If you are a recovering anorexic, bulimic, or binge eater, it's likely that one of your biggest fears is that you will lapse back into old, destructive habits. Yet it's important to remember that few eating disorder sufferers are able to stop cold turkey. Relapses should be considered a given. What's imperative is having a plan for getting back on track when they do occur.
Marcia and I devote a section in our book de-stigmatizing relapse, and discussing practical responses to it. We want you to have as few of those "I've-blown-it-so-I-may-as-well-go-all-the-way" experiences as possible.
First, try asking yourself after a relapse, "Has the overall trend of my eating behaviors been positive?" If the answer is "yes," then remind yourself that slip-ups along the way are normal. Calm down and go right back to your food plan.
Whether the answer is "yes" or "no," the next thing to do is analyze your relapse. Most likely you found yourself in a high-risk situation where relapse was simply too hard to avoid. Here are a few common high-risk scenarios and helpful responses:
- Restricting food intake, perhaps because you felt you overdid it, or you didn't like the number on the scale this morning. Solution: keep your intake steady, and especially don't skimp on protein, fat and what we call "fun foods," foods eaten purely for pleasure after your nutritional needs have been met. (See Marcia's blog post Sugar Isn't Toxic, It's My Weight Loss Secret for more on our approach to desserts and "fun foods") Cutting back on these elements of your food plan will only set you up for relapse.
- Encountering "fear foods" or "dangerous foods," foods that have historically triggered binges for you. There tend to be two responses to this scenario, abstaining completely as in the 12-step model, or the "vaccination" approach, which we recommend. With the latter strategy, your goal is to get over your fear of these foods by learning to eat and enjoy them in small amounts. Taking the "fear" out of fear foods also takes away their power to trigger a relapse.
- Abandoning your food plan prematurely. You might have felt that you followed the plan long enough, and you're ready to fly solo. Solution: get back on the food plan. Maybe you need to change it up to keep it interesting, or to reflect your changing food preferences. Maybe you just need to focus on those "risky" times when you are vulnerable, when you are tired, after work, etc. Come up with a plan for what you will eat during these moments.
- Dangerous moods. Often depression or anxiety can trigger relapses. Solution: A relapse post-mortem, during which you scrutinize the outcome ("Was it worth it?" "Did it make me feel better in the long run?" "What would have been a healthier alternative?"). Counseling and anti-depressants can also be helpful in mitigating dangerous moods because they can aid in clearing the tangle of emotions that may surround food and eating for you and help clarify your approach to food.
- Dangerous places: These can include in front of your television, or being home alone. Solution: If there is no one who can sit with you or your child at these risky times and places, devise an alternate plan: switch off the television to go for a bike ride or engage in another type of exercise, pick up a book, call a friend.
- Changes in exercise routine. Sometimes going on vacation, indulging more and exercising less can trigger anxieties about weight that lead to a relapse. Solution: Upon return to your normal routine, revert to your meal plan, and resist the temptation to diet or overexercise. Over time, your weight will normalize. Remember that while exercise is good for your health, it is only a minor factor in maintaining weight. More important is normalizing eating over the long term, and understanding that some ups and downs in your eating, exercise patterns and weight are to be expected.
Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders. Marcia is the author of Nutrition Counseling in the Treatment of Eating Disorders