Relapse – The Sneaky Voice of ED

While I’m not an eating disorder treatment professional, I have been trained professionally to recognize the signs. And as my readership has grown, it’s become clear that I have a large segment of my readership that is in treatment (or seeking treatment) for disordered eating. For this reason I’ve provided many resources for finding treatment in my blog posts and ebooks for people who believe they may be dealing with disordered eating, and have stressed the importance of seeking professional help.

Some people decide to forego treatment and attempt to handle the issue themselves. As I’ve said before, this can be quite dangerous for several reasons, not the least of which is the process of recovery from starvation requires medical supervision to identify and avoid any potentially fatal side effects of refeeding. The bodybuilding and fad diet communities have unfortunately co-opted the term ‘refeeding’ to refer to what is more accurately termed a ‘cheat-day’, which has had the unfortunate effect of diminishing the gravity of the term and the process of true refeeding. We’ve got people all over the internet claiming they are ‘refeeding’ when really they are simply ‘taking a break’ from dieting, or having a cheat day or week, or carb loading, or even just using the term as an excuse to eat what they want to eat. (You don’t need an excuse to eat what you want to eat, by the way. You’re a grown adult, you have every right to eat what you want. No explanation or excuse necessary.) True refeeding is serious business, people, and needs to be implemented under the supervision of a medical professional and as part of an eating disorder recovery treatment protocol.

A less dangerous, but more insidious, problem associated with attempting to recover from disordered eating without professional treatment is the very real danger of relapse. Even people in the very best treatment programs can relapse. The danger is exponentially higher when there isn’t a knowledgeable, experienced professional there to identify early warning signs and provide perspective and resources, as is the case when a person attempts recovery without the support of a knowledgeable and experienced ED professional.

Here’s how I see it play out so, so often. Things are AWESOME at first. The person feels a tremendous sense of relief at being free of their self-imposed rules. They revel in their new freedom. They have more energy and their mood improves. They may see improvements in their health. Gweneth Olwyn calls this the ‘Honeymoon Period’ and describes it as such on

“Many experience a tremendous sense of relief and initial joy at eating in an unrestrictive way. Understandably, you have many, many distributed and ingrained systems that ensure you eat because your survival depends upon it.

However, the restrictive eating disorder will not allow that relief to stand for very long. Soon you will find yourself starting to feel edgy and anxious. For many the fast physical shifts in the body will become a focal point for allowing the eating disorder to suggest that the process is not going 'according to plan' and that somehow trusting your body cannot apply to you as it does to everyone else.”
~From Phases of Recovery

But soon the very normal, but less pleasant, effects of recovery begin to create anxiety and a sneaky voice starts in and whispers “This isn’t working. Look at you! Gaining all this weight, not working out as hard as you should. You’re lazy! And fat! This was all a big mistake! You should go back to what you were doing. It was working so well! Remember how thin you were? Remember how in control you felt?” Sometimes that voice comes from inside your own head. It is the voice of your eating disorder. Sometimes, unfortunately, that voice comes from outside, in the form of a ‘well meaning’ friend, or a stranger on the internet, or someone else trapped deep in the spiral of disorder who can’t bear to be alone there. It is the voice of someone else’s disorder, or simply the disorder so deeply entrenched in our diet culture. This is a very normal stage of recovery, but it is the point at which relapse becomes almost inevitable without a supportive, knowledgeable, experienced treatment team. Which is why it is so vital to seek out professional treatment if you are dealing with symptoms of disordered eating. So that there is someone there to identify that voice for what it is: the Voice of Disorder. And to give you the tools and perspective to shut it down before it drags you right back down into the darkness.

Read more about relapse, and find resources to help you through:

NEDA: Slips, Lapses and Relapses
NEDA: Recovery and Relapse Prevention
NEDC: Relapse and Recurrance
Youreatopia: Phases of Recovery
Youreatopia: Relapse

Find ED treatment resources:

ED Referral


11 thoughts on “Relapse – The Sneaky Voice of ED

  1. Great post. I have quite a few recovering ED very young people follow me on IG…. I believe in balance in life & never call my treats a cheat day.. never have…. Thx for bringing this up. I had not even read about that fitness community using refeeding for their cheat days….

  2. Amber, thank you so much for writing this. I love the fact that your main concern is health of the body and mind, first!!

  3. Getting a knowledgable and experienced team is more difficult than it sounds in my experience! In the uk you go on a waiting list for an indeterminate length of time for 4 sessions with a counsellor. I was deemed not sick enough to need to be considered any more quickly. The NHS is great, but they do have to prioritise a minimal budget and I get that.
    Personally I was lucky enough to find counselling through the local university who did it at 15 a session – it was the best 1500 ish I’ve ever spent, but it still remains the fact that not everyone is able to find that money each week and the scheme I benefited from is now not operating.
    While I agree that relapse is a danger, I think it’s important to acknowledge that some people have to go it alone.
    Try to find a trusted friend who you c&a talk to totally openly and won’t be offended by anything, talk about everything you’re feeling, now and in the past. Get on any lists for local therapy you can. Try local group sessions – I did some and didn’t find them great for me, but it’s another open space to talk. Join clubs and groups, ideally not exercise or food focused ones. Tell family and friends what you need from them. See your doctor, see other doctors until you find someone supportive and keep seeing them – mine were happy to keep an eye on my weight. Finally, think about how media makes you feel and be selective…I mean, women’s magazines, health magazines, websites, gym social networks, Facebook groups… Avoid anything that makes you feel guilt, you can always come back to it later.

  4. This came at a very opportune time for me…thanks, Amber. I have been in recovery from anorexia and bulimia for 14 years. Recovery is a spiral, and people need not fear nor beat themselves up for slips…AND I agree that asking for help can keep slips from becoming dangerous, full-blow relapse. It is way easier in this society to find people who band together in their body dissatisfaction, but there ARE communities out there shifting the body-hate epidemic. Never give up!

  5. Thank you so much for posting this… I have been dealing–off and on–with anorexia and exercise bulimia for 20 years. With job stress, life changes, and physical issues such as injuries, surgeries, and chronic pain (what I’m currently dealing with), come my major setbacks. It’s as though I don’t always know who I “truly” am sans ED, as well, I have realized. That said, I have a great team in place–nutritionist and therapist–as well as an incredibly supportive spouse, amazing family, and understanding friends. I am fortunate that I can afford to take advantage of some amazing resources. That said, the road to recovery is still long and winding, and sometimes one feels alone as one navigates the rocky terrain out of ED Land!

  6. I really enjoyed reading your post. Thank you for sharing. A year ago, I found myself in this recovery phase, thought gaining all this weight isn t the best solution. But after I started Crossfit, I HAD TO GAIN weight. hard training needs more than a low-calorie diet. And I did it! 15 pounds or so and I m seriously NOT fat right now. My performance and work capacity is still growing. What I like to say is that changing believes and mind is hard work, particularly with all the “good advertisment” out there. living on a 1200cal diet isn t right!

  7. Amber I visit your site weekly and have read all of your blog posts up to date. My husband and I were on a low fat vegan diet for three years at the advice of his cardiologist. We both lost weight, but after three years started having health issues. I didn’t realize that I was wasting away, and thought it was okay to be that thin.

    Unfortunately my husband ended up in the hospital for 21 days because of severe abdominal pain. He had his gallbladder removed and then had pancreatitus. It was so scary because we have two small children and I was terrified that something really bad was going to happen.

    Anyway, he lost over 30 pounds while in the hospital and he stayed on IV nutrition and fluids. They sent us home with NO guidelines as to how and what he should eat, he ended up with severe pain again and took him back into the hospital the next night.

    I wish we had known of the NICE refeeding guidelines, because I don ‘to think he would’ve ended up back in the hospital.

    Before his second discharge we met with a nutritionist, who made no suggestions as to refeeding and the dangers of it. He was also an advocate of Paleo.

    How come well educated medical professionals don’t know about the dangers of quick weight loss after surgery and how to deal with refeeding? I had no idea how dangerous it was.

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