Catching the Lapse

Success in treatment is no small feat.  You’ve faced difficult fears, questioned unhealthy assumptions, and changed behaviors that had seemed immutable.  So you’re all set now, right?

If only maintaining hard-earned gains were that easy.  Instead, more often than not, the process of recovery is, in fact, a process, meaning that it involves continued progress and continued effort.  Part of the recovery process is acknowledging and appreciating your successes; another part is expecting that challenges and obstacles will arise and bracing yourself for the inevitable bumps in the road.

While navigating those bumps and obstacles, it’s critical to recognize the difference between a lapse, a relapse, and a full-blown collapse.  A lapse is a single instance or event that marks the re-emergence of a previous habit.  For someone recovering from an eating disorder, a lapse may involve skipping a meal, exercising while sick or injured, or refusing to buy a cute skirt because the size that fit well was “too high.”  Lapses are normal and often valuable experiences – they provide information about areas of vulnerability that encourage further growth and prepare individuals for future success.

Lapses are also invitations for self-reflection, decision-making, and action.  They can be like bumpers on the sides of a bowling lane, nudging the spinning ball back to center, or they can be the gutter, derailing the ball from its intended course.  Research on relapse in mental illness suggest that the most important factor determining whether or not a lapse becomes a relapse or a collapse is the person’s interpretation of and response to the lapse.  In short, mindset matters. Relapse is much more likely when a lapse is interpreted as a sign of negative, unchangeable qualities about oneself (e.g., “I fail at everything”) and significantly less likely when situational factors are considered (e.g., “That party was really stressful and challenged me beyond my capacity to cope.”).  In fact, taking an honest look at the factors that contribute to a lapse can point to new directions for promoting positive, healthy change.

Preventing as many lapses as possible and keeping the inevitable lapses from becoming relapses and collapses requires sustained effort.  However, like most things, the more you do it, the easier it becomes.

The following guidelines are designed to help you lower your risk for lapses and relapses at any stage in the recovery process:

Stay aware. 

• Especially in the early stages of recovery, it is important to keep a watchful eye out for the re-emergence of unhealthy thoughts and behaviors.  The changes may be subtle – cutting back on added fats or making comparisons to other’s bodies – or they may be obvious.  Seeing lapses for what they are, however big or small, is an important step in keeping them from developing into a pattern.
• Anticipate stressors and plan ahead.  Know your vulnerabilities and weaknesses.  Do you fare better or worse during busy periods?  Are there certain times of year when you tend to struggle more with eating or body image?

Stay calm.

• Avoid catastrophizing; remember that lapses are a normal part of recovery and will help you grow stronger if you let them.
• Let the lapse guide you back to health.  Be gentle with yourself, find ways to self-soothe, and recommit to putting your best foot forward.  Try to keep your focus on the present moment, practice accepting reality, and remember to be grateful for the good things in your life, including how far you’ve come in your recovery.

Stay supported.

• Identify sources of positive support such as friends, family members, and mentors.  Some people also find a community of individuals going through recovery from an eating disorder to be a useful source of support. Don’t be afraid to ask for help and rely on those who have offered to be there for you, while still respecting their limits and needs.  Also, consider giving your supports permission to talk to you if they notice certain early warning signs that a lapse might be on the horizon.
• Consider staying in treatment longer than you might feel is necessary so that you can navigate life stressors with a built-in support network.  Give your treatment team permission to check in about symptoms like exercise, purging, or restricting long after they’ve ceased to be active problems; this will keep those behaviors on your “radar” and will make questions about them feel less loaded.
• If it’s been a while since you’ve been in regular treatment, know when to seek professional help.  If your lapses are more frequent or more intense now than they were a month ago, it may be time to check in with a clinician.  If any medically dangerous behaviors have re-emerged (e.g., regular purging, rapid weight loss, compulsive exercise), seek help from a therapist, nutritionist, or medical doctor as soon as possible.

Stay engaged in your life.

• Maintain and develop other aspects of your life to slowly take the power away from your eating disorder.  Cultivate other interests; volunteer at a soup kitchen, join a book club, take art classes.  Devote your time to activities that give you a sense of purpose and meaning.
• Set short-term and long-term goals for yourself and give yourself rewards for taking steps toward your goals.  Living your life purposefully and authentically every day will remind you why recovery is worth the continued effort.

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