in eating disorder recovery, this means returning to their pre-eating disorder weight and/or growth trajectory.
6. Decreased Global Functioning: If your overall mental health is suffering, it is quite possible that you could be at risk for a return of eating disorder symptoms (again- this sounds obvious but it’s still very important to note). The eating disorder symptoms, after all, emerged in an attempt to help regulate your emotions. This is where a support system is key; your loved ones can offer feedback and emotional support if they observe you struggling.
7. Lower Motivation: Motivation to recover can certainly wax and wane over time. It can be crucial to stay connected to that which motivates you towards healing and recovery. Is it living life to the fullest? Is it being able to truly connect with loved ones and be present in the moment? Is it so you can have a strong body, allowing you to have adventures or participate in sports? Whatever most motivates you, find things that help anchor you to your recovery.
So, what can you do if you find yourself facing a relapse? First and foremost, be gentle with yourself. As cliche as it sounds, remember that recovery is a marathon, not a sprint. Here are some steps you can take:
1. Reach Out for Support/Professional Help: Don't be afraid to lean on your support system – whether it's friends, family, or a licensed therapist. Opening up about your struggles can help lighten the burden and remind you that you're not alone. It can also help you push the “reset” button on your recovery.
2. Revisit Your Treatment Plan: If you've worked with a therapist or treatment team in the past, consider revisiting your treatment plan. Identify what strategies were helpful in the past and brainstorm new approaches to address your current challenges. What once worked might need to be tweaked or changed all together. We have different needs as we enter different phases of life.
3. Practice Self-Compassion: Be kind to yourself during this time. Recognize that setbacks are a natural part of the recovery process and that you're doing the best you can in this moment. Treat each relapse as an opportunity to learn more and more about yourself.
4. Focus on Self-Attunement & Self-Care: Check in with yourself, identify what you’re feeling, and discover what you’re truly needing in this season. Prioritize self-care activities that nourish your whole health: mind, body, and soul. Whether it's practicing mindfulness, engaging in creative outlets, or spending time in nature, find what brings you peace and joy and make it a priority.
If you’re currently navigating a relapse or facing the fear of one, know that you are stronger than you realize. You've already taken the first step by acknowledging your struggles- this is huge! Keep moving forward, one step at a time, knowing that you can never undo the progress you’ve made, and you can always return to the path of recovery. You’ve got this.