Lapses, relapses and pre-lapses are part of the cycle of recovery from an eating disorder, just as they are from any powerful addiction. I was recently asked to write a blog post and do a podcast episode about how to recognise the signs of relapse and prevent it. Pulling on the content from the relevant chapters of my two books, Addicted to Energy Deficit and Aiming for Overshoot, I'll give a detailed oversight of these critical points in recovery.
This post is the first in a series of three on the topic of relapse. In this post I cover what lapses, relapses and pre-lapses are and the differences between these concepts. It also explores what's happening in your brain when you experience a lapse or relapse.
The second post covers the signs that you are experiencing a lapse or relapse and what to do if you notice things are sliding.
And the final post covers how to prevent lapses or relapses and what to do to give yourself the best chance of getting and staying firmly in a fully recovered state.
Relapse With An Eating Disorder
Relapse is the term you are most likely to be familiar with. A relapse in relation to an addiction or eating disorder is when you have all but overcome the addictive disorder but then return to fully using your drug (in this case, energy deficit).
Perhaps you have fully abstained from all the eating disorder habits for a prolonged period. You are fully out of energy deficit and have restored to your set point weight. The brain circuitry driving the eating disordered behaviours has been unwired from the old habits, and new non-disordered habits have wired in strongly so they are now automatic. Your dopamine deficit has restored to a healthy level and ultimately, you have fully overcome the eating disorder, mentally as well as physically.
A relapse is said to have occurred when you are at this recovered point but then you re-enter a state of energy deficit, triggering a new, positive reward response. This response pushes you back into the pursuit of those previously addictive disordered behaviours and the fixes that energy deficit creates.
A relapse is defined as a full-blown return to the eating disorder and can occur months, years or even decades after you have overcome it.
Lapses With An Eating Disorder
Lapses are less significant than a full relapse but still need to be acted on quickly.
An example of a lapse is if you have all but overcome an eating disorder but start dabbling again in old behaviours and then quickly realise and abstain again. Lapses can be used as learning opportunities, e.g. if you have a lapse due to a stressful life event, it can be a sign that you need better support systems for when the next inevitable life stress hits.
The term lapse can also be used when you take a backward step in pursuit of fully overcoming the eating disorder. In this case, the term relapse isn't appropriate, because for a relapse you should first have reached a recovered state.
Therefore, when still in the process to fully overcome the eating disorder, a lapse is when you have made good progress but then find that your urges and cravings become stronger, luring you back into a higher level of engagement in the addictive behaviours, which in turn creates a deeper energy deficit.
Lapses in the recovery process are natural and common. They are part of the process. But each time they happen, it’s key to notice as soon as possible, learn from them and put measures in place to prevent them recurring.
Pre-lapses With An Eating Disorder
Pre-lapse is a less commonly used term but is important to be aware of.
A pre-lapse is when some thought patterns are beginning to revert but before your behaviours have followed. The stage of pre-lapse can begin a reasonable time before you engage in the old behaviours again, or it can precede a faster descent back to the destructive pursuit of energy deficit.
Increasing thoughts such as those listed below are a sign of a pre-lapse when you have all but recovered from an eating disorder:
Surely it can’t hurt to lose a couple of pounds now.
I don’t think I need that bag of crisps today with my sandwich for lunch because I’m going out for dinner tonight.
Maybe I will take up long-distance cycling. I’m sure it can’t hurt when during the eating disorder, it was running I was addicted to.
These thoughts indicate the onset of new cravings for a hit of energy deficit and are a sign of pre-lapse. If this isn't addressed, it could lead on to a lapse or a full relapse.
Other signs that can be an indication of a pre-lapse include:
Increasing irritability or anger;
Becoming more defensive about certain behaviours or habits or being increasingly dishonest with yourself or loved ones;
Signs of depression or low mood;
More negative thoughts or an increasingly pessimistic outlook on life;
Becoming increasingly busy and on the go, not allowing yourself to stop mentally and/or physically; and
Disengaging from support systems that you have in place.
During the recovery process and afterwards, it's important to remain aware of your state of mind and being. This will help to ensure that you quickly notice any signs of possible lapse or relapse and address them quickly. Otherwise the slope back can be very slippery.
What's Happening in Your Brain When You Have a Lapse or Relapse in Eating Disorder Recovery?
If you have learnt about the process of brain reprogramming to overcome an eating disorder, you might think that once you have abstained from your drug (of energy deficit) for an extended period, your brain circuitry will be fully rewired, making relapse unlikely.
This is true to an extent, but unfortunately, some weeds from the old brain network that drove the eating disorder will linger.
To get into some basic neuroscience—to learn new things, the connections between the neurons that drive the new learning form bonds with one another. The more times the new learning is pursued, the stronger these bonds become, creating brain pathways and networks that make it easier to pursue automatically. At the same time, the connections between the neurons for habits that are no longer being pursued are weakened and depleted. In this way the brain circuits for old habits will unwire.
However, in someone who has a history of an eating disorder or addiction, it’s thought that although there might not be active or conscious pursuit of the old circuits, the circuits can still be activated, even years later.
It could be that at night you have dreams about engaging in some of your old eating disorder behaviours or of when you had a smaller body. Perhaps you occasionally notice someone or see an influencer who is pursuing a life that is very health driven or fitness focused. You deem them to have a perfect and happy life and feel a fleeting moment of regret or sadness that this isn't you.
These thoughts, emotions and subconscious dreams can prevent the old synapses and circuits from fully breaking down. While the old synapses are still present, if the right triggers come along, there is a risk of them being reactivated.
The other factor that makes an eating disordered brain circuit hard to fully remove is the power of the emotional and pleasure response that created it. The floods of dopamine and other brain chemicals that occurred when you were pursuing the eating disordered circuits made for incredibly powerful fertiliser as your brain formed the synapses between those neurons. These connections are likely to be stronger than any that your brain creates, and it may not be possible to fully break them down, leaving lingering weeds, that you don't realise are still there to present a degree of risk.
For anyone with the genetic susceptibility to a restrictive eating disorder, entering a state of prolonged energy deficit in future is also a lifelong risk to reigniting those old circuits.
Any energy deficit beyond a key point in someone susceptible can switch back on the evolutionary flee from famine response. This is a risk factor to relapse that you will need to stay very mindful of for life, deliberately pursuing a lifestyle that keeps you safely away from any degree of energy deficit.
The next post goes into the signs and symptoms that are likely to occur if you are experiencing a relapse or lapse.