The process of recovering from an eating disorder can be long and arduous. At times you may feel hopeful and empowered, while other times you may feel exhausted and discouraged. The path towards recovery is not a straight path - slips and relapses happen. It is important to know your warning signs so you can intervene. Be gentle and compassionate with yourself when you do slip, and know that now is always the best time to turn things around.
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Warning Signs:
It is important to know your warning signs when things are becoming more difficult. At these times you may become more vulnerable to using unhealthy or ineffective coping behaviors or slip into old habits. Below are some common warning signs. Make a list of your warning signs and be sure to share them with your support people so they can help keep you on track.
- Increased obsessive thoughts about food, weight, body, appearance
- Black and white thinking
- Isolating
- Avoiding situations involving food
- Increased "food games" (cutting food into small pieces, pushing it around the plate, etc)
- Eating disorder rules becoming more rigid
- Feeling hopeless or helpless
- Wanting to be in control or feeling out of control
- Canceling appointments with providers
- Avoiding support people who know about the eating disorder
- Feeling numb or avoiding your feelings
- Ignoring your body's signals
- Neglecting your needs (emotionally, physically, mentally, spiritually)
- Fantasies about being thin, losing weight, eating a lot, etc
- Lying
- Not trusting others
- Denying or minimizing that things are challenging
- Difficulty asking for help or rejecting help that is offered
- Impatience/irritability
- Depression
- Blaming others
- Justifying eating disorder symptoms
- Using other unhealthy coping behaviors
- Feeling invincible
- Trying to convince yourself that you're cured or don't need help/support
- Allowing your weight to influence your whole day
- Compensating for your nutritional intake
- Over/under sleeping
- Increased body checking
- Dwelling on the past
- Canceling plans
- Placing increased emphasis on exercise
- Crying a lot
- Difficulty making decisions
- Avoiding phone calls/emails/texts
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- Major life changes
- Stress
- Transitions
- Illness
- Criticism
- Feeling out of control
- Relationship difficulties
- Conflict
- Difficult emotions
- Changes in support system
- Talking about difficult issues in therapy
- Changes in your routine
- Comments on body, weight, appearance or food
- Changes in your weight
- People's reactions to the changes you are making in your life
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Relapse Prevention Strategies:
- Lead a healthy and balanced lifestyle - eating, sleeping, hydration, exercise, relationships
- Take your prescribed medications
- See your providers regularly
- Avoid other harmful behaviors or environments
- Spend time doing things you enjoy
- Build mastery every day to gain confidence
- Stay in touch with your emotions
- Engage in something meaningful
- Identify your triggers
- Maintain relationships
- Practice coping skills, even when you don't "need" to use them
- Create a daily ritual - can include a daily commitment to working on recovery, gratitude, accomplishments, affirmations, daily reading, mindfulness practice, etc
- Recognize slips before they turn into relapse
- Be kind with yourself when slips occur
- Stay active in your recovery process (journal, do recovery projects, etc)
- Develop a list of healthy coping skills
- Share important information about your eating disorder recovery with others such as warning signs, short-term and long-term goals, what they can do to help you, etc
- Plan effective ways to deal with risky situations
- When slips happen, look at what happened and identify what you could do differently
- Process difficulties as they arise
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Creating your own plan...
It is very important to create a personalized relapse prevention plan. There are many different versions of plans, so choose the one that works best for you, or even make up your own. After you create your plan, share it with your treatment team and other members of your support network. Keep it in a convenient location so you can refer back to it, and remember to update it frequently. The following are some ideas of what to include in your plan.
- Names and phone numbers of treatment providers
- Names and phone numbers of crisis lines
- Names and phone numbers of other support people
- List your warning signs
- List your triggers
- List healthy coping behaviors
- My motivations to recover
- My short-term and long-term goals
- Negative self-talk and positive self-talk alternatives
- List things you can do to get yourself back on track after a slip
- Names and phone numbers of my treatment team (therapist, doctor, psychiatrist, dietician, social worker, occupational therapist, etc)
- Names and phone numbers of the 3 people I will call when I get the urge to use symptoms
- The first 3 healthy coping skills I will use when I feel the urge to use symptom
- If my first skills don't help, 2 more skills I will try are...
- When I am struggling I will tell myself...
- I will reward myself for using healthy coping skills instead of eating disorder behaviors by...
- 5 reasons why I want to recover
- List of my triggers and 5 healthy ways to deal with them
- When I am starting to slip, the first 5 warning signs are...
- List of other warning signs
- When I do start to slip, 3 things I will do to get myself back on track are...
Relapse Prevention Outlines from other websites:
F.E.A.S.T. Relapse Prevention Contract (most thorough plan I have ever seen) Mirror-Mirror Relapse Prevention Plan
A Hunger to Recover Relapse Plan
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For more information on the process of relapse, visit the post "Understanding and Interrupting Relapse" from February 12, 2013
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