Recognizing Eating Disorder Relapse:
What to Know and Do
Tammy Beasley, RDN, CEDRD, CSSD, LD
Vice President, Clinical Nutrition Services
Recovery from an eating disorder is the hopeful focus that holds your client on the long journey of inevitable twists and turns often involved in the process. Recovery from an eating disorder is the belief that you as a clinician hold as true, attainable, and the primary reason you are committed to this work. When recovery holds all the hope and purpose for the investment of time and energy that you and your client have both made to get there, it is sometimes hard to see the small signs that can reflect your client’s increasing struggle to stay the course.
Learning From Lapses
Recovery is never “perfect” and will include lapses of thoughts and behaviors. Your client may have to learn that a “lapse” itself is not an automatic “relapse.” Your client needs your support and experience to see that temporary lapses are not failures as they offer important opportunities to translate recovery into real-life language. The work of eating disorder recovery includes learning from lapses. It is when the lapses become more frequent and the willingness to disclose and discuss these lapses becomes less frequent that a potential relapse requires honest reflection.
Recognizing Eating Disorder Relapse
What do you need to know to recognize eating disorder relapse? Every individual will have a unique recovery story and as the treating clinician, you offer a safe space, a shame-free mirror, that can most accurately reflect symptoms and behaviors needing attention. Some of the general signs that may indicate a risk of relapse include:
- A pattern of missing or rescheduling appointments with you and others on the treatment team
- A shift from the eating plan that your client was following during the early stages of recovery
- Eliminating a new food or progressive elimination of foods from a specific food group based on social media advice or community pressure
- Avoiding social meal outings due to discomfort from eating in public or fear of the menu regardless of social support available during the outing
- An increase in rigidity around eating patterns, including rigidity around the recovery eating plan itself due to fears of making mistakes or too much dependence on “the plan that worked”
- Signs of withdrawal or depression in both independent and social situations
- An increase in time spent perusing social media
- An increase in conversations comparing body or food behaviors with others
- Signs of an increase in a behavior pattern that may reflect a transfer of “addictions” such as more frequent shopping trips or package home-deliveries
- More frequent participation in group exercise classes or individual exercise in general
- An increase in “mirror checking” or trying on clothing previously worn during the active eating disorder days
- A pattern of missing small but cumulative “daily life skills,” like buying groceries, paying bills, walking a pet, self-care appointments, doing laundry, etc.
- A pattern of missing prescribed medications, whether from forgetfulness or avoidance.
- A change in personal hygiene as an indication of isolation, depression, and apathy
- A significant change in body weight in either direction compared to usual weight range
- A lack of focus on work, including an increase in missed days on the job
If your client is showing one or more of these signs, it is worth reflecting on the consistency of any individual patterns as any of the above, standing alone, may not be more than a temporary transition back into the real world as a newly recovered individual. However, patterns, or an accumulation of signs over time, may warrant closer observation and a compassionate conversation about the possibility of relapse.
Lapses and Relapses Are Not Failures
At Alsana, we are here to support you and your client through every stage of the recovery journey. For some clients, that may include multiple re-admissions to a higher level of care or frequent transitions between levels of care. Frequency does NOT mean the loss of hope in full recovery as research tells us that breaking the chains of an eating disorder can require several admissions into a higher level of support before full recovery has been reached. Every lapse, and even a relapse, is an opportunity to learn more about the underlying thoughts and behavior patterns that your client has used to survive and cope with life in the moment – and any opportunity to recognize and confront hurtful thoughts, beliefs, and behaviors within an empathetic, supportive and safe environment will strengthen the very foundation on which lasting recovery is built.
Here to Help
The eating disorder professionals at Alsana are here to help your clients achieve full recovery from the eating disorder. If you’d like to discuss whether our services may be right for your client, give us a call at (855) 915-0213 or learn more here.