What Are the Early Signs of an Eating Disorder Relapse?

Eating disorders are treatable, but it’s seldom a straightforward process. Instead of being a linear path, most people in recovery from disorders such as binge eating disorder, anorexia nervosa, or bulimia nervosa often follow a more back-and-forth path. It’s common and quite normal to experience relapse.It may seem discouraging when entering treatment for the first time, but eating disorder treatment specialists make it clear; expect to have some setbacks.

For this reason, modern eating disorder treatment facilities don’t stop their treatment after residential or day treatment programs have ended. They normally include “step-down” programs and/or alumni groups to continue their charges’ recoveries following discharge. These programs can provide support for recovering individuals and help manage potential relapses. There are a few ways a person in recovery and those closest to them can spot the factors that might contribute to a relapse.

These aren’t hard and fast rules, of course. Every person and every recovery path is different.However, there are some general signs that a relapse is coming. Here we’ll look at some of the ways a person in recovery can tell they are at risk for a relapse.

Frequent Signs That a Relapse Might Be Coming

Mindfulness training is a major part of most eating disorder treatment programs. These practices teach individuals how to become aware of their emotions and thoughts in an objective way, being able to experience them without acting on them. However, mental health disorders have a way of obfuscating a person’s thoughts and perpetuating themselves, even after treatment. There are several different signs and symptoms of a pending relapse, though. Here are some commonly observed indications that a relapse might be coming.

Mechanisms for Coping With Eating Disorders Are Becoming Less Effective

Most eating disorder treatment programs introduce skills designed to deal with stress and other triggers for relapse. When the healthier coping skills taught by eating disorder specialistsfail to work, that is a clear sign that additional help is needed. One example of these skills is mindful meditation. Clearing the mind regularly through meditation helps people in recovery re-center and become more aware of their urges to use disordered behaviors. When a person stops using this technique, or it becomes less effective, it can mean the is a risk of relapse.

There are many other coping skills available to people in recovery, and one type of skill being less effective doesn’t necessarily mean a relapse is on the way. Overreliance on one particular technique can be a recipe for disaster – it is often a process of trial and error trying to find what works. However, if several or all of the coping mechanisms are becoming less effective, or the person is not using them regularly any longer, it can be a trigger for a return of disordered eating behaviors.

Stress and Emotional Trauma Are on the Rise

Stress and trauma are the most powerful triggers for relapse when it comes to eating disorders or other kinds of mental health conditions such as substance abuse disorder or depression. Eating disorder behaviors release dopamine, which alleviates negative feelings and emotional trauma. For this reason, people with eating disorders often resort to disordered behaviors like binge eating, purging, and calorie restrictions when they are feeling especially stressed or have experienced trauma.

Most people think of stress as coming from things like work or school, and those elements can certainly cause problems for people in recovery (or otherwise). However, trauma can come from a wide variety of sources. Things like relationship difficulties, medical issues, worrying about problems friends or loved ones are having, or even something as simple as being stuff in traffic can cause stress. Managing these stressors, often with coping mechanisms like we mentioned earlier, is essential for preventing relapses.

Drops in Self-Esteem

Body image is central to many forms of eating disorders. In particular, binge eating disorder, anorexia nervosa, and bulimia nervosa behaviors are often driven by a distorted body image that makes people unhappy with their weight or body size. Oftentimes, a person in recovery will begin to gain weight after the disordered eating behaviors have stopped; this leads to bouts of lowered self-esteem that must be managed. Low confidence in the effectiveness of the recovery program can also trigger the return of disordered thought patterns.

There are post-treatment (also known as aftercare) activities designed to maintain a workable level of self-confidence and self-esteem. When a person is feeling bad about themselves (and please note that it’s not always about the body or weight), they are at much higher risk of returning to disordered eating behaviors.Fortunately, they can often receive help from their treatment team or local therapists and support groups. If reaching out to them is too difficult at the moment, they can also tell their social support system or a private therapist.

Increasingly Distorted Thinking Patterns

Eating disordered treatment centers use techniques like CBT and DBT to help clients identify disordered thinking. These clinical exercises show individuals how their thinking affects their behavior and emotions, and how to avoid using eating disorder behaviors. Disordered thought patterns almost always return before a relapse. Like any mental health disorder, eating disorders and their associated thinking patterns always remain, but have to be managed. In other words, the thoughts and feelings associated with the disorder can come back at any time. But when they will not stop, the thoughts could make it hard to remain recovered from bulimia nervosa and other eating disorders.

However, when these thoughts begin to recur more frequently and more insistently, there is an indication a relapse could be imminent. Even after treatment, objective perception of your thoughts is difficult,so people in recovery are often encouraged to write in a journal. It’s also encouraged to speak with someone regularly and to be frank about their thinking and emotions. This can be a therapist, a fellow recovered person or a close friend.

Increased Body Consciousness and Dieting

There’s a saying in eating disorder recovery circles; “Diets don’t work.” For a person prone to disordered eating, the potential health benefits don’t nearly keep up with the drawbacks of self-critical body perception. If a person in recovery starts to count calories and engage in dieting, especially for a person with anorexia nervosa or bulimia nervosa, it’s an indication that disordered eating patterns might soon follow. For a person in recovery, it’s much better to gain weight than take measures to control it; many programs ask their clients to use a “restore” meal plan to help them gain weight.

Another sign that disordered eating behaviors may return is increasing justification for these behaviors. As an example, a person with binge eating disorder might say that they’ve been “good” all week to excuse a binge eating episode. Or a person in recovery from anorexia nervosa might say their doctor recommends losing some weight “for their health.” If a person you know is making these kinds of justifications more frequently, it might be a sign they are returning to disordered eating behaviors.

Friends and Family Mention It

It’s easy to miss many of these signs in yourself.  Many people who suffer from mental health conditionscan’t accurately perceive their disordered behaviors, ignoring the signs that are right in front of them. Unchecked, minor changes in thinking can lead to relapses.

Friends and family, however, can help by educating themselves about eating disorders and their typical behaviors. They can then, with compassion and without judgment, mention it to their loved ones.If a person in recovery hears that their friends and family are concerned about changes in their behavior, it might provide a wake-up call that can help prevent a relapse.

Just feeling out of sorts is another way for college students to gauge their well-being and see if they are doing okay in remaining recovered. Any time emotions or behaviors swing out of control, it is a good idea to seek help from skilled eating disorder treatment professionals.

How Treatment Programs for Bulimia Can Assist

Eating disorder treatment centers tend to have alumnae services and aftercare programs available to their clients. Most programs make aftercare a core component of their treatment plan. These services often include:

  • Online therapy sessions and peer meeting groups for support
  • Family resource libraries with educational materials
  • Guides to local support services and therapists

When people in recovery need additional support, all they have to do is reach out to their therapists or other members of their care team from residential treatment. They can then select from the many different resources available to them. A relapse is not the end of the world, but it can be prevented. If you’re in recovery or know someone who Is, the most important thing they can do to prevent relapse is to reach out regularly to friends, family, and professionals. Eating disorders can be overcome – it’s essential to take advantage of available resources to keep it going strong.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.