Unfortunately, relapses are inevitable. They will happen; the best way to get through one is to accept and work through it.
Why do I believe you will have a relapse with your eating disorder? Because you are human, and eating disorders are challenging and exhausting. I don't even have an eating disorder, and I'm exhausted. I cannot imagine what my child is feeling.
Constantly having to think about food, exposing yourself to food fears, and then confronting and challenging anxious thoughts is an all-day, full-time job.
My kiddo is at the tail end of his first relapse. He is gaining back the lost weight and can eat more at meals with less anxiety. I didn't prepare for this relapse, but looking back, I know what caused it and how I plan to prepare for the next one because there will be another.
What caused the relapse?
The main contributor to the relapse was when he reached the top of the ARFID mountain and saw a beautiful view of no food fear. He had gained enough weight not to be considered underweight, no longer had nutrient deficiencies (although at the low end of normal), and had mild anxiety when eating.
Also, his therapist*, at the time (a non-eating disorder therapist) discharged him, saying he no longer had ARFID. He felt so great that he didn't have to work hard on his anxiety. He could take a little break.
He had one good month, then the anxiety started creeping in, and food intake decreased. The thing with anxiety is that if you avoid it, it grows. Throw in some safety behaviors, and it grows more. Anxiety will win if you do not challenge it.
How are we getting through this relapse?
He's getting close to being at the top of the ARFID mountain again, but this time, we are prepared.
1. Eat on a schedule. We plan to eat on a strict schedule. A routine is essential for many reasons. The main reason is that it teaches you to tune into hunger cues. Someone who has restricted food intake for a long time has learned to ignore hunger cues.
I remember the first few times my kiddo was experiencing hunger cues. We didn't know it at the time and thought he was anxious. His stomach hurt, he had a headache, and he was irritable. After eating, he felt great. A couple of weeks later, he realized he wasn't experiencing anxiety. He was hungry.
The second main reason it's essential to eat on a schedule is that it increases self-awareness, like what happened to my kid when he realized he was hungry and not anxious. This insight is essential to those with ARFID because they can better identify anxiety and normal body reactions to hunger.
2. Reducing discomfort when eating. Understanding hunger cues can help identify fullness cues. A considerable aspect of ARFID for my kid was when he ate, he felt like he would vomit. He mixed the feeling of nausea with fullness. So he would eat less and less over time to escape feeling full.
By understanding fullness cues, he could work on exposure therapy that, over time, provided evidence he would not throw up from being full—this built self-trust.
Some experts recommend chugging several glasses of water before a meal to expose fullness. I'm afraid I have to disagree with that. This practice will prevent the individual from eating as many calories and nutrients as they could in that setting.
Instead, the individual should plate the food they usually eat and add an extra serving of what they are eating or a serving of another food. This will allow them to eat their normal amount of calories and nutrients while also working on exposure to fullness by eating the extra food.
3. Acknowledge and challenge every anxious thought. The third part of our plan is that he will acknowledge and challenge anxious thoughts regardless of anxiety. As I said above, avoidance fuels anxiety. Anxiety creeps in slowly, and if not challenged, it will snowball into feeling unmanageable.
So, how can you challenge anxiety?
First, identify the fear and your reaction (physical sensations and emotions)to it, and rate it.
Second, ask yourself if the thought is true. Is there another explanation? What is the best and worst-case scenario? What is the most realistic outcome, and what would you tell a friend with the same thought/anxiety?
Third, rate the anxiety again. Continue this process until you understand your anxious automatic thoughts. And remember, automatic thoughts are NOT facts.
My kiddo and I continue to learn how best to work through his ARFID and anxiety one day at a time. I have learned that while informative and valuable, my professional dietetic courses and experiences do not compare to the lived-in experience we get daily. Each individual with ARFID will experience it differently, and what works for them will also be different.
If you're at a place where you are relapsing, congratulations. It means you have made progress. Spend time to understand why you relapsed and how you will get back on track. Think back to when you first started working on ARFID and begin again. Take it one meal at a time.
*I highly recommend finding a therapist that works with eating disorders. Find someone who has experience working with ARFID individuals. ARFID differs from other eating disorders; therefore, the treatment is different. My kiddo now sees a therapist from his eating disorder clinic with ARFID experience.
