Eating Disorder Relapse Prevention Tips & Strategies

Navigating life after recovering from an eating disorder can be a profound challenge, often requiring ongoing diligence and support to maintain a healthy relationship with food and body image. It’s a deeply personal journey, marked by victories and setbacks–including the risk of relapse. We’re here to share some tips and strategies to help people in recovery and recovery centers help minimize the risks of relapse.  

One of the strongest tools to help is a personalized relapse prevention plan tailored to an individual’s specific triggers, vulnerabilities, and coping mechanisms. It serves as a proactive strategy to anticipate and manage potential setbacks. This plan can also contribute to overall well-being and sustained recovery.  

The benefits of a personalized relapse prevention plan extend far beyond mere relapse avoidance. They encompass the preservation of hard-earned recovery, the cultivation of self-awareness, and the promotion of holistic well-being. By embracing and implementing such strategies, individuals can navigate the complexities of life post-recovery with greater confidence and resilience. 

• Anorexia nervosa: 37% over 31 months¹ 
• Bulimia nervosa: 31% over 24 months² 
• Overall relapse rate: 20% to 50%³ 

Relapses have significant impacts on mental, physical, and emotional health. Relapses can increase feelings of anxiety, depression, shame, and failure. Individuals may experience a loss of self-esteem and struggle with negative thoughts about their body and self-worth.  

Physical consequences can vary greatly by disorder, but typically include nutritional deficiencies, electrolyte imbalances, gastrointestinal issues, cardiovascular complications, and hormonal disruptions. These health issues can be severe and may require medical intervention. 

Relapses can be emotionally devastating, causing distress and frustration for individuals who have worked hard to overcome their eating disorder. It can lead to feelings of hopelessness and despair, as well as strained relationships with family and friends who may struggle to understand or support the individual’s challenges. 

The emotional toll of relapse may also trigger a cycle of guilt and self-blame, which can further perpetuate disordered eating behaviors. Overcoming these emotional challenges often requires professional support and a renewed commitment to recovery. 

Recognizing the early warning signs of an eating disorder relapse is crucial for intervening and preventing a full relapse. Here are key signs to watch for: 

• Changes in Eating Patterns: Watch for shifts in eating habits, such as skipping meals, avoiding certain foods, or restrictive behaviors around food. This might include increased focus on calorie counting or rigid meal planning. Pay attention to mealtime behaviors and attitudes towards food. 
• Distorted Body Image: Notice any return of negative body image thoughts or behaviors. This may include frequent body checking, obsessive weighing, or critical comments about one’s appearance. Changes in clothing choices (e.g., wearing baggy clothes to hide body shape) can also indicate body image struggles. 
• Emotional Instability: Look for changes in mood or emotional well-being, such as increased anxiety, irritability, or mood swings. Emotional distress can be a significant trigger for relapse. Pay attention to any signs of heightened stress or difficulty managing emotions. 
• Social Withdrawal: Observe if the individual begins to isolate themselves or withdraw from social activities. Avoiding social interactions can be a way of hiding disordered behaviors or feeling ashamed of relapse thoughts or behaviors. 
• Physical Changes: Be aware of physical changes like weight fluctuations, changes in skin or hair quality, or signs of fatigue or weakness. Physical symptoms can indicate underlying nutritional deficiencies or health complications related to disordered eating. 
• Return of Rituals or Compulsive Behaviors: Notice if old rituals or compulsive behaviors related to eating or exercise start to resurface. This could include strict exercise regimens, obsessive food rituals, or secretive behaviors around mealtimes. 
• Dishonesty or Secrecy: Pay attention to any signs of dishonesty or secrecy around food or eating behaviors. Hiding food, lying about meal consumption, or being evasive about activities can be red flags for relapse. 

• Stay observant and attentive to changes in behavior, mood, and physical appearance. 
• Maintain open communication and encourage honest discussions about feelings and challenges. 
• Keep a journal to track eating behaviors, emotions, and triggers. 
• Involve trusted loved ones or professionals in monitoring and recognizing signs of relapse. 
• Seek guidance from a healthcare provider or therapist if concerned about potential relapse. 

Eating disorder relapses can be influenced by a complex interplay of factors, including psychological, social, and environmental elements. Understanding these contributing factors is essential for developing effective relapse prevention strategies. Here are several key factors that can contribute to an eating disorder relapse: 

• Stressful life events or major transitions (e.g., starting college, changing jobs, relationship changes, or financial difficulties) can trigger relapse by disrupting coping mechanisms and increasing emotional vulnerability. High levels of stress can lead individuals to revert to familiar but unhealthy ways of coping, such as using disordered eating behaviors. 

• Emotional triggers, such as anxiety, depression, low self-esteem, or unresolved trauma, can contribute to relapse. Emotional distress can intensify negative thoughts and feelings about body image and self-worth, prompting a return to disordered eating behaviors as a maladaptive coping mechanism. 

• Societal ideals of beauty, unrealistic body standards portrayed in media, and societal pressures to achieve a certain body shape or size can worsen body dissatisfaction and fuel disordered eating behaviors. Constant exposure to these messages can undermine body positivity and trigger relapse. 

• Insufficient or inadequate support systems, including limited access to specialized eating disorder treatment or a lack of understanding from family and friends, can increase the risk of relapse. Without ongoing support and professional guidance, individuals may struggle to maintain recovery in the face of challenges. 

• Co-occurring mental health disorders, such as anxiety disorders, depression, obsessive-compulsive disorder (OCD), or substance use disorders, can complicate recovery and contribute to relapse. These conditions often interact with eating disorders, amplifying symptoms and making relapse more likely without comprehensive treatment addressing all underlying issues. 

• Environmental factors, including exposure to triggering environments (e.g., gyms, social gatherings focused on food, or environments that emphasize thinness), can influence relapse. Environments that reinforce disordered eating behaviors or body image dissatisfaction can undermine recovery efforts. 

Preventing eating disorder relapses involves a multifaceted approach of personalized strategies, professional support, and healthy coping mechanisms. Here’s an overview of effective prevention strategies: 

• Work with a healthcare professional (therapist, dietitian, or counselor) to create a personalized relapse prevention plan tailored to individual triggers, warning signs, and coping strategies. 
• Identify specific relapse triggers (e.g., stress, body image issues, social situations) and develop coping skills to manage these triggers effectively. 
• Outline concrete steps and action plans for addressing early warning signs of relapse, such as changes in eating behaviors, body image disturbances, or emotional distress. 

• Regularly attend therapy sessions with an experienced eating disorder specialist to address underlying issues, develop healthy coping mechanisms, and monitor progress. 
• Consider medication management if co-occurring mental health conditions (e.g., anxiety, depression) contribute to relapse risk. 
• Engage in ongoing treatment and follow-up care to maintain accountability and receive guidance in navigating challenges. 

• Learn and practice effective coping skills, such as mindfulness, relaxation techniques, and stress management strategies, to reduce emotional distress and manage triggers. 
• Develop adaptive ways of expressing emotions and processing difficult feelings without resorting to disordered eating behaviors. 
• Explore alternative coping mechanisms, such as creative outlets (art, music), physical activities (yoga, walking), or journaling, to foster self-expression and emotional regulation. 

• Implement self-care practices that promote overall well-being, including adequate sleep, balanced nutrition, regular exercise (in moderation), and relaxation activities. 
• Establish a healthy routine that includes regular meals and snacks, mindful eating practices, and self-monitoring of physical and emotional health. 
• Practice self-compassion and cultivate positive self-talk to counter negative beliefs and promote self-acceptance. 

• Cultivate a supportive network of family, friends, and peers who understand and respect recovery goals. 
• Communicate openly about challenges and seek understanding and encouragement from trusted individuals. 
• Join support groups or engage in peer support networks (online or in-person) to connect with others who have similar experiences and share coping strategies. 

• Participate in relapse prevention programs or workshops that focus on developing skills for long-term recovery and resilience. 
• Stay connected to recovery-oriented communities and resources, such as recovery-focused websites, books, or podcasts. 
• Regularly assess progress, adjust strategies as needed, and celebrate milestones and achievements in recovery. 

Maintaining recovery from an eating disorder and preventing relapse involves establishing healthy eating habits and a balanced approach to nutrition. Here are some practical tips and best practices for sustaining recovery: 

• Plan balanced meals and snacks in advance to ensure regular and adequate food intake throughout the day. 
• Include a variety of food groups (carbohydrates, proteins, fats, fruits, vegetables) to meet nutritional needs and prevent feelings of deprivation. 
• Use meal planning as a tool to promote structure and predictability around meals, reducing anxiety and impulsivity related to food choices. 

• Pay attention to hunger and fullness cues, savor flavors and textures, and eat slowly and without distractions (e.g., phones, TV). 
• Engage all senses during meals to enhance the eating experience and promote a positive relationship with food. 

• Embrace flexibility in food choices and eating patterns, allowing for spontaneity and enjoyment without rigid rules or restrictions. 
• Challenge fear foods gradually by incorporating them into meals in a controlled and supportive environment. 

• Serve meals on smaller plates or use measuring tools to gauge appropriate portion sizes. 
• Strive for balance by including a mix of macronutrients (carbs, proteins, fats) and micronutrients (vitamins, minerals) in each meal. 

• Schedule three main meals and planned snacks throughout the day to maintain energy levels and stabilize blood sugar. 
• Avoid skipping meals or going too long without eating, as this can lead to intense hunger and potential overeating or bingeing. 

• Work with a registered dietitian or nutritionist specializing in eating disorders to develop personalized meal plans and address specific dietary needs. 
• Regularly check in with a healthcare provider to monitor progress, adjust meal plans as needed, and address any nutritional concerns. 

• Identify and address emotional triggers or stressors that may impact eating behaviors.  
• Develop alternative coping strategies (e.g., journaling, relaxation techniques) to manage emotions without turning to disordered eating. 
• Build resilience by learning to navigate setbacks or difficult situations without resorting to unhealthy behaviors. 

• Make nutrition a priority by dedicating time for grocery shopping, meal preparation, and mindful eating practices. 
• Experiment with new recipes and food combinations to keep meals interesting and enjoyable. 

• Regularly assess thoughts and feelings around food, body image, and recovery progress. 
• Prioritize self-care activities that promote overall well-being, such as adequate sleep, regular physical activity, and engaging in hobbies or interests. 

• Acknowledge and celebrate achievements and milestones in recovery, reinforcing positive behaviors and reinforcing motivation to continue on the path of recovery. 

It’s important to approach eating as a nourishing and pleasurable experience, focusing on overall health and well-being rather than strict rules or calorie counting. Developing a balanced and sustainable approach to eating supports long-term recovery and enhances quality of life. Remember that recovery is a journey, and seeking support from healthcare professionals and loved ones can make a significant difference in maintaining progress and preventing relapse. 

The importance of eating disorder relapse prevention cannot be overstated, as relapse can pose significant challenges to individuals who have worked hard to overcome their eating disorders. Implementing personalized relapse prevention approaches is essential for sustaining recovery and promoting overall well-being. Here’s why personalized prevention strategies and professional support should focus on the following: 

1. Tailored to Individual Needs 

2. Enhance Accountability and Support 

3. Encourage Healthy Coping Mechanism 

4. Promote Long-Term Recovery 

Remember, recovery is a process that requires ongoing effort and dedication. By investing in personalized relapse prevention strategies and accessing professional support, individuals can empower themselves to maintain recovery, thrive in their lives, and break free from the grip of eating disorders. 

If you’re looking for ways to improve your patient documentation to support these needs, Kipu can help. Our website has more resources for eating disorder centers available if you’d like to take a look. 

Sources 

1. de Rijk ESJ;Almirabi D;Robinson L;Schmidt U;van Furth EF;Slof-Op ’t Landt MCT; (n.d.). An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta-analysis. The International journal of eating disorders. https://pubmed.ncbi.nlm.nih.gov/37855175/  

2. W; O. M. A. (n.d.-b). Rate and prediction of relapse in bulimia nervosa. The American journal of psychiatry. https://pubmed.ncbi.nlm.nih.gov/8166317/  

3. WebMD. (n.d.). How can I prevent a relapse of binge eating disorder?. WebMD. https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/how-to-prevent-a-relapse-of-binge-eating-disorder 

About the Authors

Kipu is bettering the behavioral health landscape, helping treatment centers achieve the best outcomes and empowering patients and caregivers on every step of the recovery journey.