Relapse risk

When normal becomes normal again, most parents' focus turns to a fear almost as bad as at the beginning: "what about relapse?"

"The strong effect of insufficient weight gain during first admission and lower BMI at first discharge emphasizes the importance of adequate interventions."

For home-based treatment the rules for long-term success are the same: sufficient initial weight gain, and don't quit before the job is done. But we have an advantage: time. We can assure maintenance of weight and behavior and supportive environment for longer than any insurance policy or home equity loan checks to residential treatment.


  1. This is something I worry about a lot and my husband thinks I'm nuts. My daughter has been weight restored for 3 years. However, I still find her thinking odd at times. She will still make comments about being 'fat' at times, not liking her body, will still occasionally do the repetitive mirror checking, etc. This makes me understandably nervous. She is more comfortable than previously with friends, but I wouldn't say that she is relaxed. I can tell she is 'working' at it. So, the anxiety level is still somewhat heightened. She goes through periods of being picky about what she will and won't eat, but she has maintained her weight just fine--if anything, she is a bit on the heavier side for her "natural" projectory pre AN. So, I am as vigilant as I can be without becoming overly anxious myself, at least in front of her. I am a bit surprised by all this given that she's been weight restored for so long and hasn't had any dips or relapses. Maybe continued counseling or CBT does have a place at this point if she wants it. Have others had this experience?

  2. My daughter has been at a fully restored weight for 6 months and I'm trying to learn about how to help avoid a relapse. There doesn't seem to be a lot of good scientific information out there. Like you, anne, I'd be interested in hearing from others who have insight.

  3. Anne, as a patient, and a mother ... I have to say there is more than weight to an ED ..and her behaviors are very ED based. You're right to be concerned. She may be just experiencing the OCD part of the eating disorder ..or she may be bulimic and you'd never see any eating disorder behaviors because they are all so secretive.

    I would strongly suggest getting her some help.

    even if it's *just* OCD, her thoughts are most likely interfering with her daily functioning.

  4. Thanks, dreaming. I have never, ever seen any bulimia from her in all these years. But her thoughts and other behaviors due worry me.

  5. I believe anyone who has had an eating disorder is always at risk of relapse - it is a biological response to low nutrition for people with these types of brains.

    I think what makes the difference between those that stay well and those that continue to dip back is a combination of skills and support.

    You can live well above the level of the water, or just above it, but the water is still there.

  6. True true,

    I just heard from a friend whose treatment facility set her a target BMI of 18.5 -- which is of course ridiculous -- as she is an adult.

    Kind of pisses me off when MY program insisted I get to a BMI of 20 -- and 2 kilos over for insurance.

    But having been at a "kinda" healthy weight, I truly believe there is a risk of relapse under a BMI of 20. This has also be proven through research.

    A :)

  7. My ED is ED-NOS so BMI isn't an issue.

    For me, my relapse was related to the fact that I simply did not believe that the ED could kill me.

    I had a medical scare (they thought I had diabetes) which scared the DAYLIGHTS out of me ..the idea of not having a say of when I eat, how much and what content ...shocked me into cooperating with my treatment team ...for a couple of years.

    Then I got under too much stress ...and I had a significant relapse ... SEVERE relapse ...

    Now, weight isn't an issue ..but my blood tests for 2 months in a row show malnutrition, and I've got severe pitting edema with my kidneys working overtime (which, if they do that too long, they go into failure)

    It took the edema for me to realize the ED could actually take MY life ...

    I think I had to get real with what an eating disoder could do to me before I could do anything about it. I'm 2 weeks into the realization ... and 2 weeks into the terror of really recovering.

  8. DA,

    I want you to know how I admire and cheer for you. I am so glad for your steps toward recovery.

    I'm wondering what you make of the research discussed in this article:

    Kaye believes that anorexia kind of makes the brain "blind" to most of the effects of the ED that the people around the patient are jumping up and down about. Does this resonate for you?

  9. Absolutely. Blaming the media is an easy out.
    It is also an easy thing to focus on rather than the real issue at hand (not feeling the emotions that one is trying to avoid feeling that must be felt in order to recover).

    Spending hours a day searching through the ultra thin models, trying to find the thinnest one, to compare one's body to ... and declare that therefore I must be fat ... would give someone's mind something to focus on ...very ED behavior.

    Just like focusing on being hungry, and not filling that hunger, or counting calories and making sure you don't go over that 'magic' number.

    Media models are not the cause, yet another ... crutch? ...not sure that's the right word.

    I cringe when I hear the blame placed on the media and models because as long as it is about looking like a model ...then it won't be about a coping mechanism to not deal with pain.

    Make sense? I feel like I'm rambling.

  10. I had anorexia in 2005. I am 18 and a half now and I am terrified of relapsing for the second time. I have recently lost 10 kilos due to exercising, but my eating has been on track.

    I am seeing a psychologist, a dietician and a doctor and I am still so afraid of relapse!

  11. Anna,

    Is your family involved with your care?


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