Eating
Disorders
Dealing with an
Eating Disorder Relapse
by A. David Wall, Ph.D., Director of Psychological Services,
Remuda Ranch Programs for Anorexia and Bulimia
Although complete recovery from eating disorders is possible, many
experience slips and relapses during the recovery process. A slip is a once or
twice, perhaps occasional, return to maladaptive behavior. A relapse is a
complete and longer-lasting return to the behavior or worse. In a relapse,
someone with an eating disorder would be back where she was before she entered
recovery.
The best way to deal with an eating disorder relapse is prevention. Those in
recovery need to identify risky situations in advance. A suitable analogy is
black ice. When a driver encounters black ice, she skids out of control. Yet,
if the driver knows where the black ice is, she can take precautions by going
slower, driving more deliberately, or taking another route. For women and
adolescents recovering from eating disorders, black ice is anything likely to
trigger the eating disorder. Triggers are highly individualized. Often, but not
always, they are the same situations and experiences that caused the eating
disorder in the first place. Identifying these risky situations in advance
allows the person to strategize how she will cope with the thoughts and
emotions associated with her trigger situations.
Even with rigorous planning, slips may occur. If so, it is important for the
individual to understand why the slip happened. Using a behavior chain
analysis, she can identify the links in the chain-the events and her
reactions-that led to the unhealthy behavior. She can process what happened
step by step, understanding what transpired in her mind and emotions at each
step. With this information, she may not need her eating disorder when
encountering the same situation in the future, because she can break the chain
with different, pre-planned choices.
If relapse occurs, the individual can:
- Be hopeful and choose recovery again.
- Acknowledge her behavior is destructive and will damage her life now and in
the future if she chooses to continue.
- Seek help from a healthcare professional.
- List the pros and cons of returning to the eating disorder. This list can
re-establish the value of recovery.
- Talk to someone rather than choosing the eating disorder for support.
- Think about her accomplishments and what she will lose with a relapse.
- Identify goals and activities that relapse will prevent.
- Set small goals that can lead back to recovery, and congratulate herself
for every success.
- Acknowledge that although her eating disorder has advantages, she already
knows of healthier and less dangerous ways to obtain these same advantages.
- Remember her personal rights-the right to say "no", to express
her feelings and opinions, to ask to have her needs met.
- Start a journal to help her identify feelings, internal messages, and
triggers leading to the relapse.
- Let go of faultfinding, blame, guilt, and shame. Focus on the present and
what she can change today.
- Ask her Higher Power for guidance.
Parents and spouses can also help during eating disorder relapses by
speaking to their loved one with truth and love. The dialogue takes place in a
nonthreatening environment. Confrontation must always be preceded by listening,
understanding, and validation. Validation comes through words such as "I
love you and am really proud of you," or "I know how difficult this
is for you." Confrontation without validation is perceived as an attack
and the person will retaliate or withdraw.
When addressing the relapse, cite actual behavioral examples to prevent
denial. Present the facts using supportive statements, such as "Help me
understand what's going on," or "Obviously this fills a need; how can
I help?" Encourage the person to seek renewed treatment.
In case of self harm or imminent death, take action-up to and including
legal action-to ensure the person receives the help she needs.
Professionals specializing in eating disorders can be located by
contacting
Remuda Ranch Programs for Anorexia and Bulimia at
1-800-445-1900.
This article is part of a continuing series of monthly columns. To be
notified of updates, please sign up for the
HealthyPlace.com Eating Disorders Community Newsletter.
Other column's include:
Concerned about whether you might have eating
disordered behaviors?
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Attitudes Test.
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