Eating Disorder Relapse: 50 Warning Signs That Predict Relapse

Eating disorder relapse = regressing after making improvements with your eating disorder.

Relapse doesn’t mean failure – it’s a common part of recovery, and if you slip you can still turn a negative into a positive by learning from what went wrong and taking steps to avoid repeating your mistakes in the future.

Of course, nobody wants to relapse, and early identification can make all the difference. Are you on a path to relapse? Do you need to take extra steps right now to protect yourself?

50 Relapse Warning Signs

To check yourself, compare your current thoughts, feelings and actions against this list of 50 warning signs. The more warning signs you identify with – the more concerned you need to be.¹²

1. You are weighing yourself or mirror-checking more frequently.
2. You are dieting (or sort of dieting).
3. You’re avoiding social situations that involve public eating.
4. You have been missing or skipping meals. Sometimes you forget to eat a meal.
5. You are eating mindlessly and not sticking to a structured eating plan.
6. You have been thinking more about food.
7. You are ignoring your feelings of hunger or fullness.
8. You are starting to exercise excessively.
9. You’ve started or restarted food rituals, such as slow or fast eating, excessive cutting, excessive chewing, etc.
10. You’ve been looking up calorie information for the foods you eat on the internet, or visiting pro ana websites.
11. You’ve been having arguments with loved-ones about food or treatment adherence.
    
12. You feel like you no longer need treatment. You’ve been pushing for more space and freedom and less involvement from your support team. You have been arguing against accountability measures.
13. You’ve started chewing more gum.
14. You’ve started eating more low-calorie or no-calorie food and drinks.
15. You’ve increased your caffeine consumption.
16. You feel more tired or weak – you have no energy
17. You are displaying more physical signs of poor nutrition, such as excessive bruising, thinning hair or the loss of menstrual cycle.
18. You can’t handle the cold as well.
19. You are more rigid in your thinking.
20. Ritualized or OCD-like behaviors are increasing.
21. You’ve started wearing less-revealing clothing.
22. You’ve cancelled or rescheduled treatment appointments
23. You don’t feel as engaged and involved in treatment. You’ve been lying to or withholding information from members of your treatment team.
24. You want to make a big change in your treatment plan.
25. You’ve felt more moody or argumentative lately
26. You’ve felt more depressed lately. Things that used to bring you pleasure aren’t as enjoyable lately.
27. You feel more negative about your body lately.
28. You’ve been avoiding uncomfortable emotions and experiences.
29. You’re feeling overwhelmed by stress.
30. You feel increasingly numb.
31. You’re feeling increased anger and hostility.
32. You feel increasingly doubtful about your chances at a full recovery.
33. You feel defensive when your loved ones broach the subject of recovery.
34. You feel increasing guilt or worthlessness. You feel guilty after eating.
35. You feel more self pity.
36. You’ve been feeling more resentful and have been dwelling on past hurts.
37. You’ve been feeling fat and making more negative comments about your weight and appearance.
38. You are less careful to avoid or minimize relapse triggers.
39. You are feeling tired of working at recovery.
40. You are having more trouble concentrating.
41. You are engaging in black and white thinking.
42. You are comparing yourself to others.
43. You’ve been feeling more urges and fantasizing about acting on urges.
44. You’ve been remembering the positives of your past disordered eating without remembering the negatives.
45. You’ve been feeling less trusting of others and/or experiencing more paranoia and fear.
46. You are isolating socially.
47. You are lying or deceiving those closest to you.
48. You are having relationship problems.
49. You have been trying to do too much and school/work demands leave you little time for yourself.
50. You’ve been putting yourself under unreasonable pressure to perform. You are responding to life’s challenges with perfectionism.

To Prevent/Deal-With Relapse

If it happens, don’t beat yourself up about it. Relapse is an unfortunately common part of recovery. It’s what you do after relapse that truly matters.

If you relapse or if you worry you are about to relapse:³

• Get right back in touch with your Eating Disorder Treatment team and support network. Going back to get help doesn’t indicate treatment failure – treatment failure occurs when you don’t rely on your treatment team and you allow things to spiral out of control.
  
• Don't focus on failure – instead, focus on what positive steps you can take to improve your situation. Try to avoid getting discouraged. Recovery is a long-term process and it’s normal to go through difficult periods. You already know how to improve yourself, you just have to redouble your efforts again.
• Think about what triggered recent problems and then make a conscious effort to limit your exposure.
• Use your coping strategies.
  
• Give yourself the time and space you need to focus on your recovery. You can’t fight for your life when all your energy and time is committed to work or other responsibilities.
• Lean on your support network.
• Spend time engaged in activities you enjoy with people you care about.

Learning from Relapse

Recovery rarely happens along a straight upward path – life just doesn’t work that way!

• We learn from our mistakes…so don’t get to upset about making a mistake or two along the way…
• You will probably have periods when you slide back into negative behaviors. Though this is obviously frustrating, instead of feeling discouraged, try viewing these slips as teachable moments and opportunities for significant self improvement.
• Don’t feel discouraged – even after a slip, if you compare where you are today to where you were at your lowest point, you can see that treatment definitely works.⁴