Relapse Prevention: The Signs You Aren't Looking For

So I've gone through my Prelapse Signs, and my red light, yellow light, and green light signs. Although I think it's invaluable to know areas that are likely to trip you up, it's also important to be aware of (to paraphrase Donald Rumsfeld) the things we don't know we don't know are going to sideswipe us.

Case in point: when I was in Europe last month to attend the AED Salzburg meeting and then tool around Austria for a week or two, I got a nasty stomach bug. This meant intense nausea, being unable to eat, and other fun symptoms that I'll leave to your imaginations. As a result, my eating was dramatically diminished for several days and dwindled to apple juice and some pretzels on one day. My mom was, not surprisingly, freaking out until she got what I had and we were both puking.

My mom's concern was that this not eating would make the ED thoughts come roaring back. I vaguely scoffed--the ED thoughts had been no worse than usual during the trip, and I'm doing better than I ever have, recovery-wise--and for much of the time, it was a moot point. I couldn't have eaten anyway. However, as the nausea started to diminish, I was at first very hesitant to start eating more simply because a) I was enjoying the novelty of no nausea and b) I was afraid it would aggrivate my stomach. Then the pushback started to take on a life of its own, and I just didn't want to eat. I started thinking that maybe this would be the perfect opportunity to lose some weight, and...

Yep. I was totally gobsmacked. I was back into full-blown ED thoughts and it seemed there was no "real" trigger. Except that bit about not eating.

Stomach bugs are inevitable, and so (almost certainly) is an inadvertantly missed meal or snack. Here's the thing: before I left treatment, I was warned about all sorts of relapse triggers, such as family problems, reading fashion magazines, hearing people talk about their diets, or other stressors. What no one mentioned was that being unable to eat (whether it was due to a virus, being stuck on a tarmac for 8 hours, whatever) for any period of time could also be a trigger. I never thought it would be such a potent trigger, either. You'll notice most of my relapse prevention plans don't really have much to do with these situations. Some of that is I can't really prevent many of these situations, and the other is that I really don't like that I'm so sensitive to changes in food intake. It really pisses me off! It seems so much less rational than an actual event to set off the ED.

Yet there you have it- the ED is the ED and my triggers are my triggers. It's not like one is "better" or "worse" than any other, and it's not that one trigger will only set off a benign relapse and another will be an utterly wretched relapse. So much of my relapse prevention planning has been coming to learn what my triggers are and accept them at face value, without judgement.

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Cathy (UK) said...

Agh... stomach bugs... Much of my OCD behaviour is linked to trying to avoid these horrors.

I had one of these last year and I inevitably lost weight. Once the nausea subsided I was scared to eat more in case it returned, but also because I knew I had to gain the weight back, and that meant eating more.

I have always been restrictive around eating, even pre-AN, and eating more than a certain amount freaks me out. It's so hard to explain, because it's not related to fear of getting fatter. It's just that eating more than a certain amount makes me feel VERY uncomfortable both physically and mentally.

I had a tooth extraction on Monday and couldn't eat all day because of bleeding and pain (the latter causing nausea). On Tuesday (still with sore mouth and galing, oozing hole in jaw) I had to resort to consuming sloppy high calorie stuff (Haagen Dazs ice cream...). I didn't enjoy it at all. I simply viewed it as 'medicine'.

EvilGenius said...

oh those are definitely my worst triggers too. if I look back at relapses over the years, the majority started with the flu, a hiking expedition, an upset stomach..etc etc. I was mostly already quite underweight then though...the thing which has affirmed my trust in my recovery most lately is discovering that now (I'm at a higher bmi than I've been before) I can forget a snack or miss breakfast and not have problems. I have stomach problems from the ED and lately they've been flaring up a bit, but a week or so of picky eating hasn't done much where it would have previously had me very triggered. however...I am sure there is a level of time spent eating less or weight loss where I would have problems...and I am not eager to find out what it is ;)

Angela Elain Gambrel said...

I ran into this last fall when I contracted the H1N1 flu. First I couldn't eat, but I was scared. Then I felt so bad I didn't care about eating or anything - I just wanted the flu to go away. Several weeks of this did cause some weight loss and again at first, I was frightened. Then the ED thoughts crept in ... then of course I was lost, unprepared and I went back and forth until I relapsed a few months later.

Now I keep Ensure in the frig for moments such as these. I can always get one of those down, even if it's with a straw. At this point, I am using Ensure to help with weight restoration, but it also helped a few weeks ago when it was so hot and humid I literally felt like I couldn't eat or I would be sick and of course that was another way the ED thoughts crept in ...

Other signs I need to watch for is certain stressors, i.e. bad news, triggering comments or feeling overwhelmed. This series has been really helpful in teaching me what I need to look out for, because knowing helps so much!

Thanks for all that you do - you have helped so many with this series and your other writings!

Anonymous said...

Its soooo easy for that to happen. That was one of the main causes of me relapsing last year.....
It just seems to creep up when I least expect it....

lisa said...

Ah, Carrie, my daughter is in residential tx and about3 weeks into treatment she developed severe nausea, repeated projectile vomitting, they continued to feed her initially until they realized this was a virus. The vomitting was not her MO but afyer she began ti feel better 24 hours later, she felt that desire to reflux and was confused. She began tio believe maybe she wasnt sick at all. I believe the virus triggered ed behaviors. It's so hard for so many to understand how these are real physiological triggers. Chemical changes in the brain wired for AN. You are a brave strong young lady and you have the right ideas about life..

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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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