Relapse Prevention: Prelapse Signs

On Saturday, I shared some of my recovery green light signs, which was a list of thoughts, behaviors, etc, that were indicating my recovery was going along well. I am going to share my yellow light signs (warning signs of relapse) and red light signs (take action now, do not pass go, do not collect $200). But somewhere in between green light and yellow light are the signs of prelapse. If yellow light are the signs preceding a relapse, then prelapse consists of the signs before the signs.

I realize I haven't really defined some terms, so that we all know we're referring to the same idea, here are some (brief) definitions:

lapse: a one-time return to ED behaviors. It means you purged once, or skipped a meal, and so on.

relapse: an ongoing return to ED behaviors.

prelapse: the indication that you might be be heading for a lapse or at high risk for a lapse. It doesn't mean a return to ED behaviors.

Some of my prelapse signs are very related to the eating disorder (urges to skip meals, increase in body dysmorphia) but many of them aren't. Although I'm not sure that eating disorders have nothing to do with food, many of my vulnerabilities to anorexia and to returning to anorexia have nothing to do with food.

Here is my list of prelapse signs:

  • preoccupied with food/eating
  • avoiding friends and family
  • urges/compulsions to overexercise
  • increased rigidity in life and activities
  • thoughts/urges to skip meals
  • increased preoccupation with body image
  • lingering sadness and depression
  • feelings of restlessness
  • return of OCD behaviors
  • difficulties sleeping
  • intense feelings of guilt and worthlessness
Many of the things on my list of strategies to deal with these prelapse signs are similar to what I wrote in an earlier post on identifying your triggers.

  • deep breathing
  • reduce stress
  • ensure adequate sleep
  • make plans with friends and family even if I don't feel like it
  • snuggle with Aria
  • work on creative projects (crochet, jewelry, etc)
  • practice opposite action (watch a funny movie when I'm feeling down)
  • eat several tablespoons of peanut butter before bed
  • practice self-compassion
  • increase appointments with treatment team
  • BE HONEST about urges
Please share some of your prelapse signs in the comments section!

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Cathy (UK) said...

Great post Carrie, and I like the definitions :)

I have occasional lapses, which I know are not prelapses. Prelapses set of 'warning bells' and it's often the time that I ask my psychiatrist/therapist for an extra talking session.

My main prelapse signs are as follows:

*feeling overwhelmed - by life - and consequently over-anxious
* feeling hopeless/low mood
*shutting myself away and ignoring the telephone
*having urges to over-exercise or to restrict food, but for no reason other than it makes me feel more 'in control' of my anxiety and my existence

I really like your list of strategies to deal with signs of prelapse...

BTW, have you ever tried cashew nut butter? It's twice as expensive as peanut butter, but twice as yummy :D

Abby said...

I found this post helpful in a slightly different way, in that many of your "prelapse" behaviors are characteristic of how I am right now. Knowing that (for you), those are signs of slipping back lead me to believe that although I am making progress, I still have to be aware that my behavior isn't "normal."

June Alexander said...

Dear Carrie,
I never cease to be amazed at the similarity in our thought patterns. Your current post is my experience in every instance. At your age, I thought I was the only one in the world, having such bothersome thoughts. It is comforting to know, even at my age (ancient enough to be a grandma) that I am not alone, that others share my inner 'language'. Catching those triggers before the lights turn amber took me years to master and I continue to be vigilant.
Ride on Carrie, keep heading for the light. Your writing and your insights are always a delight.

Anonymous said...

I'd have to add irritability to that list of prelapse signs-- when ED urges are in the back of my mind I tend to be quick to lash out at loved ones for silly reasons. I also find myself talking more negatively about things I usually like (my classes, relationships with friends, my career).

kushika said...

I like the idea of the traffic light system analogy and you post has made me realise that relapsing is not a black and white sort of thing and that ED behaviours can occur along a continuum.

Thanks for posting all these wonderful posts!

Angela Elain Gambrel said...

Many of my prelapse symptoms are similar to what you listed. I also tend to get crankier and more argumentative, particularly about meals and food. Another sign (I hope this isn't too personal) is that I start to lose interest in sex. I feel overwhelmed by everything, even the smallest things that seem inconsequential - answering an e-mail, reading an assignment, taking a story to write or even going to the store. It is harder to get out of bed and harder to just be.

And perhaps the weirdest thing is that I stop listening to music, which I usually love to do.

Reading the list makes me realize I'm in a prelapse stage (although I had already suspected that) and heading toward a relapse (if I ever left the original relapse in the first place).

I'm fighting it - still attending class, doing my assignments, trying to do social things - in spite of the massive anxiety it brings. And I'm still meeting with Dr. S. and now have a dietician on board. But it all makes me very tired.

(Sorry for the depressing post. I'm just not in a good space right now, but it will come!)

Anonymous said...

I just want you to know that I find this post pretty helpful, at least for the moment, as I sit at 32, at work and unable to concentrate on work itself (hence why I am reading up instead of finishing a presentation like I should be...)

For me I'm in my recovery at a very stable weight for a few years now. But my preoccupation with my weight and with guilt surrounding eating, water weight, weight at all - fear and total unrest with differentiating scales and their vast difference in scale weight numbers...

Some days are better than others, and I am able to focus on the things in my life that are really, really good because of my recovery weight. I'm able to turn away from the scale even though I do weigh myself, and not to want to purge every meal I consume...

but other days the insane amount of guilt that I feel as a result of eating - and in that case, plain old regular meals, the healthiest -- by anybody's standards - is almost unbearable.

What I ask you good people is this: why don't I feel like I am doing the right thing by eating regular meals? Why do I feel like my heavier weight (and in this case, heavier than I was at my healthy weight long before my eating disorder ever entered the picture) is so dramatically much a direct indication of my losing any self discipline and worth of a better body, a smaller waistline, and therefore of feeling good about the way I look?

Anyone else struggling with adult onset anorexia/purging disorder, the recovery from it and then the continual mini lapses and times of body checking, dysmorphia, obsession with the scale and how you look in all angles, mirrors, pictures...

Can you give me some advice? I don't want to fully relapse. Not again.

Thanks for listening, back to work I go.


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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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