When in recovery, it can feel like an empowering experience. You may feel that you have more control over your life once you have been balancing life and recovery for a while.
But then it hits, a stressful situation, or unrecognized trigger and you find yourself beginning to slip on recovery priorities. Soon you may find yourself back in the throes of an eating disorder. Seeking treatment is a brave and honest step towards getting back on track with recovery.
Tell your therapist and treatment team at your next appointment, or if it feels like a crisis, you can call your treatment team’s hotline, or local hotline for assistance . If you feel that you are unable to be safe with yourself then call 911 or go to your closest emergency room.
Work to follow your relapse prevention plan, but if that seems to be too overwhelming or the slip has turned into a relapse, then you might need to look at higher level of care for treatment.
When to Seek Higher Level of Care During Eating Disorder Relapse
Often, the phrase “higher level of care” brings on eye rolls, facial expressions of anxiety or fear when presented by the outpatient treatment team. Higher level of care is a way to help you overcome your triggers and symptoms of the eating disorder. It does not mean failure in anyway.
Higher level of care might mean residential treatment, where you stay 24 hours in a facility where you are supported through the treatment process. All meals and snacks are provided at this level of care. Full days of therapy and group therapy are also included.
Partial hospitalization program (PHP) is where you spend 10 to 12 hours a facility but are able to go home at night. Typically, all meals and snacks are provided at PHP level. In intensive outpatient programs (IOP), group therapy is offered 3 hours a day up to 7 days a week. You are often responsible for bringing your meal and/or snack to the programming.
The Complexities of Eating Disorders
Simply put, eating disorders are a mental illness that can cause disruption to a person’s eating patterns, body functioning, and cognitive awareness .
Anorexia is characterized by significant food restriction, massive weight loss and an obsession with body shape and size.
Bulimia is marked by binge and purge episodes where the purges can be compensating behaviors of vomiting, laxative use, over exercise, or diuretics.
Binge eating disorder is where individuals will consume large amounts of food in a short time period, more than is normal for their culture and society.
The person does not engage in compensating behaviors and will feel shame and guilt and potentially try to hide evidence of the binge episode.
All of these types of eating disorders can cause serious, life-threatening physical and mental issues .
In bulimia, serious damage can be done to the gastrointestinal tract, individuals can develop an electrolyte imbalance, and there is increased risk of cardiovascular disease. Anorexia can cause muscle wasting, heart and brain damage, and multi-organ distress and failure. Binge eating can cause high cholesterol, diabetes, obesity, heart issues, and potentially sleep apnea.
In eating disorders, dopamine, or the reward center chemical, seems to be altered . Those individuals struggling with bulimia have weaker than the general population response in the reward circuits. Those with anorexia tend to be overly sensitive to food-related stimuli .
New research also shows that those with anorexia tend to have higher rates of habitual behaviors, linking to higher activity in the dorsal striatum . This study leads researchers to believe that eating behaviors and patterns may have more to do with habit than willpower.
Returning to Eating Disorder Treatment for Recovery and Support
Emotions are static. They change, evolve, and dissipate. They are not always the same, and our mind and body can withstand any intensity of emotion we have. Thinking you are a failure is an emotion. You will not feel that way for the rest of your life. You possibly felt that way prior to your first treatment and maybe your last treatment attempt, but each treatment admission is a brave step towards recovery.
Each treatment stay is a learning tool. It allows you to build on the treatment you have received before. Often, many clients report that they do not recall most of their early treatment experiences due to being so caught up in their ‘ED head.’ Multiple treatment tries, at various levels, is typically what it takes for a person to be motivated, committed, and in a healthy mind-space to be able to have the treatment work.
Treatment, no matter how many attempts, is not failure, it is progress. It is progress toward new coping skills, feeling new emotions, learning new skills, and making new supports along the way.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References: Slips, Lapses and Relapses. (n.d.). Retrieved June 11, 2017, from https://www.nationaleatingdisorders.org/slips-lapses-and-relapses
 Weir, K. (2016, April). New Insights on Eating Disorders. Retrieved June 11, 2017,
from http://www.apa.org/monitor/2016/04/eating-disorders.aspx American Psychological Association, Volume 47. Number 4
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on August 25, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 25, 2017.
Published on EatingDisorderHope.com