It’s extremely common for people with eating disorders to relapse at least once after feeling as if they’re in recovery or on their way to recovery. Some stats put relapse rates as high as 80%, although with more research on good treatment and long term support for people with a history of eating disorders, it’s likely that the number will go down. But unlike lots of other mental health problems, eating disorders live in a place where the bad behaviors are often praised, and triggers are basically everywhere all the time.
It’s astounding to me that anyone manages to recover at all. I’ve been doing fairly well for about six months, but the longer I spend away from the eating disorder, the more I realize how many unhealthy messages there are all around me. I recently had a conversation in which someone who was well aware of my eating disordered history and who brands themself a skeptic and scientifically literature person suggested that a diet of 1200 calories was an appropriate form of weight loss. Almost every day I hear people talking about how unhealthy it is to eat sugar or carbs or gluten or really anything. No matter how many times I try to remind myself that what’s important is eating food that tastes good to me and eating enough food that I feel full, I am constantly and every day reminded that being hyper aware of diet seems to be synonymous with health.
And yes, there is good evidence that being at a mid range weight, not eating tons o sugar, and getting decent exercise are good for you. The problem is how to interpret that statement when your brain is built for all or nothing thinking and perfectionism, for guilt tripping you and punishing you. How do you find any sort of middle ground between “I am allowed to eat what I want” and “I should try to eat in a healthy manner”? This to me is what makes eating disorder recovery so hard. There is no cold turkey to eating disorders because food is always going to be part of your life, which means at least a few times a day you’ll be thinking about the thing that ruled your mind for so long.
In addition, there’s tons of conflicting information out there about what’s healthy. Even for someone who doesn’t have an eating disorder, sorting through the morass of studies and recommendations can be incredibly difficult, and reading about diet studies can be extremely triggering for someone with a history of an eating disorder. That means most of us just want someone to tell us what’s right, what’s ok. No one can and no one will, so instead we’re surrounded with a thousand different messages and left reeling about what is or isn’t appropriate food behavior.
The unknowing is almost more triggering than the obviously pro-skinniness, pro-dieting messages. The deep uncertainty about whether or not your weight is too high or too low, your diet is too unhealthy or too many calories or too few calories, or not enough veggies, that gets into your mind until you just want the clear rules again. Unlike nearly any other mental health problem, eating disorders circulate around something that’s considered completely acceptable to comment on publicly: food. And it’s a conversation that everyone wants to have, so no matter how you try to avoid it, you have a coworker who says “Oh I’ll be bad and have a cupcake” or a family member who says “I’m down 15 pounds!” in a tone of pride. Each time you try to retrain your mind to erase the disordered messages that say “skinnier is better”, someone else comes along and nonchalantly dismantles your hard work.
Perhaps worse is the fact that many people seem to believe that choosing a “this works for me” approach is unacceptable when it comes to eating. You must be doing what is the most healthy, backed up by evidence, best diet ever or you’re not healthy at all. That means that for someone who has an eating disorder and might have to take some shortcuts (like: if I feel hungry for x food I let myself eat x food so that I get enough calories), their (perfectly logical and healthy) choices are derided as illogical and unhealthy. Some of us know that we engage in unhealthy behaviors and have to accept that to get food in our bodies at all. Some of us need to ignore some of the research to convince ourselves that eating more than 1200 calories a day is necessary. Some of us need to be irrational in order to be healthy, and that’s ok.
On top of all of that, you carry your biggest trigger around with you every day: your body. The changes that happen in your body, even if they’re completely natural, are extremely noticeable to a brain that’s used to nitpicking every ounce of fat. The weirdest things will set you off. I found yesterday that I couldn’t fit into a pair of shoes that had been in my closet since last fall, and that my ring size appears to have changed. These are tiny little reminders that I’m moving into uncharted territory, things to be feared.
All of this is to say that I understand why the relapse rates of eating disorders are so high. I hate blaming diet culture for eating disorders, since a mental illness is not just a diet, but it is true that all the conflicting and horrible information about healthy eating has serious impacts on people trying to bring their eating back to a reasonable middle ground. The good news is that there are people who have managed to recover and stay healthy. The good news is that we’re allowed to set boundaries, remove ourselves from conversations filled with diet talk, block the hell out of triggering websites and ads. The good news is that we’re entitled to our own health and well being, no matter what anyone else says about the appropriate way to eat.