6 Tips for Eating Disorder Relapse Prevention

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Once someone has experienced an eating disorder, there are many things that can re-trigger eating or weight anxiety, including experiences like:

• pregnancy,
• a family member or friend losing weight or starting a restrictive diet (e.g., going vegan or paleo), and it triggering a sense of comparison/competition,
• gaining a little weight yourself and wanting to lose it,
• spending time with a very thin person (e.g., a new colleague),
• an injury that prevents exercise,
• starting sport or exercise after a period of not doing it,
• starting using activity/health tracking apps,
• accidentally stumbling on "thinspo" (thinness-inspiration) videos, or
• a high-stress situation, like studying for the bar.

Now obviously this is a long list (and far from exhaustive) so it's normal to encounter things that are re-triggering. Keep in mind however that, given the same experiences, one individual may feel re-triggered and another may not. Also, being re-triggered doesn't mean you're doomed to relapse. You may just find yourself having recovery wobbles for a day or two (or even a week or two), and get yourself back on track. To help increase your resilience, here are some specific tips.

Strategies for Coping When You're Feeling Re-Triggered

1. Acknowledge to yourself when you're feeling triggered, and tell someone.

Secrecy and denial are hallmarks of eating disorders. If something triggers your eating disorder vulnerability, try telling someone you trust about what you're going through. This doesn't need to be a huge, deep, and meaningful conversation. It can just be simply acknowledging what you're feeling.

2. Remind yourself what's good about not having an eating disorder.

Start making a bullet point list of all the good things you personally experience by not having an eating disorder. It's better to make this list when you're feeling good so that you have it to refer back to. Here are a few examples, but make your list your own.

• Having more concentration, focus, and energy.
• Having mental space for other goals.
• Not feeling guilty about causing your loved ones anxiety about your health.
• Not getting stared at for being very thin.
• Your hair not falling out.
• Having normal periods and the ability to get pregnant.

3. Curb any creep in subtle symptoms.

Part of how eating disorders take hold is through various self-imposed rules and goals that become increasingly rigid and restrictive. One day your goal is to be 120 lbs, and once you hit that, all of a sudden 110 lbs is your new goal. One day, you're cutting out takeout and the next you're cutting out all oil.

The very good news that, if you find yourself feeling more obsessed about something, breaking the chain once or twice can restore your capacity to be psychologically flexible. For example, if you're becoming increasingly avoidant of foods with oil (or carbs), then eating those a few times is likely to make it dramatically easier to do so. Start with something that you don't find too stressful, like adding add a few splashes of sesame oil to a stir-fry, or whatever is relevant to you.

Another example of breaking a chain of increasing obsessionality might be skipping a day or two of exercise, or not increasing the duration/intensity of your exercise every single workout.

Or, here's another scenario: For some random reason, you end up skipping lunch a couple of days in a row, and start experiencing a strong urge to keep doing that. Before the couple of times you skipped lunch, you weren't experiencing any particular urge to do that. The urge has been triggered by the behavior. If you eat lunch as normal for a few days or a week, your urge to avoid lunch will likely return to what it was before, that is, mild or non-existent.

Pay attention to increases in any of these 20 subtle signs of eating disorders.

4. Consider avoiding certain triggers.

As a general rule avoidance isn't a great idea. In fact, it's usually a terrible idea. For instance, if you are socially anxious, then avoiding your triggers will usually make you more anxious. However, there can be some situations in which trying to avoid certain non-essential triggers makes sense. Let's say you start using an activity tracking app and you find yourself feeling anxious if you don't increase your distance moved or calories burned every day. It might make sense to delete the app rather than having to fight feeling re-triggered.

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In some cases, subtle trigger avoidance might be your best move. For example, if your colleague is starting a paleo diet and talking about it a lot. You might be politely responsive but not be drawn into extended conversations about it.

5. Pay attention to Seemingly Minor Decisions.

Seemingly Minor Decisions are those that put you on the pathway to trouble but that on the surface appear reasonably innocuous. For example, you're ordering your usual vitamins online and also order a large size of a no-calorie sugar substitute so you reach the minimum purchase for free shipping. These are the types of decisions that put you in the position of needing to use a tremendous amount of willpower not to get sucked into a problem spiral. If you find yourself having made these types of decisions, try to walk them back (like the earlier example of deleting an activity tracking app that's stressing you out). Or, unsubscribe from sales emails for wherever you bought the big bag of sugar alternative, (if those sales emails are likely to offer you similar products based on your purchase.)

I've written extensively about Seemingly Minor Decisions (aka Seemingly Irrelevant Decisions) in my book The Healthy Mind Toolkit.

6. Take potential relapse seriously but don't panic at the first hint of being re-triggered.

There are a lot of potential eating disorder triggers in our environment. Therefore experiencing some of these is going to be a fact of life. As I said at the outset of this article, there's no need to panic that feeling some sense of being triggered is going to lead to automatic relapse. However, you do need to be somewhat vigilant about the decisions you make when you're feeling triggered.

Try turning the experience into a situation in which you affirm your commitment to being well by taking positive steps to support that. This includes: eating regularly, eating enough, eating a variety of foods, engaging in physical activity in non-obsessive ways, and devoting your mental energy to whatever is important and non-competitive to you, like spending time nurturing your relationships with others.

If your sense of feeling triggered is lasting more than a week or two, and you've worked with a therapist previously, consider recontacting them and asking for a booster session. You can let them know you're booking the appointment as a preventative measure, and are just looking for one or two appointments to help you stay on track. If you think there might be a wait for an appointment, call sooner rather than later and ask to pencil in an appointment that you can cancel if you don't need it. You can also try "channeling" your former therapist and thinking about what they'd advise you to do in the situation you're in. This thought experiment might be enough to help you remember the skills you've learned.

If you've overcome an eating disorder, you've already accomplished something amazing. Sometimes you might feel tempted to go back to some of your old behaviors, but you've got the skills to cope with those urges. You've got this!