What causes an eating disorder relapse?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Photo courtesy of Pixabay.com

Can we predict who will have an eating disorder relapse?

People who work in the recovery field are struggling to figure out how relapses on mental health issues are like and how they are different from relapses involving substance abuse.

Eating disorders are a strong example of that difference.

With substance abuse, most authorities think any return to using or drinking constitutes a relapse. Some authors have tried to differentiate a “Lapse,” a single case of starting to pick up followed by a decision not to return to active use, from a relapse.

Most recovering people are uncomfortable with the idea that any case of picking up can be excused. Rule one for their recovery is “Don’t pick up.” Still, if you do relapse the sooner the return to recovery behaviors the better the chances.

With eating disorders we understand everyone needs to eat, many of us may worry about our weight and sometimes do something excessive to control that weight. To be a relapse on an eating disorder we think we need to see not just one incident but a return to the overall pattern of bad relationships with food.

That part of an eating disorder relapse is similar to relapse to other disorders. The relapse begins before picking up or purging behaviors. It begins with changes in thinking and failure to maintain your recovery.

Four key factors appear to predict who will have an eating disorder relapse (Per McFarlane et al 2008.) These factors may have an application for other mental health challenges.

1. How bad was the eating disorder before treatment?

The more severely affected the person was the more it will take to change those behaviors. People who have been starving, binging, or purging or even overeating for decades do not become cured overnight.

They may make significant progress in a short period of time but they will need a lot more time to consolidate those improvements if they have had the disease for a long time and the symptoms have gotten severe.

2. Higher level of eating disorder symptoms at end of treatment.

This makes intuitive sense. Someone still running a fever is at more risk than someone whose temperature has returned to normal to relapse into a physical health crisis.

The more the urges and cravings, the harder it will be to continue on the path to recovery and not lapse back into old behaviors.

Sometimes professionals are in too much of a rush to fix people and we may send them out of treatment before they are ready. With eating disorder symptoms the more there are and the larger the symptoms are the more the risk of relapse.

Pressure from managed care systems to cut costs is one source of the rush but there are others. Patients want to get this over with and get home. They often think they were cured when the professional known the symptoms are not even all gone yet.

3. Slow response to treatment predicts an eating disorder relapse.

Clients who enter a 28-day program need to hit the ground running. There is no time to waste. Unfortunately many are still not sure they want to change or that they really have a problem. In drug treatment, it is not unusual for clients to avoid treatment for the first thirty days. Somewhere along the way, they see others getting better and they want that result for themselves.

Eating disorder clients who do not start to make progress until three weeks into treatment will not be better, regardless of what that scale says, at the end of the 30 days.

Clients who are slow to respond to treatment need longer to consolidate gains and they are at a higher risk of relapse which means they need more support as the treatment frequency decreases.

4. Higher weight-related self-evaluation predicts relapse.

When your idea of your self-worth is based on an outward characteristic, like weight, it is hard to give up any control over your eating no matter how slight the risk.

This whole area of self-evaluation is a cause of a lot of mental illness and just plain unhappiness. Learn to like yourself for who and what you are inside and anyone who only likes you for your outward appearance is not worth your time.

Selling people things is big business. Sell people on the need to have and eat certain foods, sell them on the joys of eating large and high-calorie foods, make extra fat a standard menu item on fast food menus and you will make money. Then when we get done selling you high-calorie food we tell you it is your fault that you have gained weight.

Don’t buy the yo-yo. Learn to eat healthy in the first place but accept that no one keeps that elementary school figure without giving up a lot of life.

There is a whole lot more inside you than what will show on the scale. The secret to happiness is in keeping your life in balance, not in winning the prize for self-deprivation.

People who think their self-worth is all about their weight will never get happy. Get happy first and you will like yourself regardless of your weight.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

4 thoughts on “What causes an eating disorder relapse?

  1. Hi David,
    I have nominated you for the Readers apprecation award! 🙂
    Your comments have guided me through thick and thin, I am grateful to have your advice so readily available. Thank you.



Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.