Recognising relapse: my personal and professional perspective
Amy-Jasmine is an Art Psychotherapist who battled with eating disorders prior to training. Five years on from a relapse, she shares her insights.
What I can tell you about my experience of the early stages of relapse I hope will be helpful to friends/family/colleagues and employers and people in recovery, to make helpful choices and not ones that mirror the eating disorder anxiety and control.
EDs whittle away your confidence in whatever you usually do well. Even with years of psychoanalytic psychotherapy, I still often feel powerless to fight back when the fear of eating creeps upon me and the battles between my recovery self and anorexic self kick in. There's many dos and don'ts about how to be supportive, and they aren't the same for every person, but here's my own thoughts.
If people don't understand, I feel like I cannot share my feelings. Too often I've been met with dismissive or unhelpful comments. My experience is that you can have disordered eating for months, and behaviours can get really entrenched and unmanageable before people finally notice you need some help. By then it's panic stations because too much weight has visibly dropped off. As if until you appear thin and weak, everyone colludes with the denial of the problem. It doesn’t need to be that way, and intervention can happen so much sooner if we all see the signs and stop looking at body weight as an indicator of illness.
Not having many friends or family nearby, the people I work with are the ones I need the most support from. I don't need them to supervise or try to fix me; often I just want to be able to normalise and calm the chaos in my head. It helps to sit down and eat with others and be distracted from my thoughts. There's something about eating together that makes it less frightening. But after a meal the thoughts can get really loud, especially if I feel too full.
People don't realise how attacking or judgemental their 'support' can sometimes be. Please don't tell me to "stop analysing" or my "thoughts are irrational" because it won't help me. Judgements just fuel the inner mantra that says, "You need too much, you're greedy and stupid and did this to yourself and they just want rid of you." I often think people regret making friends with me. That isn't a helpful thought to focus on.
Don't label them "attention-seeker". This phrase is steeped in negativity, and what I hear is, "You're a drama queen with pointless worries." Even though you don't intend it that way, I already feel like I am annoying enough so your words get twisted because our inner narrative can become our reality.
Be thoughtful about how you respond to someone and if you don't know what to say, it's okay to say that, as long as you communicate wanting to understand. Sometimes just saying, "I know it's painful but you can do this, you need to" is all you need to say for someone to know they’re not alone. Sometimes asking the difficult questions like "What have you managed today?" can break the cycle of restriction and loneliness.
Having purpose and identifying my personality outside of anorexia has been pivotal to my recovery. I believe being supported to stay in work and focus on what you are good at can distract from thoughts about food. If someone is made to stay home and rest, lack of purpose and loneliness can leave space and time to further perpetuate ED behaviours. If you are an employer, don't freak out and send your employee on sick leave; work together to find what is right for each individual. There is a time for sick leave, but it might not be at the point that you become aware of the employee’s problem.
Look out for preoccupation with weight, size, food and body parts. If I'm saying I feel fat and want to "fit into" something, here's your first clue. Negative talk about body and/or excitedly joining in conversations about diets is toxic. Eating disorders can be very competitive. Listen out for resolutions of exercising more. People probably won't be explicit about their struggle. It's too hard to name the problem.
Look out for lethargy and tiredness. You can bet if I'm not eating, I'm not sleeping well either, and my exercise regime is taking all my energy.
Notice lapses in concentration and absent states generally. Also, avoidance or long pauses and indecision when offered food or choices. That pause is where my anorexic brain is screaming at me not to eat, telling me lies about the foods on offer and making me think I'm not hungry, because "not hungry" is the easiest defence. Indecision is indicator that I'm having an internal battle.
Look out for always being busy, on the move, filling any moment with things other than eating. If I'm too busy or have too much to do, it's likely my internal voice is prioritising the jobs I need to complete above eating, because eating is stressful, but so is having lots to do. Encourage me to spend some time with you whilst we eat and chat, or have a 'working lunch' together. Distractions make it easier to eat. Silence is dangerous.
It's okay to tell me I'm not eating enough, and encourage me to eat more if done gently. It's okay to challenge the anorexic thoughts.
Listen out for "painfully full". People may struggle to appropriately regulate portion size. If what I’m eating is hurting my stomach, I've probably not been eating enough or regularly and the discomfort of feeling too full is when I'm most likely to make myself sick to relieve the pain and intrusive thoughts. Some people become very distressed with the feeling of fullness. Be with me, and offer reassurance. Some anorexic behaviour will mean people try to hide food to pretend they have eaten it even if they want to get better.
Look out for social withdrawal but increased media messaging and neediness to be responded to. For me, it's a sign I can't be alone with my thoughts but am also too scared to be 'seen' by people. It's my eating disorder’s way of sabotaging wellness, to withdraw from activities, but it might also indicate exhaustion through not eating enough or exercising too much.
If I tell you about my lack of appetite this is an invitation not to ignore. You don't have to have long in-depth conversations, just be mindful that this might not be just one bad day, but a road to something more enduring.
If someone you know says this a few times, you might need to ask those difficult "What have you had today?" questions and encourage more energy dense foods.
For me relapse didn’t start with restriction or cutting out food groups; it started with not feeling hungry and struggling to force myself. If you have a good relationship with someone who appears to be eating less, you could ask them, "Are you having negative thoughts about food or your body?" This could be the opening someone needs. Often responding to a direct question is easier than open-ended "Are you okay?" questions where the easiest thing to say is "Yes, I'm fine."
Often there isn't treatment or support from services until you get really unwell, so friends, family, colleagues and even employers can be so valuable if they learn about eating disorders and relapse before it gets that bad.