National Eating Disorders Association

Relapse and RecoveryRecovery from an eating disorder can take months, even years. Slips, backslides, and relapse tend to be the rule, rather than the exception. Re-learning normal eating habits and coping skills can take a long period of time and often requires lots of support from professionals, friends, and family. Moving forward is key, however slow it might be.

People struggling with an eating disorder have to address any immediate medical concerns caused by their disorder, work on reducing or eliminating eating disordered behaviors, address co-occurring issues like depression, anxiety, or trauma, and then develop a plan to prevent relapse. Some psychologists call recovery the process of creating a life worth living. Overcoming food and eating concerns during recovery is a central goal, but it’s far from the only task of recovery.

Psychologists have identified three broad areas of recovery:

  • Physical recovery. This involves normalization of the physical effects of the eating disorder, including restoring weight to an appropriate level for the individual, normalizing electrolyte and hormone levels, resuming menstruation (if applicable), and other health issues caused by the eating disorder. Those with longer-term disorders may not be able to fully reverse all health consequences, but will be able to address other areas.
  • Behavioral recovery. This aspect of recovery means a cessation or dramatic reduction in food restriction, overexercise, purging, and/or binge eating.
  • Psychological recovery. Perhaps the hardest area of recovery to define, psychological recovery means addressing the cognitive and emotional aspects of the eating disorder, such as body image distress, perfectionism, and rules around food, eating, and weight. Those with co-occurring conditions such as mood and anxiety disorders may also need to manage those disorders to sustain lasting recovery.

Support System

An active support system often plays a key role in recovery. Parents can help encourage their children to stay in therapy, eat regular meals, and use new coping skills. Partners and friends can provide support during difficult meals and help build a life outside the eating disorder. For people with long-term eating disorders, normal social support systems have often waned, as friends and family often ‘burn out’ from providing care. So for some with eating disorders, recovery involves building a support system to help out when times get tough, as well as learning how to utilize it.

Maintaining Recovery

Although everyone has the potential to recover fully, not everyone will. This is not the patient’s fault, but rather is caused by a complex range of issues, including lack of access to treatment at the right level and for a long-enough duration, imperfect treatments, sociocultural barriers (e.g., bias and discrimination against larger body sizes), and more. Even for those who don’t recover completely, treatment can often make dramatic improvements in level of symptoms and quality of life. 

Eating disorder researchers have yet to develop a set of criteria to accurately define what factors are necessary. Emerging results suggest that a full year without behaviors is a major indicator of recovery. Even if recovery is formally defined, each person’s recovery will look a little bit different. Some people may find the structure of a meal plan helps them stay well, while others prefer more flexibility around food. An active social life may be part of one person’s recovery while adequate time for solitude may be just as important for someone else. There’s no right or wrong way to do recovery.

Relapse

Recovery is a long and difficult process, and it’s common for people to return to eating disordered behaviors, especially during times of stress. Some common stressors include:

  • Going off to college
  • Moving to a new town or away from home
  • Starting a new job
  • Financial challenges
  • Infertility or getting pregnant
  • Birth of a child
  • Marriage or divorce
  • Death of a loved one
  • Diagnosis of a chronic disease
  • Menopause

It’s not uncommon to be tempted to return to old behaviors during these times because you remember that they once made you feel better, at least temporarily. Hopefully, time in recovery has also shown you how much fuller life can be without an eating disorder.

Learn more about the stages of recovery >

Common warning signs of relapse

Just as all eating disorders are slightly different, so are all relapses. Still, many have a similar set of signs that can help identify potential problems:

  • Avoiding meals and events involving food
  • Making efforts to eat alone
  • A return to obsessing about food and weight
  • Overwhelming feelings of shame and guilt after eating
  • Concealing information from loved ones and your treatment team
  • Resuming repeatedly checking appearance in the mirror and weighing outside of treatment
  • Justifying small slips and lapses, saying that it’s no big deal or it’s not that bad
  • Becoming irritable when the subject of food or eating disorders is brought up
  • An increase in stress with no way to manage it
  • Increasing anxiety, perfectionism, and depression
  • Sleep disturbances
  • Isolation from friends and loved ones

The best way to deal with relapse is to accept the possibility that it might happen, soon or in the distant future, and make a plan to help manage it. 

  • Identify your triggers. Based on what you’ve learned in recovery, identify the types of situations where you think you might be most likely to struggle. Write down as many as you can realistically think of.
  • Identify warning signs. What are signs that recovery is continuing to go well for you? What about when you might need more support? Lastly, what are the signs that you are in full-blown relapse? Note psychological, behavioral, and social signs, such as avoiding meals, not sleeping well, increasing perfectionism, irritability, and breaking plans with friends.
  • Identify support people. Find several people, including a therapist, dietitian, psychiatrist, or other professional, whom you can turn to when you’re stressed or having concerns about emerging eating disordered behavior. If appropriate, encourage them to talk to you about any concerns they see as well.

LIFE DURING RECOVERY: QUESTIONS TO ASK YOURSELF

What's life supposed to be like without the eating disorder? This is a question you'll need to consider if you are in recovery. Ask yourself: "If I woke up tomorrow morning and my eating disorder had magically disappeared, what would my life look like? What would be different? How would I know it's different?" Knowing how your life will be different gives you a clue as to what you want from recovery. How you answer is a very personal decision.

Here are some questions to ask yourself to help you have a clearer vision of what you want and need for staying in recovery:

Let Go of the Comfort Zone

Ask yourself: How can I keep going even when I feel uncomfortable?

Expect the recovery process to be uncomfortable. You have to live through the painful emotions and uncomfortable physical changes to reach your healing destination. For instance, take the objective of normalizing your behaviors with food. At first when you are asked to follow a structured food plan, it can feel overwhelming to think you have to eat three meals a day, plus snacks. With time and consistency, your body physically and emotionally adjusts to a normal eating pattern. And eventually, you'll be comfortable.

Lean on Support

Ask yourself: How can I allow others to support me?

Recovery is a time to let support in, not push it away. However, many people find it difficult to reach out and accept support from others. The truth is it's much easier to walk the road of recovery with someone walking alongside you than making the trip on your own. If you are having difficulty accepting support, think about how you feel when you are given the opportunity to provide support to others. Remember, it is a gift.

Set Small, Achievable Goals

Ask yourself: What is one mini-goal I can set today?

No one says you have to recover overnight. Most people don't wake up one day free of the disorder when they've been struggling for months or even years. There are many mini-goals that need to be realized first before you can reach the ultimate goal. Your goal may be to eat out at a restaurant with friends without anxiety or guilt. To reach that goal, you may first have to practice eating meals with your family at home. Once you've successfully accomplished this goal, you can expand your repertoire to eating a meal with your family at a restaurant, and then move to eating a meal out with your friends. Keep in mind that your success in reaching your goals is often achieved when you break it up into smaller, more manageable pieces.

Make Peace with Normalcy

Ask yourself: How will life be better when I am "normal?"

While it may feel anxiety provoking, let yourself make peace with normality: normal eating, normal body size, normal weight range, normal coping. I fought for many years from being "normal" at many levels. My behaviors when I was sick were very abnormal, but for some reason they felt safe. I was afraid of my identity being "normal." Recovery is a journey to normalcy and healing. This is not to say you can't be unique in your own right, but recovery from an eating disorder takes you to a place of normal functioning—and that's a healthy, productive, life-enhancing place to be. Don't fight it, embrace it.

Find Uniqueness the Healthy Way

Ask yourself: What qualities make me a unique and special person?

Having an eating disorder sometimes becomes someone's identity. You may feel unique and special, and fear losing this identity—even if it's destroying lives along the way. Your task in recovery is to find your identity apart from the eating disorder. That person will be far stronger and more unique than any identity you could assume while being sick. Allow the passion of who you are meant to be bring you closer to your new, healthy identity, one living without the eating disorder.

HELPFUL TIPS FOR AFTER RESIDENTIAL TREATMENT

After spending time at a residential program, the transition back to the real world can be a difficult one. When you think about all the elements that were working while you were in treatment, you will need to continue to create these things at home. A residential program does not "fix" us for life, but teaches us what we need to do for ourselves. Here is a list of what works in residential programs, and what you can continue to create:

  • Willingness: Admitting that you need help is hard, but it is a first step toward recovery. It takes willingness to propel us into action.
  • Accountability: Plan meals with others. Get an accountability coach or another friend in recovery. Call each other every day to check in. Have someone in your life that you HAVE to tell all the sneaky stuff to. Trying to do it alone got you into treatment; learning to "do it differently" will keep you from going back.
  • Structure: Follow your meal plan even when you don’t feel like it. Set up a regular recovery schedule to follow. Plan ahead for triggering situations.
  • Meetings and Support Groups: Go to meetings even when you’re not in the mood and feel ashamed. Everyone who is there has been where you are now.
  • Support: Reaching out breaks the shame and isolation. Get a list of five or ten people you can call when you are in trouble. Allow yourself to feel vulnerable with another person. Remember how you feel when someone tells you they are hurting. Giving support is a gift. Allow yourself to receive.
  • Feelings: Separate eating disorder behaviors from stress. Be willing to feel all feelings, even when they feel awful. Feelings won’t kill you, but an eating disorder might. Be willing to sit with discomfort by taking one minute at a time. Breathe, don’t run. Running from our feelings just takes us in a circle right back where we started.
  • Therapy & Treatment Team: Make treatment a continued priority. Without dealing with the issues that come up, you could relapse.
  • Emotional Needs: Usually we are using an eating disorder to fill a need. Find out what your "hunger" is really about and then find a way to get the need met. For example, if it's a partner you crave, ask yourself: "What would the partner do for me that would make me feel better?" The answer could be nurturing, in which case you’d want to focus on comforting yourself. Or ask yourself, "What do I want?" If the answer is to be thinner, then dig deeper to ask what that really means. If your answer is "I would like myself better," then you need to work on self-esteem and self-acceptance and separate it from the weight issue.
  • Boundaries: Many times our eating disorder is a protection to keep people at a distance. Take an assertiveness class. Setting limits and saying no can feel terrifying at first, but the more you practice, the easier it gets.
  • Spirituality: Find purpose; do things that help you find spirit, hope, and connection. It's too easy to get distracted by work, media, and material things. What really matters is love and life.
  • Service: Volunteer, get outside of self, and help others with eating disorders.
  • Fun: Make plans for the weekend! Allow yourself to have fun. Staying home and isolating is a breeding ground for an eating disorder.
  • Creativity: Do something where you feel you shine—but allow yourself to suck at it too. Let go of perfection.

Recovery is one of the hardest things you will ever do in your lifetime, but well worth the effort.

 

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