addiction, Diet, disordered eating, Eating Disorders, Food addiction, Eating Disorders, Recovery, Gluttony, God, Health & Wellness, Mental Health, overeating, prayer, wellness

Disordered Eating Relapse Prevention

Information in this article is excerpted and revised from the book Pam wrote entitled Food as an Idol: Finding Freedom from Disordered Eating (ABC’s Ministries, 2017) (pp. 84-90, 94-95).

Written by Pamela K. Orgeron, M.A., Ed.S., BCCC, ACLC, Author

Short of God’s intervention with a miracle of deliverance (God delivered me!), relapses cannot be avoided completely but can only be faced through having a plan, according to research (Arterburn & Mintle, 2004; Cipolia & Berman, 2015; Klimek, n.d.; Komosky, n.d.; Muhlheim, 2017; NEDA, 2016h). Dr. Gregory Jantz (2010) who founded The Center: A Place of Hope that utilizes a whole-person approach to treating disordered eating that is personalized to each individual’s needs also warns those in recovery to expect relapse. Jantz (2010) reported that while moving through the recovery process, some individuals “may want to ‘recycle’ back into old patterns. . . . Second Peter 2:22 says this tendency to return to destructive patterns is like a dog returning to its own vomit or a washed pig going back to wallowing in the mud.”   (p. 141)

Disordered eating did not develop overnight nor will it be healed overnight. Recovery comes in stages, often with a few slips along the way. If not handled appropriately, these slips can lead to full-blown relapse. What can one do to ward off relapse? First, having a relapse prevention plan is crucial to success in recovery. Additionally, those in recovery need to know the stages and signs of relapse to be able to help self-monitor potential situations that may lead to relapse. 

Have a Plan 

Keep doing what works. What helps and how much it helps one move forward in recovery will vary with each individual. Here are common practices that people in recovery can do:

  • Keep eating regular healthy meals.
  • Plan healthy meals and snacks.
  • Shop wisely and consistently for healthy foods.
  • Keep a food log.
  • Review literature given out by one’s professional clinicians. (Komosky, n.d.)
  • Review one’s journal entries. I found that reviewing my recovery notebook that included both literature from specialists and my writing reminded me where I came from and how much I had progressed.
  • Keep exercising regularly in moderation.
  • Get plenty of sleep and rest.
  • Practice self-care.
  • Rely on God.
  • Practice spiritual disciples. Arterburn and Mintle (2004) list the spiritual disciplines as “prayer, worship, confession, Bible study, giving, fasting, submission, service, and forgiving.” (p. 233)

Avoid triggers. Triggers are those foods, places, or anything else that might tempt one to slip off the road to recovery. Triggers differ with each individual. Common triggers include:

  • Being in a grocery store—if grocery shopping is a temptation, those in recovery should send someone else to the store, or take a friend along for accountability.
  • Gyms—for those who used exercise to purge after a binge, going to a gym to work out may trigger bad memories and a slip.
  • Mirrors—if looking in the mirror causes distress, one can remove the mirror or post positive messages, especially favorite Scriptures, on the mirror that promote positive thoughts when using the mirror.
  • Scales—Klimek (n.d.) reported, “A scale is not a necessity to sustaining life, so a woman in recovery should not have one. It is that simple.” (Looks For The Things that Help & Hurt Recovery, ¶ 4) I remember hiding my bathroom scales for a season during my recovery from disordered eating. I measured my success by how my clothes fit.
  • Fashion and mainstream magazines—Komosky (n.d.) reported that the airbrushed body images depicted in magazines “are, in fact, scientifically unattainable. There’s zero need to attempt to live up to ‘cultural standards’ that simply don’t exist in the real world.” (¶ 3) Not to mention a lot of the nutritional advice and advertisements in magazines can be incorrect or misleading.

Muhlheim (2017) compiled a list of situational triggers for disordered eating. This list includes:

    • Stress and/or a busy schedule which makes planning meals difficult
    • Becoming overwhelmed by feelings and emotions
    • Loss of a family member, friend, etc.
    • Marital, social or family problems
    • Change in schedule (such as going on summer break) or a move (going away to school, etc.)
    • Weight gain
    • Dieting or any form or food restriction
    • Missing a meal or snack
    • Juice cleanses and detox efforts
    • Being under the influence of a diet guru or overly health conscious person
    • Having friends or family who diet
    • Following any form or [sic] restrictive eating plan
    • Being in unfamiliar food environments and/or having unrestricted access to food (at a buffet, holiday, or potluck for example)
    • Getting weighed at the doctor
    • Shopping for clothes
    • Pregnancy
    • Dating
    • Others commenting on your weight
    • Health problems (¶ 3).

One last possible trigger that I found reported in literature is using fitness trackers (Eikey & Reddy, 2017; Emily Program, 2017), “those trendy apps people use to record things like steps, calories, and heart rate.” (Emily Program, ¶ 1). Eikey and Reddy concluded from a small study they conducted of women with DE that “While these apps can be beneficial to users, they can also have negative effects on users with eating disorder behaviors.” (Abstract, ¶ 1)

The Emily Program (2017) reported that Eikey and Reddy (2017) classified the ways in which the women used the apps unhealthily. These classifications include:

  1. Using the apps obsessively
  2. Striving for perfection in tracking food eaten
  3. Dire awareness of numbers. One participant wrote, “I think it’s definitely very triggering because you become obsessed with food, you look at food differently…That’s protein, that’s fat, that’s carbs instead of like that’s a chicken breast, that’s peanut butter, that’s a piece of bread.” (Emily Program, ¶ 2)
  4. Restricting
  5. Manipulating the app to drop pounds quicker (e.g.: not reporting all their exercise when they over-exercised)
  6. Compensatory actions (e.g.: not eating enough calories one day when they ate too many another day)
  7. Using the app to circumvent undesirable emotions (e.g.: not reporting correctly everything that one eats on days they cheated).

Think permanent lifestyle change. In overcoming disordered eating the goal should be to make the positive changes made become a natural part of one’s being. These changes become a part of a life-long pattern of making healthy choices for living well. 

Stages of Relapse 

Arterburn and Mintle (2004) discussed “the phases of relapse” (pp. 228-230). These phases or stages include complacency, confusion, compromise, and catastrophe.

Complacency. This is when those in recovery first let their guard down and neglect doing what they need to do, what they have been doing that has helped them move towards healing. During this stage people may think they no longer need help. Thus, they may relax their boundaries and even drop support groups or therapy that have been keys to their previous progress.

Confusion. Secondly, they become double-minded. Doubt is the dominant thought. They have doubts about the severity of their disordered eating or whether they need additional long-term treatment and support. Their recovery plan is put on the back burner with unhealthy and erratic choices made.

Compromise. During the phase of compromise, people revert to “using food to comfort and to fill emotional needs once again.” (p. 229) Because they refuse to accept responsibility for their actions and pull further away from their support team, they are headed for disaster.

Catastrophe. At this stage, those who have backslidden into disordered eating have lost any and all previous feelings of control. “The main feeling at this stage is helplessness and hopelessness.” (p. 230) They have gained a “significant amount of weight back, and there is no end in sight to that state of being.” (p. 230) 

Signs of Relapse 

National Eating Disorders Association (NEDA) (2018) reported warning signs to relapse. The following warning signs are adapted from NEDA’s list:

  • Constant thoughts about food, diet, or weight
  • Lying to one’s treatment providers
  • Worrying one has lost control; overcompensating by striving to be perfect.
  • Feeling there are no buffers to stress in one’s life
  • Feeling one has no purpose or goals in life.
  • The primary goal has become to be attractive rather than eating and exercising for health.
  • Believing one can’t be happy without looking a certain way
  • Seeing oneself at an unhealthy weight
  • Others indicate a person has a faulty self-perception.
  • One compulsively weighs or looks in a mirror.
  • Skipping meals; purging after eating
  • Irritability
  • Feeling guilt and shame over what one eats
  • Avoiding activities where food is present
  • Isolating oneself; eating in secret
  • Looking down on others with a weight problem (projection).

What can one do to get back on track during a relapse? Cipolia and Berman (2015) shared seven tips to remember during a relapse:

  1. Get professional support.
  2. Talk with members of your support system (e.g.: family) to allow them to help you.
  3. Remember you are not a failure. Relapses can make you stronger. Get back on track.
  4. Remember your motives for recovery.
  5. Remember you are worth taking care of, including enjoying life. Practice self-care, and find new hobbies to enjoy.
  6. Reflect on the relapse to determine the trigger. Think about what you might do differently when faced with similar situations in the future.
  7. Live in the present moment. Don’t live in the past, or worry about the future. Each day offers a new beginning.

I want to point out that although I believe our goal is to have a permanent healthy lifestyle, we want to remember as Muhlheim (2017) reported,

During the recovery process it is not always possible to avoid slips and relapses. Many people tend to be very hard on them selves if they do have a slip or relapse. It’s important to remember that no one can recover perfectly. If you have a bad day, you can forgive yourself, put it behind you, and continue to move forward in your recovery. It is important to look back at the lapse to learn from it and at the same time, be compassionate and not beat yourself up. Lapses are a normal part of recovery and can actually be helpful in making recovery stronger. (¶ 6)

“While a relapse may feel demoralizing, or that everything you gained through recovery is gone, it’s actually far from that. Relapses are often natural parts of the process. As they say, sometimes you need to take a step back to take two forward.” (Cipolia & Berman, 2015, ¶ 3).

For those asking, “What’s the number one relapse prevention tool?” I believe Jantz (2010) answers that question best. Jantz indicated that prayer is the best defense to prevent relapse. He suggested the following prayer:

Dear God, I’ve been existing in the stagnation of my disordered relationship with food, living from moment to moment in destructive obsession. I want to be free! I will reclaim the joy of faith in the future. Help me to see beyond today.

Thank you for helping me refocus my thoughts on the inward beauty of your creation. I will to see myself as someone lovely, valuable, and precious. Thank you for helping me love myself (p. 142).

Like Jantz (2010), I believe it is crucial for individuals who practice disordered eating “to establish, regain, or strengthen a healthy relationship with God” (p. 208). For more information on The Center or the ministry of Dr. Greg Jantz, visit their websites at https://www.aplaceofhope.com/ or http://www.drgregoryjantz.com/, respectively. The Center Staff may be reached through email, info@aplaceofhope.com; or by telephone at 888-771-5166 or 425-771-5166.

References

Arterburn, S. & Mintle, L. (2004, 2011). Lose it for life: The total solution—spiritual, emotional, physical—for permanent weight loss. Nashville: Integrity. Available for purchase at https://www.amazon.com/Lose-Life-Stephen-Arterburn/dp/1591452457

Cipolia, G., & Berman, M. (2015). 7 Things to remember during a relapse in eating disorder recovery. Walden Eating Disorders Treatment. Retrieved May 22, 2017 from http://www.waldeneatingdisorders.com/7-things-to-remember-during-a-relapse-in-eating-disorder-recovery/

Eikey, E. V., & Reddy, M. C. (2017). “It’s definitely been a journey”: A qualitative study on how women with eating disorders use weight loss apps. Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems (pp. 642-654). Abstract. Retrieved July 20, 2017 from http://dl.acm.org/citation.cfm?id=3025591

Emily Program. (2017). Fitness trackers and disordered eating. Retrieved July 20, 2017 from https://www.emilyprogram.com/blog/fitness-trackers-and-disordered-eating

Jantz, G. L. (2010). Hope, help & healing for eating disorders: A whole-person approach to treatment of anorexia, bulimia, and disordered eating. Colorado Springs: Waterbrook Press. Available for purchase at https://www.amazon.com/Hope-Help-Healing-Eating-Disorders/dp/0307459497

Klimek, A. M. (n.d.).  Preventing relapse of eating disorders.  Retrieved June 9, 2017 from https://www.eatingdisorderhope.com/information/eating-disorder/preventing-relapse-of-eating-disorders

Komosky, B. (n.d.).  6 Keys to maintaining eating disorder recovery. Walden Eating Disorders Treatment. Retrieved May 16, 2017 from http://www.waldeneatingdisorders.com/6-keys-to-maintaining-eating-disorder-recovery/

Muhlheim, L. (2017). Relapse prevention plan.  Retrieved June 9, 2017 from http://www.mirror-mirror.org/relplan.htm

National Eating Disorders Association. (2018). Recovery and relapse. Retrieved March 8, 2018 from https://www.nationaleatingdisorders.org/learn/general-information/recovery

Orgeron (aka, Owens), P. K. (2017). Food as an Idol: Finding Freedom from Disordered Eating. Nashville, TN: ABC’s Ministries. Available for purchase at https://www.amazon.com/Food-Idol-Finding-Freedom-Disordered/dp/0997956534

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