Signs That a Loved One May Be at Risk for Eating Disorder Relapse

Contributor: Staff at Timberline Knolls Residential Treatment Center

Eating disorders often involve a long-term effort to resolve. People who have received treatment and learned to manage their symptoms are often described as being in recovery from the disorder they had developed.

Many people are able to remain in recovery without returning to the harmful behaviors that had previously threatened their well-being. Unfortunately, a significant percentage of people who make a full recovery from an eating disorder will someday relapse.

If someone you care about is in recovery from an eating disorder, your ability to recognize possible warning signs or symptoms of relapse can allow you to play an integral role in helping them maintain their health.

What Is an Eating Disorder Relapse?

When used in relation to a substance use disorder, the term relapse is generally understood to mean a return to substance use after a period of abstinence. For those who are in recovery from addiction, using substances even once is typically considered to be a relapse.

Unfortunately, a similarly universal understanding of what qualifies as an eating disorder relapse has not yet been achieved.

For example, a study that was published June 14, 2017, in the Journal of Eating Disorders noted that experts have not established a common definition for eating disorder relapse, nor have they agreed on a standard set of criteria for determining if a person has relapsed. [1]

This study, which was led by Sahib S. Khalsa of the Laureate Institute of Brain Research, reported that differing definitions of eating disorder relapse during prior research efforts have included:

• Having a BMI of less than 16.5 for more than two weeks or having a BMI of less than 18.5 for three months in a row
• Losing 15% of body weight after achieving a healthy/normal body weight during or after treatment
• Experiencing a return of psychiatric symptoms as indicated by achieving certain scores on the Eating Disorder Examination (EDE) or Psychiatric Status Rating (PSR) scales
• Engaging in disordered eating behaviors after having ceased these behaviors during treatment [2]

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Possible Warning Signs of Eating Disorder Relapse

Determining if a person has experienced an eating disorder relapse is a clinical decision that can only be made by a qualified professional. But you don’t have to have advanced training to note that someone you care about may be in danger of relapsing, or that they may have already begun to reengage in disordered eating habits or dangerous compensatory behaviors.

As is the case with the development of an eating disorder, the warning signs of eating disorder relapse can vary considerably from person to person. If you suspect that a loved one may be at risk for an eating disorder relapse, here are a few signs to watch for:

• They have begun to make excuses or take other steps to avoid eating with others. Eating disorders are often accompanied by shame and secrecy. If you notice that your loved one habitually eats by themselves, this may be a sign that they are following a dangerously restrictive diet again or are otherwise engaging in self-defeating behaviors that they’re trying to hide from friends and family members.
• They make negative comments about themselves or others that focus on weight or weight-related attributes. Everyone has moments when they get down on themselves or are less than charitable when discussing others. But given the significant role body image can play in a person’s struggles with an eating disorder, any outward signs that they are judging themselves or others on the basis of weight, shape, or size can be cause for concern.
• They have begun to deviate from their wellness plan. A person’s post-treatment plan is designed to ensure that they’re connected with the services and resources they need to maintain their recovery. If your loved one has begun to reduce their participation in support group meetings, miss or cancel therapy sessions, and otherwise decrease their involvement with people who have been helping them and holding them accountable, this may indicate that they are once again engaging in dangerous weight management behaviors.
• They demonstrate noticeable changes in mood, attitude, energy level, and motivation. Significant changes in any area of a person’s life may be a sign that they are struggling. For people who are recovering from an eating disorder, these types of changes may be warnings that they are on the precipice of a health crisis or have already succumbed to self-defeating urges.
• They are spending less and less time with family and friends, and they seem to have lost interest in activities or events that were previously significant to them. Remaining in recovery from an eating disorder isn’t simply a matter of managing food-related behaviors. Successful recovery includes fully engaging in a healthy and productive lifestyle. A person who withdraws from others or loses interest in significant activities may have relapsed, or they may be struggling with depression or another mental health concern. In any case, these can be clear signs that they’re in danger.

Again, it is important to remember that diagnostic decisions can only be made by qualified professionals. But your familiarity with your loved one’s behavior patterns, personality, and habits can help you play a vital role in protecting their health and ensuring that they get the care they need.

How Common Is Eating Disorder Relapse?

Given the divergent professional opinions regarding what does and does not qualify as eating disorder relapse, determining the prevalence of this problem can be difficult. However, multiple studies indicate that at least one-third of people who have been treated for anorexia and bulimia will experience some form of relapse.

In 1999, a study that was published in the Journal of the American Academy of Child and Adolescent Psychiatry reported that about 33% of women who had either anorexia or bulimia relapsed after achieving what the researchers defined as full recovery. [3]

A 2016 study in the journal BMC Psychiatry evaluated the progress of 83 patients who were enrolled in an anorexia relapse prevention program. Eighteen months after completing this program, the researchers found, 11% of the participants had experienced what they defined as a full relapse, while an additional 19% had met their criteria for a partial relapse. [4]

The authors of the 2016 study also noted that several previous research efforts had determined that the relapse rate among patients who were treated for anorexia nervosa was between 35% and 41%. [5]

Every person who recovers from an eating disorder has some risk of relapse. But those who have the support of family and friends who understand the risks and can identify warning signs may be better prepared to either avoid relapse or get help before a temporary relapse transforms into a long-term problem.

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References

1. Khalsa, S.S., Portnoff, L.C., McCurdy-McKinnon, D. et al. What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. J Eat Disord 5, 20 (2017). https://doi.org/10.1186/s40337-017-0145-3.
2. Khalsa, S.S., Portnoff, L.C., McCurdy-McKinnon, D. et al. What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. J Eat Disord 5, 20 (2017). https://doi.org/10.1186/s40337-017-0145-3.
3. Herzog, D. B., Dorer, D. J., Keel, P. K., Selwyn, S. E., Ekeblad, E. R., Flores, A. T., Greenwood, D. N., Burwell, R. A., & Keller, M. B. (1999). Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(7), 829–837. https://doi.org/10.1097/00004583-199907000-00012.
4. Berends, T., van Meijel, B., Nugteren, W., Deen, M., Danner, U. N., Hoek, H. W., & van Elburg, A. A. (2016). Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study. BMC psychiatry, 16(1), 316. https://doi.org/10.1186/s12888-016-1019-y.
5. Berends, T., van Meijel, B., Nugteren, W., Deen, M., Danner, U. N., Hoek, H. W., & van Elburg, A. A. (2016). Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study. BMC psychiatry, 16(1), 316. https://doi.org/10.1186/s12888-016-1019-y.
   

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About Timberline Knolls

At Timberline Knolls Residential Treatment Center, located outside of Chicago, Illinois, we provide specialized care for women and girls who are living with mental health disorders. Our private facility offers female-only treatment programs for eating disorders, addiction, and a range of mental health conditions. We work closely with each person to develop treatment goals to maximize strengths while focusing on individual needs. Our treatment team understands that each woman has unique needs and that she must play a role in her journey to wellness.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 21, 2021. Published on EatingDisorderHope.com
Reviewed & Approved on June 21, 2021 by Jacquelyn Ekern, MS, LPC