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June 24, 2024

Maintaining Post-Treatment Progress and Preventing Eating Disorder Relapse

Maintaining Post-Treatment Progress and Preventing Eating Disorder Relapse

Discharging from treatment is a significant milestone — a testament to your eating disorder patient’s hard work and progress in recovery. While this is often a cause for celebration, there is still more healing to do. Providers like you play a key part in guiding these patients toward long-lasting freedom and stability.

As your patient continues their journey toward recovery, they will undoubtedly face a variety of triggers, both new and old. In fact, transitions themselves are a risk factor for eating disorders, and the transition from treatment to “normal life” is no exception. Stepping back into everyday life can also bring forth a set of challenging situations, including inappropriate comments from others and diet culture pressures.

Read on for strategies and insights that will empower you to guide your patients in facing these challenges head-on.

4 Ways to Help Prevent Relapse in Your Patient

1. Identify triggers and make a plan

It’s inevitable that your patients will encounter eating disorder triggers after treatment. Helping them to identify their specific triggers (e.g., food-centered events and social settings, the presence of former “fear foods,” changes in routine, diet culture messaging, etc.), is an important first step in relapse prevention. 

Once you and your patient have identified the events or thoughts that trigger their eating disorder behaviors, it’s time to develop a plan. For example, if your patient is most worried about receiving comments about their weight, you can focus on preparing for such situations. Perhaps you can collaborate on a few responses that the patient feels comfortable saying—such as, “I am not taking feedback on my body right now,” or “I am focusing on my well-being and not what my body looks like. Can we talk about something else?” 

2. Apply skills learned in treatment 

Your patient learned numerous coping and nutrition skills in treatment, but putting them into practice can present challenges. Your support is essential in empowering your patients to build and practice skills such as emotion regulation, interpersonal relationships, mindfulness, and self-compassion. 

Putting these skills into practice may involve a patient noticing a change in their clothing size, and instead of engaging in disordered behaviors, they employ a healthy coping strategy. Coping strategies may include journaling about triggers, reading a recovery story, meditating, going for a walk, or discussing their feelings with you or a loved one. 

3. Pay attention to any behavior changes

No matter how well you and your patient have prepared for triggers, disordered behaviors may still resurface. A non-linear healing process is common given the complexity and aggressiveness of these illnesses. Take note of any changes in your patient’s behaviors around food, eating, or exercise. If you notice the reemergence of unhealthy behaviors, approach your patient with kindness and patience. 

Here are some examples of signs that your patient may be headed toward relapse:

  • Perfectionistic thinking returns or strengthens
  • Dishonesty
  • Changes in mood, attitude, and energy level
  • Isolation
  • Other mental health issues worsen
  • Changes in eating patterns or exercise

4. Identify and engage supportive loved ones

In addition to professionals, support people play a critical role in your patient’s successful recovery. Helping your patient identify people in their life who would be supportive in their recovery is an important first step. After you’ve determined who the patient feels comfortable leaning on, assist them in involving their loved ones in their recovery. 

Involving support people in recovery may involve the patient asking them to be available during triggering events, to join them in eating an especially challenging food, or to join them in removing diet culture language from their vocabulary (e.g., “I’m so ‘bad’ for eating this,” “I’ll have to ‘make up’ for this food tomorrow with my workout,” “Thank goodness this brownie is the ‘guilt-free’ version,” etc.).

Advice for Primary Care Providers

Primary care providers are often the first responders for a patient’s eating disorder. They must treat a potential eating disorder as they would any other complex health challenge. Also, the primary care provider is the only member of the treatment team that knew the client before their eating disorder began, so they may have a relationship that is unique and not illness-based. This perspective could be beneficial throughout the recovery process if the primary care provider can recognize disordered thoughts and behaviors in contrast to an individual’s baseline. 

What Primary Care Providers Should Not Do

  1. Do not tell someone to wait it out.

A common mistake made in primary care offices is a medical provider saying, “Maybe you’ll snap out of it, come back to see me in a month and we can see what happened.” 

Two or three things are likely to occur in this scenario. The client may hear that what is happening to them is not that serious, perhaps thinking, “My doctor doesn’t think it’s a big deal, so maybe it’s not.” Another outcome may be that the person will get worse over the next month. And if the eating disorder gets worse, it becomes increasingly less likely that they will seek treatment. So, telling someone to wait should be avoided at all costs.

  1. Do not validate disordered behaviors.

A second problem is when providers don’t fully understand fully that not eating enough is far more dangerous for most people than eating too much. If I’m seeing a 15-year-old in my office who is either 30 pounds underweight or 30 pounds overweight, clearly that 30 pounds underweight is much more dangerous and life-threatening for that client in particular. 

Many times, the underweight client will instead be validated for their great weight control and the overweight client will be shamed. Neither of these responses are helpful and both increase the likelihood that someone who needs treatment will not get it. 

What a Primary Care Provider Can Do for an Eating Disorder Relapse

If there are signs of relapse, it is imperative that a client receives an eating disorder assessment. The experts who assess for eating disorders and level of care are fantastic, so the patient and provider should feel comfortable knowing that their client is in good hands. If a client does not think they are struggling but the provider sees signs of relapse, that is a very hard situation. It’s challenging to tell someone who doesn’t think that they are ill that they are. This is part of what makes eating disorder treatment so difficult and we wouldn’t expect all providers to be experts in this. 

The primary care provider can be in a great position to help facilitate getting help with the relapse, though. This can be done by pointing to specific medical concerns and saying, “This is dangerous.” This can include heart rate changes, weight changes, lethargy, and other things. Being able to say “these are the facts I’m seeing” rather than having a debate is important. 

I also recommend saying, “Go back and get an assessment, if you’re right and you aren’t ill, that’s what the assessor will say. I’m not asking you to start treatment again, I’m just asking you to go back, get an assessment, and prove me wrong. If you are right and that’s what the assessment says, I’ll back off.” From there, the patient will often complete an assessment, and a new plan can be put into place. In short, the unique perspective of the primary care provider can be a critical key in sustaining ED recovery. 

Your Patient Has Relapsed. Now What?

Similar to eating disorders themselves, relapse is complex. However you or your patient may define it, relapse is common. It does not mean your patient has “failed” recovery, nor does it mean that your patient cannot regain a path toward healing.

Your patients’ journey to recovery may not follow a straight line, but with your support, recovery remains within reach. If you feel your patient needs support beyond what you can provide, please do not hesitate to refer them to an eating disorder treatment center like The Emily Program. 

If one of your patients is showing signs of an eating disorder relapse and needs more support, The Emily Program is here to help. Refer your patient to us today by calling 888-364-5977 or by submitting an online form.

ABOUT THE AUTHOR


Mark Warren headshot

Mark Warren, MD

Dr. Mark Warren (he/him) is the Chief Medical Officer of Accanto Health, the parent company of The Emily Program and Gather Behavioral Health. His primary focus enhancing patient safety and providing comprehensive treatment that addresses both the physical and psychological aspects of eating disorders. Working alongside our executive team and our medical staff, Dr. Warren is dedicated to helping all of our patients embark on a path toward a meaningful and joyful life.

Dr. Warren is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders, where he co-founded the special interest group (SIG) for Professionals and Recovery and the SIG for Males and Eating Disorders. He is a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He has published and spoken extensively on males and eating disorders, professionals and recovery, and DBT and FBT in the treatment of eating disorders.

Dr. Warren is a founding member and former co-chair of the Academy of Eating Disorders Medical Care Standards Committee and serves on the FEAST Medical Advisory Board and The Visiting Committee of the Case Western Francis Payne Bolton School of Nursing.

Having personally experienced an eating disorder as a young man, Mark feels privileged to be working in the field of eating disorders for over two decades.



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