Oct 14, 2022
I’m Worried My Loved One Might Be Having an Eating Disorder Relapse
There is a common misconception that people can never truly recover from an eating disorder or that they are destined to relapse. It’s true, the risk of relapse can be significant: the numbers vary depending on which study you look at, but research suggests that up to 50% of people in eating disorder recovery relapse within the first few years of treatment. While the statistics can be disheartening, it’s important to know that true healing is possible. To help your loved one get there, it’s essential to understanding relapse risks and warning signs — and be prepared to intervene.
Relapses can happen any time, but we know from research that the first year after completing treatment is the most vulnerable period for patients, with the relapse risk generally decreasing over time. In addition, certain , can be common triggers for relapse. Some of the most vulnerable times for relapse include:
- Starting or returning to college
- Beginning a new job or graduate program
- Getting married
- Surgery, particularly oral surgery, such as wisdom teeth removal
- Weight loss for reasons not related to an eating disorder (illness, grief, medication, increased activity, etc.)
- Death of a loved one
- Loss of a friendship or romantic relationship
- Traumatic events
If you’re concerned a loved one may be experiencing a relapse, that worry can sometimes be a sign in itself — even if you can’t put your finger on a specific behavior or red flag. Family and friends who’ve supported someone through eating disorder recovery talk about developing a “spidey sense” that the eating disorder may be active again.
The same can re-emerge during a relapse, as well as relapse-specific warning signs. These may include:
- Deviating from the post-treatment plan (specific to relapse)
- Looking back at the eating disorder with fondness (specific to relapse)
- Secrecy around food or exercise (While secrecy is also a sign of the onset of an eating disorder, the secrecy that develops with a relapse may be more pronounced, as the person struggling knows that most of the people around them are aware of their eating disorder history and treatment plan.)
- Weight loss
- Lack of expected growth in children and adolescents
- Skipping meals
- Avoiding eating with family or friends
- Following new “rules” about eating
- Wearing baggy or oversized clothing
- Evidence of purging behaviors (e.g., using the bathroom after meals, excessive exercise)
- Changes in mood, such as symptoms of depression or anxiety, or signs of euphoria
If you notice warning signs of a relapse, . It’s important to share your concerns with compassion and a nonjudgmental tone. Your loved one , despite the evidence of relapse being clear to you. Their eating disorder may lead them to vehemently deny there is a problem, or they may realize what’s happening but refuse to acknowledge it due to a sense of shame.
Expressing your unconditional love and willingness to support them can go a long way toward encouraging a continued recovery journey. Practical steps, like offering meal support and scheduling appointments with medical and/or mental health care providers, will help you both feel steadier as your loved one resumes focus on healing.
Some patients and families prefer, when possible, to continue care with members of their prior treatment team; others find it necessary or helpful to start working with someone new. No matter what the next stage of treatment looks like, having your loving support can make all the difference.
It can feel overwhelming to consider starting treatment again. It makes sense to feel grief and fear at the thought of returning to the hard work of recovery. The good news is you aren’t usually starting over at square one — this time, you have a lot more skills, knowledge, and resources than you did before.
So while it may feel like “starting over,” both patients and their families are often more equipped to handle the challenge. And for those who didn’t have sufficient support during prior treatment, a relapse can be a time to gather additional professional and social support for recovery.
Sometimes it’s difficult to tell if someone is experiencing a temporary struggle or is on the path to a relapse. A lapse, a brief or isolated return of eating disorder behaviors, does not always signal the beginning of a relapse but could indicate the need for more skill-building and support.
It can be helpful to remember that recovery isn't linear; it's common throughout the weeks, months, or even years of recovery to occasionally have periodic returns of eating disorder thoughts or behaviors. It’s unrealistic to expect that recovery means always feeling happy or never having an eating disorder thought. SWe should expect that these challenging moments will happen, and understand that experiencing these emotions, thoughts, and urges is normal.
What matters most is how someone responds to these challenges when they come up. Do they respond by acting on these thoughts or feelings? Or do they use skills they learned in treatment or reach out for more support? The former signals an inability to bounce back from these moments, and could turn a lapse into a relapse..
Encourage your loved one to be kind to themselves and remember that no one is perfect, and recovery certainly isn't perfect — nor does it need to be. Even those without eating disorders have bad days. A lapse doesn't have to lead to a full-blown relapse. Instead, a lapse can be an opportunity for your loved one to use skills, reach out for support, and learn what they need to be more resilient going forward.
The first step in lowering the risk for relapse is reaching a solid recovery rather than what many call “partial recovery.” Partial recovery often means the patient has a significant reduction in symptoms or an improvement in nutrition that resolves medical complications (such as orthostatic vitals, bradycardia, or amenorrhea) but they still feel burdened with eating disorder thoughts and behaviors that interfere with their life. Some families describe partial recovery as “surviving,” while full recovery is “thriving.”
Patients in partial recovery may have a lot of rules around eating, anxiety around certain foods, fear of weight gain, and/or body image concerns. Often these patients have restored some weight but may not be at a ; research indicates that a . Other patients may have reached a recovery weight range but still feel beholden to the eating disorder’s “rules” around foods, exercise, or body size; .
Recovery is hard work that takes time and a lot of patience; it’s tempting for patients and their families to want to pause or be done once the worst is behind them. Without sufficient support to continue challenging the eating disorder, however, patients in partial or are at increased risk for a full relapse.
Even patients in a state of robust recovery still benefit from having a , or a written document co-created by a patient, their treatment team, and any family or friends supporting recovery. This plan is developed in preparation for discharge from treatment and addresses the following key areas:
- Anticipating potential triggers
- Having coping skills and strategies in place to manage stressors
- Knowing where to go for support
- Identifying signs of relapse
- Defining when a return to treatment would be necessary
In a world that is constantly sending messages that sound like eating disorder thoughts (“eat less, move more”), it can be challenging to stay in recovery. With the support of a treatment team and loved ones, however, patients can develop a relapse prevention plan that sets them up for a strong and resilient recovery.
Equip is a virtual eating disorder treatment program helping families recover from eating disorders at home. Equip’s holistic, data-driven, gold-standard care program is delivered by a team of five care professionals, giving families confidence they’re providing the best opportunity for progress and lasting recovery.