I’m not sure if I’ve ever relapsed during recovery, because I don’t think I was ever committed to recovering until we started Not Plant Based. A “relapse” to me, back in the midst of my eating disorder, would mean “failing” at the latest diet plan or lifestyle I’d embarked on in order to “fix me”. Only as soon as I learned that I didn’t need fixing after all did I begin to recover, and at the risk of jinxing myself…I haven’t relapsed yet almost two years down the line. Sure I’ve had days where I consider how much easier it might be to just throw up that large lunch, or on days when I feel unattractive I consider losing a few pounds, but the difference now is that those thoughts don’t stick around for more than a few moments after I tell them to clear off.
It’s difficult to define what exactly a relapse is, as the experience of having an eating disorder varies from person to person, but performance and eating disorder dietitian Renee McGregor explains it here a lot clearer than I ever could:
“A relapse is when someone who has started the road to recovery from an eating disorder may gradually return back to previous ‘coping’ and restrictive behaviours. While it might not be immediate, it could be that the individual becomes complacent and doesn’t initial notice they are starting to cut back; or it could be that they decide to go on a new nutrition or fitness trend that causes eating disorder mindsets and traits to reappear. They may start to appear more anxious and withdraw from social engagements as they once again become fearful of what food may be served to them. They will probably start to fixate and allow their life to revolve around food and body image again.”
My own recovery story has hardly been smooth sailing. I spent five years as a raging bulimic, knowing I had a problem but not seeing any sort of way out; two years after stopping purging was spent battling with binge eating disorder and hating my body; then about a year was spent pretending I was recovered by “managing” my weight through veganism, restriction and a mad phase of going to a gym I couldn’t afford six days a week. Not Plant Based lay bare all the remnants of my eating disorder I’d been pretending weren’t still affecting me, and allowed me to be honest with myself about what would make my mind and my body happiest, and that was to eat whatever the hell I want, whenever the hell I wanted, and to try my best to love my body as it expanded in size – albeit minimally, really.
I understand that not everyone with an eating disorder will have been lucky enough to discover Not Plant Based to help coax them along in their recovery, and so relapse may be a very real thing that they have had to contend with, or will have to in the future. So, I’ve worked with Renee to create a piece that might help put relapsing into perspective, offer advice for if you do relapse, and consider the idea that to relapse isn’t necessarily a bad thing.
How common is it for people to relapse during eating disorder recovery?
(The answer to this question comes with help from the National ED collaboration, Australia.)
While many people with eating disorders will encounter a relapse or recurrence as they recover, those who display certain risk factors may be more likely to relapse during the process of recovery.
When considering how likely relapse and recurrence will be, the below should be taken into account:
• The amount of time the person has been living with the eating disorder; the longer the duration of the illness, the higher the chances of relapse
• The age of the person at the onset of their eating disorder; the older the person is at the time of onset, the more likely they are to relapse
• Whether the person has been treated in a general hospital/clinic or a specialised eating disorder clinic; patients who are treated in an eating disorder clinic are much less likely to relapse
• Whether the person carries out excessive exercise, even after recovery is complete
• Whether an increased focus or recurring concern with body shape and weight is present, even after recovery
• Low self-esteem or poor ability to interact with others
• The occurrence of negative and stressful life events
In addition to the above risk factors, there is also evidence that relates to people suffering from Anorexia Nervosa. The following risk factors have been associated with relapse for a person with Anorexia Nervosa:
• Lower per cent body-fat in recently weight-restored women
• Lower desired weight (when a person wishes to be a lower weight even after recovery, there is an increased chance of relapse)
• Consuming an overall diet of lower energy density or a limited variety of foods
Is there a danger of people not realising they have relapsed or not wanting to admit it? For example, because they look “healthy”, but are still dieting to lose weight?
Renee responds: “Personally the biggest danger I see is either when someone who has previously had an eating disorder becomes involved in a new sport. We know these individuals are not very good at being average at anything, they need to be the best so instead of seeing sport as something that is fun to participate in, suddenly it becomes – I have to be qualify as a professional triathlete or I have to do a sub 3 hour marathon or I have to become an ultra runner. So they basically exchange one extreme behaviour (not eating) to another (excessive exercise). While this may work for a while, the difficulty occurs when they become injured or ill and can’t train because then the wheels really do come off. Only then do they fully appreciate that they still have an issue with food as they can’t eat as they are not training; or the fear of putting on weight becomes a huge cause of anxiety.
The other time it is an issue is when the “recovered” individual decides they are going to take up a new food trend such as veganism. It is an easy way to disguise a restriction but it gives them a legitimate reason to avoid foods. In these cases, though it hardly ever stops at just become a vegan, it is often also associated with also being sugar free and gluten free and so they become more and more deficient in valuable and important nutrients.
In both these examples, the individual may not be aware they are having a relapse as the eating disorder mindset and behaviours are manifesting in a different way but fundamentally, both examples will be detrimental to long term health in exactly the same way as an eating disorder.
We know that an eating disorder develops when an individuals is unhappy with their sense of self, so often their “success” is defined by a number: weight, calories, clothes etc. Until someone can be truly free of this and are able to accept themselves for who they are not what they look like or how they perceive they are seen, they will be at risk of relapsing in some way or from as they are not fully recovered.”
What can help people avoid relapsing during recovery? Any tips?
Renee says: “I think when people are in recovery they need to understand the pitfalls of recovery. They need to know that it is hard and sometimes you will take 3 steps forward and 5 steps back. They also need to know that not everyone’s ideal weight is a BMI of 18.5. Some individuals, due to their genetic makeup may actually need to be a BMI of 20 or above. In fact, studies do show that those who are less likely to relapse are those who do reach a restored BMI of 20-21.
It’s also important to understand that there is no method of controlling how or where weight restoration happens. For many, especially those who have been a very low weight, they can seem to “fill out” in their face and around their trunk to start with. Please, please remember this is TRANSITIONAL! Once the body’s metabolism returns to normal and the individuals can once again regulate, weight will also redistribute more evenly, but the body has to be confident that the threat of starvation has disappeared. The more you try and control your intake and restrict because you “feel” like you are putting weight on too quickly or you “feel” like you are eating too much, the longer it will take for your body to regulate and the more confused it will stay.
It can take anywhere between 12-24 weeks post weight restoration for the body to regulate but this restored weight must be maintained.
Finally, just because you reach your restored weight, it does not immediately mean that you will think differently – again this takes time. MRI studies have shown that it can take up to 5 years post restored weight, if this has been maintained, for brain changes to be completely rectified. Getting to your restored weight is vital to ensure that you can then start to change your mindset, be able to rationalise and challenge your eating disorder behaviours.”
How can you deal with a relapse practically?
Renee explains: “I think it is important to highlight that not all relapses should be seen as a sign of failure. Recovery is hard and many individuals will relapse. It’s important that the relapse is stopped in its tracks early on and the individual can learn from it. Perhaps they can identify what triggered those emotions and feelings that lead then to wanting to restrict their intake again.
I find with the clients I work with, once I’ve explained to them how it all works, so they understand that the reason they are so fixated on food and body image is not really about food but actually about what is going on within them but they just can’t face dealing with these emotions and fears, it becomes easier to identify when there is something bothering them. For example, once they start to recognise that they are becoming fixated on food or their body image, instead of acting on it, they start to learn to question why. Most of the time it is related to an experience they have had that has caused their sense of self to be questioned. They may have felt criticised or disapproval and because these emotions are uncomfortable, they turn to their previous coping strategy of trying to runaway or restrict/obsess about food.
In terms of practicalities, don’t be afraid to ask for help. Many people do go backwards and forwards like a dance in recovery – it takes time but just because you have relapsed it doesn’t make you a failure. You just need to remind yourself of all the opportunities you are missing out on or avoiding due to your eating disorder. Only once you start to see the eating disorder as a punishment rather than a coping mechanism, can you really start to move forwards.“
The starting points for asking for help could begin with a visit to a GP, and asking for a referral to see a specialist, or if you have been in treatment before, speak to those who previously treated you for support. You could also contact the charities Beat or Mind for additional help. From personal experience, and from managing to come out the other side of a horrendous relationship with an eating disorder, it’s important to remember that there is a light at the end of the tunnel, and I am proof of that. Nothing feels as good as recovery when you’ve experienced such a traumatic thing as an eating disorder. You are brilliant and worthy of getting better, and a bump in the road doesn’t mean that you are a failure. Remember, everything will be okay in the end. If it’s not okay, it’s not the end.