Relapse in Eating Disorders; How Safe Is Your Recovery?

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It is no secret that eating disorders can be one of the most severe and complex mental health conditions, having a huge impact on your mental and physical health. Much like any other condition, relapse can be a feature of the eating disorder recovery process. Eating disorders affect thinking, mood, decision-making, behaviour and relationships. In fact, eating disorders can affect every aspect of a young person’s life and can have a huge impact on the young person’s immediate family and friends. 

While many young people with eating disorders can make progress in recovery, relapse is a common occurrence. Eating disorder relapse refers to a return or worsening of disordered eating behaviors and thoughts after a period of improvement. Relapse can happen for a variety of reasons, and risk factors such as stress, life changes, social pressures, or triggers related to body image or food can trigger an eating disorder relapse.

Relapse can be a frustrating and discouraging experience for individuals with eating disorders, as well as their loved ones and healthcare providers. It is important to recognize that relapse is a normal part of the recovery process and does not mean that the individual has failed or that recovery is not possible. Rather, it is an opportunity to learn from the experience and recommit to the recovery journey with the support of a treatment team and loved ones.

Further Reasons for Eating Disorder Relapse

Researchers are currently looking at how and why relapse happens and are looking for ways to prevent encountering these harmful behaviours. There are some things that we understand about relapse and others that are still work in progress, but it is important to look for warning signs that eating disorder relapse might occur.

128% Rise in Eating Disorders in Boys and Men 

Eating disorders are incredibly complex psychiatric conditions that affect people of all ages and all walks of life. Eating disorders are now understood to affect particular areas of the brain linked to executive functioning, the fundamental skills of daily living and emotional regulation.  

Eating disorders affect all genders, and the number of people affected is rising globally. Hospital admission has increased by 84% during the past five years, according to The Royal College of Psychiatrists. Eating disorders usually require specialist intervention and often benefit from intensive treatment. Eating disorders are most usually seen for the first time during the pre-teen and teenage years, with fewer eating disorders beginning after the age of 26. Eating disorders are more often diagnosed in girls than in boys; however, statistics show a 128% rise in eating disorders in boys and men since 2016. 

Unfortunately, there is still a stigma that surrounds men’s mental health, especially around eating disorders. However, the more that we talk openly and freely about this topic, the more men will feel comfortable seeking help from a mental health professional, which in turn will result in a recovery process boost and a reduced chance of relapsing.

Predictors of Relapse in Eating Disorders

Young people who have a lower BMI when they leave treatment or residual symptoms when they end treatment have a considerably higher risk of relapse. We understand that BMI is certainly not central to illness or recovery and that eating disorders cannot be measured in numbers; however, we can use BMI as a type of shorthand in calculations.

Recent research indicates that young people who leave intensive treatment or stop treatment with a BMI lower than 22 or with a declining BMI are more likely to relapse quickly. This is evidenced in both anorexia nervosa and bulimia nervosa. 

Young people with long-term eating disorders or adults who have experienced an eating disorder for many years are more likely to have repeated episodes in the future. This is particularly evident in adults over the age of 30. 

Post-treatment flexibility in food choices, energy amounts and fewer rituals can mean they may slip back into old eating habits, which can encourage a likelihood of relapse to old disordered eating behaviours.

Young people who have been diagnosed with other psychiatric disorders, anorexia nervosa binge-purge sub-type and those who are slower to respond to treatment despite being in strong treatment programs may need additional support and extensive coping skills to prevent further episodes in the future. 

Understanding Relapse Is Key to keeping Up a Strong Recovery 

When young people leave treatment, the very last thing that anyone would like to imagine is relapse. But, to ignore the possibility can be deadly. It is really useful to have honest conversations about the possibility of relapse and the warning signs that are particular to each young person and sometimes a little more obvious than others. 

As part of recovery, creating good relapse prevention plans and also a crisis management plan is essential to have a good result in treatment. It means safety and predictability for the whole family system. Families who have lived with eating disorders will know how demanding they can be on resources and how planning is key. For example, it is important to meal plan in order to minimise the risk of skipping meals and establish a support network for the person in recovery to boost their self-esteem so they have more support throughout the recovery process.

Factors to Help Prevent Relapse

There are a few factors to help prevent the chances of a relapse occurring. Having higher leptin levels may have a protective factor in eating disorder recovery. Scientists are continuing to research leptin and how it may be useful in eating disorder recovery. 

Leptin is a hormone that helps your body switch on the fullness or satiety button. It is not something that can be supplemented, but leptin sources can be included in your weekly meal planning. Some of the food sources include:

  • blueberries, blackberries and strawberries
  • whole grains
  • flaxseed oils 
  • meat, poultry and fish
  • mushrooms

The Wave Clinic are able to look at leptin levels as part of the overall treatment plan. Research into leptins in anorexia nervosa is ongoing, and early results indicate that more research is needed.

Young people who are able to maintain a higher BMI are less likely to relapse. Motivation for change and finding connection and a purpose are also great reasons to keep moving forwards with recovery plans. 

Families who have engaged in family therapy and are supportive of their young person experience far fewer difficulties following treatment. This can positively affect the relationships in the family and prevent some of the difficulties arising that can be triggering to young people at risk of relapsing.

Full Recovery Is Possible if Eating Disorders Are Treated Early

Eating disorders that are treated early within specialist treatment programmes are much more likely to have a long-term favourable outcome. Young people benefit from early interventions and the support of a team trained to understand the complexity of eating disorders. Parents should also empower themselves with the knowledge they need to make informed choices in treatment, including understanding the program and the interventions.

Recovery at The Wave Clinic

At The Wave Clinic, we strive to develop programmes that help young people who are struggling with an eating disorder overcome their difficulties and face a bright and fulfilling future. In addition to providing industry-leading treatments, we work with our young people to help them realize their future goals and ambitions and lead healthy lifestyles. Contact us today to learn more about the programmes we have on offer for eating disorders.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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