If you haven’t got a team to help you build a relapse prevention plan, start with mine.
Tanya was 14 when she developed an eating disorder. A few months later she was admitted to a residential treatment program and upon returning home did outpatient treatment with a therapist, dietitian and her doctor for the duration of high school. Tanya went off to college stable in her recovery. She met a few times with the local therapist and dietitian, but felt like she was managing well enough on her own. The relapse didn’t happen all at once. It gradually and subtly occurred over time. By the end of her sophomore year she was back in the throws of the eating disorder and knew she needed help.
This story is so common, where someone is in recovery from their eating disorder for a period of time and then relapses. It may be after weeks, months, years or even decades. Sometimes, the relapse is sudden and obvious, and other times it is gradual and covert.
Remember this: There is no shame in relapsing. You did not do anything wrong. You have not failed.
Relapse is a common part of the recovery process. In fact, sometimes relapse is a blessing in disguise because it comes with gifts of wisdom. It is often a signal that you have needs that aren’t being met.
Here are 5 key steps for getting back on track:
1. Acknowledge that you have relapsed and need help. This may be the hardest thing to do, so give yourself compassion.
2. Seek professional support. Get back in with your treatment team, or connect with a new treatment team, as soon as possible. This means therapist, dietitian, and medical doctor. You need these professionals to assess the situation and guide you. I know it sounds like a lot, but they all bring a different perspective to the table.
3. Get on a meal plan. The meal plan is the glue that is going to hold your recovery together. It not only gives your body the physical nourishment it needs to function properly; it also gives your brain the fuel to think clearly and manage your emotions. Right now the food is literally your medicine — which is ironic when it is also the thing the eating disorder is most afraid of. Talk to your dietitian about these fears. She or he will help you come up with a meal plan that safely meets what your body needs right now.
4. Be curious. Relapse is usually the symptom of more fundamental problems in a person’s life. The eating disorder swoops in as a coping mechanism. What are you coping with? What are you feeling and needing outside of anything related to food and weight? Don’t judge these needs, just notice them. It’s also ok if you aren’t sure what your needs are right now. Your therapist can help you with this.
5. Be open. Trust that your team has your best interests in mind and wants you to be happy and healthy. Be open-minded to their recommendations. They may recommend a higher level of care, such as intensive outpatient (IOP) or inpatient/residential treatment, depending on the severity of your symptoms. They may recommend taking a break from things such as work or school.
6. Be aware. Keep in mind that part of what caused your eating disorder in the first place is an underlying genetic predisposition or susceptibility to the illness. You will always have this because you can’t change your genetics. Be aware that you will be vulnerable to relapse for the rest of your life, and this means you must be on the lookout for signs of relapse. It is so much easier to get back on track the earlier you catch yourself slipping.
Relapse happens. Give yourself grace and compassion, and get back on track. Recovery is worth the effort.
Katy Harvey, RD is a Certified Eating Disorder Registered Dietitian (CEDRD) from Kansas City. She has an outpatient private practice where she helps individuals heal their relationship with food, exercise and their body. She also blogs at Katy’s Blog.
Pushing Through the Final Phases of Recovery
I haven’t written in a while, you might have noticed. I relapsed, and I was too ashamed to admit it here.
It was a quick, steep backslide, and the trigger was very specific: I weighed myself. I went home for Christmas and encountered a scale. I thought I could handle the number. I couldn’t.
I freaked out. My nutritionist dissected my meal plan in order to show me I wasn’t eating excessive amounts. We discussed the natural fluctuation in weight that bodies undergo. We even discussed weight loss and how it’s not necessarily eating disordered for people to decide to lose a few pounds — provided that there is an actual goal in mind, you don’t lose weight despite having no physical resources to spare, and you don’t withhold nourishment your body needs.
Looking back, I realize no one actually gave me a green light to lose weight. We were only speaking theoretically. But all I heard was “not inherently a problem…” and off I went.
Do Not Underestimate a Relapse
The severity of an eating disorder is never undone. Every relapse brings you right back where you left off, and so you resume the old behaviors and then go a little further. The good news is that recovery, too, is never undone. So, each relapse is just a little bit easier to bounce back from.
But that’s why relapses can be quite dangerous — you think that you’ll “just skip that one meal,” or do whatever it is that your eating disorder demands, and it’ll be no big deal. Or you think that the consequences can’t be THAT BAD, because my god, how many times have you done that before? Why would this time be any different?
(You can hear the eating disorder in all that “reasoning,” right?)
Eating disorders don’t work like that. Your body doesn’t work like that. Even if you think any damage you might inflict will be minimal, your body nonetheless suffers from the cumulative effect of years of abuse.
Long story short, my treatment team didn’t waste time waiting for me to see the light. A plan was promptly put in place to begin a meal support program at Columbus Park Collaborative alongside bi-weekly medical management (blood draws, weigh-ins, heart monitoring, and so on).
That is what I’ve been doing for exactly one month today.
30 Days Symptom-Free: I Feel… Better?
I feel a bit apprehensive saying this, but… I am doing so much better.
I don’t just mean “better” in terms symptom reduction, because lord knows I’ve beaten symptoms into remission before. Something feels different this time around. Something is working. The insights, the skills, the goals, and so on have abruptly started to make sense to me. Finally, after two and half years, the recovery behaviors that I’ve been studying and practicing feel less like awkward, isolated gestures, and more like one cohesive movement.
Or maybe — to use a more personally meaningful metaphor — it feels like finally understanding a foreign language. I’m moving from merely memorizing vocabulary and grammar to speaking more freely and fluently. The words no longer feel as awkward on my tongue. Sometimes I even manage to think in this new language.
I’ve had important insights these last few weeks about my own journey and how the eating disorder functions in my life. There’s too much for one blog post. But I will note that I can think of at least one difference between this time and all my other treatment/recovery attempts. It has many names among the various recovery communities. I’ve heard it called surrender, as well as trust. But I’ve been calling it “faith” — an unusual word choice for me, since that word is laden with a religiosity that I’m not actually applying here.
Whatever one calls it, it is absolute faith in the process. It is the final (I hope, anyway) acknowledgment that my way does not, never has, and will not ever bring me inner peace.
It is the belief that there is some other, better lifestyle beyond the one I’ve been inhabiting.
Most important, it’s the recognition that I can access that desirable lifestyle, but only if I start doing things radically different than I’ve been doing them. This means eating meals and snacks, reaching out for help even when it feels uncomfortable or intrusive, and being curious instead of neurotic about my own feelings.
It means facing every fear every time because that’s the only way I’ll surmount them.
What Comes After Anorexia?
This sounds overwhelming — and sometimes it is — but, ironically, this approach has become for me the wall that protects me from past failures and future fears. It makes me so hyper-focused on doing the next right thing that I am able to put aside any and all thoughts of failure.
Keeping that intentionally nearsighted faith allowed me to battle through that initial, panicked period of contravening old habits and behaviors and forcing myself to go against my own inclinations. And that’s what I did — I went against every urge, every time. No exceptions. And believe me, that was really-really-really-effing-hard. But I did it.
Apparently, there is indeed another, much nicer, side to that experience if you don’t quit halfway through.
Perhaps it is because I’m realizing that there isn’t much more my eating disorder can threaten to take away from me… things can’t get much worse by trying all that I’ve been afraid to try in recovery. So, I’ve entered this space in which I’ve given myself permission to keep doing the “recovered” thing to do, with the reasoning that I might as well give this my all and worry about what that means when and if it comes to that.
I’m not sure I’ve ever done that before, given that I’m finding myself in this pleasantly unfamiliar space. It’s a little quieter here, a little more hopeful. Perhaps this is what’s just past the halfway mark of the middle ground.
Perhaps that’s what it takes to make that extra push forward: single-minded, unrelenting faith in the process you’ve been taught.
I’ll let you know, I guess.
Joanna Kay is a New York City writer and social media professional in recovery from a 14-year battle with anorexia. She is the author of The Middle Ground, a blog that chronicles the period between completing treatment and reaching full recovery. Having encountered many hurdles accessing treatment, she also writes frequently about insurance coverage and other urgent issues facing eating disorder patients. Joanna is a mental health advocate with the National Eating Disorders Association and writes and speaks widely about the recovery process. Visit her blog.