Relapse Prevention: Red Light Signs
Even the best relapse prevention plans might not prevent a full-blown relapse. Maybe you miss the signs, or maybe you can't figure out how to stop the relapse yourself and you end up in trouble. The point is to identify concrete, specific criteria that will spur you into action. The point of identifying red light signs isn't to identify when you're back in so deep with the eating disorder that you're severely medically compromised. The point of red light signs is to know when you have to STOP whatever you're doing because you're in trouble. It means that a relapse is clearly underway and needs to be addressed NOW. Not in five weeks now, not in five days now, NOW.
When I created my list of red light signs several years ago, they were really rather far beyond red light signs. I said that I would get worried if I dropped below X pounds. In reality, X pounds usually has me deep in the throes of ED and so far gone that I can't pull myself back out without very intensive, 24/7 support. Yes, the ED was helping me write my relapse prevention list. The other issue was that I was too afraid of creating a big deal out of nothing. I didn't want to send in the proverbial troops because I was deeply ashamed of the possibility of struggling again.
What I've learned is that ignoring the signs of relapse doesn't make relapse any less likely. I've had to (ahem) eat a large slice of humble pie and realize that my predisposition to AN isn't going away, and (to quote Mad Eye Moody from Harry Potter) the price of freedom is eternal vigilance. It means risking crying wolf when I find myself struggling and it's really not all that bad. It means empowering my parents and other support people to speak up when they see certain signs, and taking appropriate action. It means not believing everything I think (i.e., it's not that big of a deal, I've weighed/eaten less, I'm not hungry/don't like that food). It means being open to others' feedback because I'm not always the best judge of when I'm in trouble.
Now that I've gotten that out of the way...here are my Red Light Signs:
- not adding milk to my coffee
- avoiding mealtimes
- hiding food
- exercising in secret
- not taking a day off from exercise
- lying about what I've eaten (yes, even little white lies count!)
- ongoing insomnia (it might be the ED, it might be something else, but lack of sleep is one of my big triggers!)
- counting calories
- visiting calorie count and/or diet websites looking for tips/information
- purging
- subsituting candy for more nutritious food
- drinking calorie-free beverages instead of eating
- deliberately limiting calorie intake
- feeling cold
- extreme surge in anxiety and depression in conjunction with any other red light sign
- extreme fatigue (again, it might not be the ED, but it does need to be looked at)
- mentality of "I can't recover so why bother"
I still use a meal plan to help me maintain my weight, and I've worked in enough flexibility to use it more as a guide. Which makes sticking to my meal plan either a good sign or a bad sign. The bad sign is obvious: more rigidity and anxiety around food. But returning to closely following my meal plan could also be a good sign: it provides accountability against relapse. I know that if I follow my meal plan to the letter, I won't gain OR lose weight. By measuring things, it forces me to be more aware of where I may be cutting corners, and ensure that I am eating enough.
What to do with red light signs will probably vary depending on the sign and how many of them there are. It might mean an immediate phone call to my therapist and dietician asking for support. It might mean asking a friend to meet me for breakfast/lunch/dinner to help me stay accountable. It might also mean asking my mom to serve me all my meals and snacks for a few days until I'm feeling more steady.
Tomorrow's post is going to be interesting: relapse signs you probably aren't looking for (but should be!)
10 comments:
I agree that using my meal plan can be a double-edged sword. On the one hand, I have to keep it in mind so that I have a realistic idea of what I should be eating. Measuring also ensures that I'm not skimping on what a serving size is. Of course, on the other hand, I can become super rigid with my meal plan. Not adhering to it 100% can cause increased amounts of anxiety. When I have to measure everything, when I have to eat certain things (or can't eat certain things), when I'm counting every single calorie... then my meal plan is a problem. I try to stay flexible regarding it, and my dietician is good about that as well. Sometimes I keep "food records" for her, and sometimes I don't. It just depends on how I'm doing in recovery and what stressors I'm facing.
Thank you for that list, I can really relate to those signs and I think that I'll make my own list right now. I'm also going to ask for help and actively change what I've been doing NOW because I know that I'm slowly slipping. I had told myself I would ask for help in a week, or when I lost a certain amount of weight, but I know that's my ED talking and I can't afford to wait any longer. Thank you!!!
Thank you! I have been reading your blog for a few weeks now, and have found a lot of help in what you're saying.
I am going to use your example and write out my own relapse prevention plan. As a compulsive overeater, my list will undoubtedly be very different. Still, there are subtle (and sometimes obvious) signs that things are going awry. Would you mind if I link these posts in my blog (when I get around to writing my own plan)?
Carrie,
These "relapse prevention" posts are fantastic. They're comprehensive, nuanced, and as always, fantastically articulated. Thank you so much. I've printed out the other ones--this one will be joining them on my wall.
I'm very intrigued to see the next post!
Rachel
Thanks for these pre-lapse/yellow light/red-light posts. I also see connections in what I call my "general anxiety" levels and specific behaviours like writing a list of everything I've eaten that day, avoiding certain food, etc etc. It's nice to see someone speaking openly about these things.
My best friend is annorexic... she went to treatment twice now & she's been back home almost 4 months, I thought she was doing really well, but now I fear she may be relapsing. This page was extremely helpful for me, I want to help her & be there for her always & this gave me a few things to look out for... so THANK YOU
My girl friend is doing everyone of these red light signs and she won't seek help. I don't know what to do
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