When you are in recovery from an eating disorder, contemplating the eating disorder ever returning can feel just too much to think about. Hopefully, once you have beaten it, it never will return but doing all you can to prevent a relapse now and in the future is critical. Better too cautious than too complacent is what I say.
This is the third post on the topic of lapses and relapses in eating disorder recovery. The first post covered the concepts of relapse, lapse and pre-lapse and the second post provides common signs and symptoms that you are heading towards a relapse. This post is about how to prevent an eating disorder relapse. After all, prevention is always better than cure!
I will say that in my view, people who have fully (and not just partially) overcome restrictive eating disorders are at low risk of relapse because of the work, self-reflection and self-awareness they have gained during the recovery process. The knowledge gained about the risks of diet culture and why staying firmly out of energy deficit for life is so vital makes them much less susceptible to those risks and more resistant than most to diet culture’s messages.
But anyone with a history of a restrictive eating disorder will carry genetic susceptibility, meaning that the risk is always there for the eating disorder to return if exposed to the right combination of risk factors.
The biggest of these risks is re-entering a state of energy deficit but high levels of stress or emotion or facing a powerful old trigger can also be factors to reignite lingering eating disorder brain networks that have been lying dormant but not fully broken down.
Staying safely out of energy deficit for the rest of your life, not trying to manipulate or suppress your natural body weight or shape and embracing your curves will all go a long way to help to ensure you stay eating disorder free.
Therefore, initial advice would be that if you haven't yet made it to what might be considered a full recovery then for your best chance of long-term success at overcoming the eating disorder, keep aiming for overshoot and avoid taking on too many life commitments too soon so that your focus can stay where it’s needed.
The final stages of physical restoration to reach overshoot and let your body fully heal can be the most difficult but also the most critical.
Remind yourself that every stage of the process is as important as the beginning and maintain momentum until you are confident that your brain is fully reprogrammed and your body is settling at your healthy set-point level (having allowed for overshoot).
No shame
Before moving on to how to prevent a relapse, I want to make very clear that there's no shame to a lapse or relapse.
Unfortunately, a necessary part of the recovery cycle involves periods of relapse, learning from these times and going forwards more strongly. There's no shame to that so please don't berate yourself if the eating disorder has become stronger again, no matter how long you have been in recovery or how strong you thought you were in having defeated the eating disorder.
Ok, now that's out the way, let's move on...
How Do You Prevent an Eating Disorder Relapse?
Know the signs and symptoms of a relapse or lapse and act quickly if you notice anything! Understand your unique early warning signs and if you have even a tiny niggling feeling that things are heading backwards, take action.
Dont get complacent too soon…. Don’t tell yourself you are recovered when deep down, you know there’s still flickering embers of disordered thinking, even if you don’t currently act on them. Better to be cautious than overly confident and keep on the eating disorder bashing attack for as long as it takes.
Embrace anti-dietness and avoid diet culture. You can't afford to ever engage in dieting or weight loss endeavours so avoid that whole side of our culture and those tediously dull conversations, TV shows, magazine articles or social media content (unfollow is a thing!).
Avoid going back to exercise or movement for a very long time into recovery. My advice would be not to risk exercise until you are certain that you have done overshoot, settled for a reasonable period of time at your set weight, feel comfortable in your new body with no thoughts to manipulate it and feel confident that your brain is fully changed. Exercise is one of the biggest factors to pull people into a full relapse, even when they were very confident in their recovery. The brain takes time to fully embed the new, non-ED pathways and exercise can trigger those old pathways to rapidly ignite again if you risk it too soon. And if you are experiencing resistance to this advice, that in itself is perhaps a red flag.
Notice thoughts to manipulate your weight, shape, tone up or 'just cut back'. These should set off massive alarm bells which you silence by upping the food and rest levels significantly again.
Avoid getting too busy with anything. Over 90% of people* with eating disorders have compulsive 'busy-ness' making it difficult to be mentally and/or physically still. This compulsive need to always be doing something can feed straight back into the old eating disorder pathways that then lead back to a bit more restriction, old movement patterns or other disordered habits. Keep your life as calm as you can because being comfortable with down-time is critical for life!
Give yourself as much brain and life space as possible to consolidate your recovery for as long as necessary to ensure that you have the focus to continue to build and embed those new recovery positive brain pathways. This takes time. Give yourself that time.
Know your triggers, whether they are people, places, situations, types of weather or times of the year, clothes, certain jobs or anything else. Know what your triggers are, even from years ago and remain mindful of them. A trigger to the eating disorder is something that will instantly and sub-consciously pull you back to eating disordered thoughts and urges incredibly quickly, even when you had thought yourself to now be bullet-proof and immune. Avoid any old triggers that you can and establish ways to manage any that you can't avoid when you know exposure to them is inevitable.
Ask the people who know you well to raise any concerns they have if they notice anything sliding.
If people who care about you express concern, they are usually right. If you find yourself reacting with irritability to their concerns, they are definitely right! If people around you are worried, take some time to reflect with honesty on what's going on.
Stay honest with yourself and your support team. If you notice urges to lie to others about food, exercise, how busy you are or other things that could be considered eating disorder related, DON'T!
Remain reflective on how you are and what's occurring. Use journaling if that helps, adopt self-care measures and give yourself frequent down time.
Keep talking - talk to a coach, therapist or someone else in your life who gets it, while you continue to fully consolidate your recovery so that any slide is caught fast.
Life changes that will help keep you safe can be a good way forward. These can be in any area of your life to help to ensure that old habits don't slip back in. Yes, change can be hard and frightening but it can also be life-giving, leaving you wondering why you didn't do it sooner!
Times of immense stress in your life can put you at high risk, even when you are in a stage of what you might consider a more solid recovery. People who have been doing well in recovery can face a big life stress and only later realise that the eating disorder has crept back in and the timing to the relapse coincides precisely with the life stress. Just like any addiction, times of stress will be when your brain will subconsciously seek the best way it knows how to cope . If you have a bereavement, job loss, divorce or other significant life event, it might be wise to talk again to a coach or therapist just to keep you safe.
Test yourself regularly in a playful way against the eating disorder. What did you always resist the most? Perhaps it was a duvet day, staying on the couch with lots of food because you could. Hopefully, in recovery, doing things like that became ok, without giving rise to any eating disordered anxiety-based resistance. Therefore, test yourself regularly. Can you take a duvet day with a ton of "junk food" without anxiety or resistance? Great. If not, why not? Is the eating disorder creeping back?
Overall, trust your gut instincts in relation to your recovery. If something feels off when it comes to the eating disorder or you suspect old habits are reigniting then trust those instincts and do what you know is right but is likely to feel wrong (eat, rest, don't compensate!).
Finally, just to be sure... any urges towards weight loss, body manipulation or toning up should be met with doughnuts.
(*yes, that statistic is anecdotal)
What then do you do if you notice things are sliding or if the eating disorder has climbed firmly back into the driving seat?
The key advice would be to always, always go back to basics.
Act like it's day one of recovery because what you do on day one of recovery and what you do on day 1,001 of recovery is the same.
You abstain from restriction, abstain from compensatory behaviours, rest and aim for overshoot.
Keep your life as quiet and calm as possible to give you the mental capacity to focus and make the changes you need to make.
But also go back to what I said at the beginning. There's no shame if you have relapsed or lapsed in your recovery, none at all. So, please also ask for help.
No one is infallible with recovery. Relapses can and do happen for all kinds of reasons. Catch it early, go back to basics, use your support team and let this relapse be a blip and not another few years of hard slog!