Understanding and Interrupting Relapse

The recovery process from an eating disorder can be long and arduous.  It often feels like two steps forward, one step backwards.  Slips and relapses occur.  It is important to understand the process of relapse so you can intervene sooner rather than later. 

The following is an excerpt from an article on addiction relapse.  I think it is very applicable to eating disorder relapse, and provides a nice illustration of the process...

[Relapse] is the progressive process of becoming so dysfunction in recovery that self-medication... seems like a reasonable choice.  The relapse process is a lot like knocking over a line of dominoes.  The first domino hits the second, which hits the third, and soon a progressive chain reaction has started... Each domino in the line (i.e. each problem that brings us closer to [symptom] use) gets a little bigger and heavier until the last domino in the sequence is ten feet tall, four feet wide, and a foot thick.  As this 10,000 pound domino begins to fall on us, it is too heavy for us to handle alone... When the last domino falls, it hits us from behind when we're not looking.


So here we are, moving along in recovery.  We tip over one small domino.  No big deal!  That domino hits the next, and then the next.  A chain reactions gets started.  The first dominoes are so small that we can easily convince ourselves that it's no big deal.  We look the other way and start doing other things.  All of a sudden a huge domino falls on us from behind, crushing us to floor, causing serious pain and injury in the process.  We need to make the pain go away and we reach for old reliable - the magical [symptoms] that always helped us with our pain in the past.  [We are now fully engulfed by the eating disorder.]

(Understanding Relapse by Terence Gorski)

Read more for examples of the relapse process and helpful tips on interrupting relapse...
 

 

Below are some different examples of the relapse process:

Build up of stress  -->--  Emotional overreaction (crave relief of feelings, may shut down)  -->--  Denial  -->--  Failure to get support  -->--  Little lies  -->--  Increased isolation  -->--  Problems grow worse  -->--  Hopelessness returns  -->--  Self sabotage  -->--  "Use" (engaging in harmful behavior)  -->--  Defeatist reaction ("I've already blown it, I might as well keep going")  -->--  Full blown relapse

Getting stuck in recovery (we hit a problem that we are unwilling or unable to deal with)  -->--  Denying that we're stuck  -->--  Using other compulsions  -->--  Experience a triggering event (something that we could normally handle but can't right now)  -->--  Becoming dysfunctional on the inside (our emotions take control, may swing between emotional overreaction and emotional numbness)  -->--  Becoming dysfunctional on the outside (everything starts getting worse)  -->--  Losing control  -->--  Using addictive thinking (we start thinking that recovery is miserable and focus on the benefits of symptoms)  -->--  Returning to addictive people, places and behaviors  -->--  Using symptoms  -->--  Losing control

Internal change  -->--  Denial  -->--  Avoidance and defensiveness  -->--  Crisis building  -->--  Immobilization (overwhelmed by constant problems but unmotivated to take action)  -->--  Confusion and overreaction  -->--  Depression  -->--  Behavioral loss of control  -->--  Recognize loss of control  -->--  Option reduction (believing the only helpful solutions are harmful behaviors)  -->--  Use
 

 The key with relapse is intervening.   

It is possible to intervene at any step - the earlier the better.

Some helpful suggestions on how to interrupt relapses, or to keep them from getting worse:

• Reach out for help
• Recommit to your recovery (consider creating a daily ritual about your commitment)
• Revisit your relapse prevention plan and start using it
• Use your tools 
• Let go of judgments: remind yourself that relapse happens, that no one can recovery "perfectly," and that you can get back on track after you slip
• Start talking: verbalize what you are experiencing, talk to people who are supportive, express what you are feeling and thinking even if it seems irrational
• Protect your recovery: put your recovery first, protect yourself against anything that threatens your recovery
• Reality testing: ask people you trust if your thoughts and behaviors are rational
• Problem solving: brainstorm small, attainable steps you can take right now 
• Backtracking: think about what has been happening and see if you can identify the initial triggers 
• Education: learn about relapse and recovery, review your coping skills and learn new ones
• Self-care: this includes taking actions such as getting appropriate sleep, going for a leisure walk or taking a bath, as well as being gentle and compassionate with yourself
• Spirituality
• Surround yourself with supportive people
• Build mastery: do things that you are good at to build your sense of competency

 For more information on relapse, visit the page "Relapse Prevention"