It is not uncommon for eating disorder thoughts and behaviors to sneak back in sometimes, especially in the first year after leaving a higher level of care. Please know this is not a sign of failure! It happens because the recovery journey is not linear, and it is why relapse prevention must be an integral part of eating disorder care.
The goal of relapse prevention is to identify the specific thoughts and behaviors that, if/when you begin to engage in again, should be seen as an early warning that something is amiss—and that it’s time to reach out to your support system for help getting back on track before symptoms intensify.
Key Takeaways
- Relapse is not uncommon in eating disorder recovery, especially in the first year after leaving a high level of care.
- Changes in thoughts, behaviors, and routines are often an early warning sign to get help before symptoms intensify.
- Getting proper help early is crucial. It’s also important to move forward with structured support, not “rules,” punishment, or shame.
- If you are concerned about your safety, please seek emergency care immediately.
What’s the Difference Between a Slip and a Relapse?
A slip is a short-term return to disordered thoughts and behaviors followed by a course correction with increased support. A relapse is more intense and sustained, lasting long enough to interfere with day-to-day life and health. Whether a slip or a relapse, early intervention from professionals is key to preventing re-entrenchment of the eating disorder. Please remember: You deserve help!Common
Warning Signs of Eating Disorder Relapse
Warning signs of an eating disorder relapse aren’t only physical; they are also psychological (often appearing first), behavioral, and social. While relapse looks different for each individual—and the specific diagnosis and stage of recovery play a role—here are some of the most common signs:
Psychological
- Increased or intense thinking about food and body
- Perfectionism or “all-or-nothing” thinking
- Anxiety, irritability, or guilt after eating
- Feeling unworthy of nourishment or rest
Behavioral
- Eating less or skipping meals altogether
- Becoming inflexible with food routines or applying rules around food (e.g.; “I can’t eat that”)
- Increased secrecy around eating
- Purging, using laxatives or diet pills, over-exercising
- Frequent body-, mirror-, or weight-checking
Social and functional
- Increased conflict around food in general
- Isolating at mealtimes and avoiding group meals
- Isolating from family and friends
- Difficulty concentrating at school or work
- Skipping sessions with your dietitian, therapist, or doctor
Physical
Important: If physical signs are present, do not ignore; seek medical assessment.
- Notable changes in energy, strength, or overall functioning
- Mood changes or increased anxiety
- Stomach discomfort or pain
- Dizziness or fainting
- Fatigue or sleep disruption
- Cold intolerance
Why Does Relapse Happen?
Despite meaningful progress in recovery, the risk of relapse increases during life transitions and other stressful events such as relationship shifts or romantic breakup, change in employment or residence, financial difficulties, loss and grief, new parenthood, and starting at a new school or entering college.
Relapse can also be triggered by:
- Irregular eating habits or undereating
- Unresolved or undertreated psychological symptoms such as depression, anxiety, trauma, or OCD
- Setting “clean eating” rules
- Absorbing or participating in diet culture
- Expecting perfection or holding unrealistic expectations
What Should I Do If I Notice Signs of Relapse?
Before symptoms reappear, have a basic plan in place for if/when they do.
- Know who you can call for support and keep their contact information handy.
- Identify the coping tools and meals you can rely on immediately to start to ease symptoms. Write them down if that helps.
When symptoms reappear, please remember it is not a sign of failure; it is a common part of recovery. Take deep breaths and use the following steps to guide you in the first 72 hours.
A simple what-to-do checklist
- Tell someone—today! Please don’t keep your concerns and struggles to yourself. Reach out to your therapist, psychiatrist, dietitian, doctor, sponsor, or someone else you trust.
- Return to your structured meal plan. Consistent nourishment helps regulate your mood and keeps your body functioning properly.
- Avoid triggers. Take a break from the scale, diet content, checking your body, and comparing yourself to others.
- Increase support. Schedule more sessions, get more meal support, establish more structure (without “rules”!).
What Should I Do If I’m Worried a Loved One is Relapsing?
- Approach them with compassion, not accusations. “I’m worried you seem to be eating less and isolating more. I’m here for you; would you like to talk?”
- Refrain from mentioning their appearance or weight. Even a comment you think is a positive one can reinforce the disorder.
- Encourage them to get professional support. Early intervention provides the best chance of reducing symptoms and preventing further escalation.
- Offer practical help. Scheduling a session or evaluation, arranging for childcare, providing transportation, and joining them during meals are all ways you can help reduce their feelings of overwhelm.
FAQ About Eating Disorder Relapse
How common is eating disorder relapse?
Relapse is most common in the first year after stepping down from a high level of care. [OR leaving a high level of care.] It is not a sign of failure, and it does not mean full recovery can’t be achieved.
What are the earliest signs of relapse?
Relapse often begins before physical changes are noticeable. Early signs are increased thoughts about food and body, increased anxiety or guilt, increased secrecy or avoidance, and implementing rigid rules.
What should I do at the first signs of relapse?
Reach out for support right away, return to your structured meal plan, avoid triggers, and increase support. Taking these steps early can prevent a worsening of symptoms.
When Should I Seek Urgent Care or Higher-Level Support?
Seek emergency care immediately if you are experiencing:
- Suicidal thoughts
- An inability to stay safe
- Chest pain
- Severe weakness
- Fainting
- Uncontrollable purging
- Dehydration
- Confusion
It may be time to step up support if you:
- Are medically unstable or deteriorating quickly
- Are struggling to function each day
- Don’t feel safe between treatment sessions
- Unable to stick with your meal plan without supervision or significant difficulty
- Are frequently returning to compensatory behaviors
Build a Relapse Prevention Plan
A relapse prevention plan prepares you for the possibility of relapse and enables you to respond faster if/when early warning signs appear.
- Identify your top triggers (e.g.; daily stress, personal conflicts, schoolwork, holidays, social media)
- Identify your early warning signs (i.e.; specific thoughts and routines)
- Identify your support team and how to contact them (e.g.; therapist, psychiatrist, dietitian, doctor, sponsor)
- Practice your coping skills (e.g.; grounding, boundaries, meal plan structuring)
How Can Galen Hope Help?
Galen Hope offers physician-led, individualized treatment programs for adolescents and adults of all genders struggling with eating disorders or complex mental health conditions. Through an integrated, whole-person approach, our multidisciplinary teams provide a continuum of care to help clients stabilize in the acute stages and build the skills needed for long-term recovery.
If you or a loved one is noticing signs of relapse, we can help.
Call for a free assessment: 866-304-2955 Learn more: galenhope.com
Key Statistics About Eating Disorder Relapse
- A systematic review showed that the estimated relapse rate after treatment for anorexia nervosa is 31%. The risk is highest in the first one to two years post-treatment.
- A survival analysis showed that the relapse rate for anorexia nervosa is 35%. The risk is highest in the 6–17 months after discharge.
- Relapse-prevention studies show that the relapse rate at ~18 months follow-up 35–41%.
- Long-term follow-up studies often report relapse rates at ~40–50% for anorexia nervosa and ~30% for bulimia nervosa. (Estimates vary by study definitions and follow-up timeframes.)
References
- National Eating Disorders Association (NEDA). Eating Disorder Relapse.
- Beat Eating Disorders. Relapse prevention plan
- Berends T, et al. Relapse in anorexia nervosa: a systematic review and meta-analysis. 2018.
- Carter JC, et al. Relapse in anorexia nervosa: a survival analysis. 2004.
- Berends T, et al. Rate, timing and predictors of relapse… BMC Psychiatry. 2016.
- Khalsa SS, et al. What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. 2017.