by therapist Sarah McMahon
Preventing and managing relapse is a crucial- and often overlooked- aspect of recovery.
Firstly, a few truths:
- Lapses are inevitable. I have never known anyone to recover from an eating disorder without the odd lapse. Further, I would be quite worried if someone recovered without any lapses! This is because lapses are the opportunities that help you build your capacity to recover.
- Lapses and relapse does not mean you have failed. However what you do with a lapse or relapse is important- how you make it count towards your recovery. In particular, lapses are a great opportunity to learn from. Often you learn far more from a lapse then from when you are “going well”.
- Lapses are an awesome way of building the “recovery muscle”. Having lapses, particularly while you are in treatment, helps ensure you are equipped for lapses further along recovery.
- Lapses are different from relapses. Lapses are more or less a “slip up” where as a relapse is multiple slip ups over a sustained period of time. Both require the same strategy of going back to basics to get back on track. This may include [re]engagement in therapy.
- Expecting and preparing for lapses is vital in the recovery process.
- It is very normal for clients to reengage in treatment periodically after discharge to manage lapses & prevent them from becoming relapses.
- Remember- recovery is a non linear process. It takes place over a long time, usually a series of years. Once you have started this journey you can never go back to the beginning- you will have learnt too much about the eating disorder & recovery.
How do I know if I, or a loved one, is relapsing?
There are many signs that indicate relapse. Some signs that you can look for are:
- Your mind keeps going back to weight, dieting, and food items.
- You have not been truthful about your disorder with your therapist, nutritionist or doctor.
- You feel that you are losing control.
- You start feeling hopeless again.
- Your body shame increases.
- Your focus returns to weight rather than health- this may mean a “weight loss at any cost” belief system remerges.
- You keep checking your weight or keep looking in the mirror- ie increased body checking behaviour.
- You secretly start to skip or reduce meals.
- Your relationship with exercise starts to change to something that is more compulsive or rule based.
These symptoms may inform you that you might lapsing. This is when you need to start taking action and work towards steps to prevent the relapse. Some steps that can be followed are:
- Tell someone.
- Listen to your “healthy self”- honor these thoughts and feelings.
- Practice techniques you have learnt in treatment such as meditation, mindfulness, and cognitive behavioural therapy.
- Re engage in therapy if you are no longer participating in it.
- Focus on the functions of the body, rather than how it looks.
- Eat mechanically again until it is safe to practice intuitive eating.
Most importantly, it is important to consider reengaging in treatment to help you to “get back on track”.
Planning for relapse
Relapse prevention is basically about being aware of the possibility of lapses, having the skills & capacity to reframe a lapse when it occurs and utilising skills you have learnt along your journey to health. I recommend planning for relapse through completing a relapse prevention plan, which helps you take stock not just of skills you can utilise, but identify when you should put these plans in place and understand your triggers: you need to examine what triggers.
It is also vital to revisit the many reasons why you chose to leave the disorder behind initially. These reasons may change with time & recovery, however often they include:
- No longer having to live a secret life.
- Wanting to rejoin the world (physically, mentally, and emotionally). This helps to leave behind the isolation.
- You begin to feel peace.
- Being able to maintain and form quality relationships.
- Taking pride in your image and feeling comfortable in your skin.
- Enthusiasm about activities such as school and work.
- Having more energy to carry out daily activities.
- No longer feeling guilty for upsetting your friends or family members.
- Realising you are the only person around you who actually isn’t happy.
Relapse is usually a rocky road because at times you may step forward and sometimes you may take a step back. There will be many times that you fall back, but that does not matter. It is how you pick yourself up from these that counts.