I have several clients who in a few weeks are leaving to begin their freshman year in college so the topic of navigating eating disorder recovery during this transition has been on my mind. The adventure of college is typically approached with both anxiety and excitement for incoming freshman. However, for those thinking about how they will maintain their recovery, the anxiety side can be more complex. The anxieties related to eating disorder recovery during the college transition typically center around:
relapse
food fears
comparisons
decreased support
alcohol and recovery
I am going to do a series of blog posts over the next two weeks that highlight each of these issues and this first one will focus on relapse.
Relapse is a scary topic for both incoming freshman and parents alike. Scary to the point where these conversations are often avoided and yet these are critical conversations to have. I’m starting with this topic as the first post in this series because it is important to have a solid plan in place for if relapse behaviors begin to pop up. The more aware we are of how a relapse might start, what the first behaviors would be, and know our plan, the better chance we have of shifting back into recovery action without having a major life disruption such as having to withdraw from school.
When discussing relapse prevention, I commonly hear from clients “I would NEVER go back to the eating disorder” but that is the tricky thing about relapse. For most clients, once they are in a fairly stable place in recovery it is typically not a conscious thought of “I’m going to choose to relapse.” It starts with small, seemingly justifiable changes that end up leading back to the eating disorder.
A good way to prevent this is to run any change you are thinking of making around food, movement, medication, or monitoring frequency by your team. In the beginning these changes usually seem small (some examples are starting group fitness classes on campus, moving the timing of meals, walking more on campus instead of driving, etc). They may be changes that are truly neutral or even positive for you and your recovery but it is important to get a second opinion and talk through the potential impact when it comes to changes in these areas. The eating disorder can be sneaky and you might not see a potential issue that someone in your support team might be able to identify.
This is especially important to remember and fall back on when it comes to periods of high transition when the vulnerability to eating disorder relapse is heightened, and going to college is a huge transition.
Two journaling prompts that can be helpful around recognizing the beginning of a relapse are:
1. What is the argument my eating disorder would make for going back into it and how would I respond (if you don’t feel confident and grounded in your response against relapse I would encourage you to talk it through with your team and trusted supports)
2. My next relapse would start by… and then tell the story. Often when we make a change, we try to isolate it rather than playing the tape forward. So, for example, if someone has struggled with restrictive behaviors, a small change might be skipping afternoon snack some days because they have a lab twice a week. So if that was the first step, what would happen next, what would the thoughts be? So in this example, "I would convince myself that I don’t need snack the rest of the afternoons because I felt fine on the days I skipped it, and then I would drop morning snack because I started thinking that I just don’t need to do any snacks anymore because..." Keep going with the what the next step and thoughts would be that would eventually lead to full relapse and what the consequences of relapse would be. This prompt helps you recognize how these small and seemingly innocuous changes can build and support you in preventing a lapse from becoming a relapse.
*There may be aspects of these prompts and relapse prevention work that are triggering and it is still important work to do because you will likely be triggered on campus and around others who are active in an eating disorder or disordered eating behavior. Working on these prompts with your team offers an opportunity to cope with exposure to some of these triggers in a supported environment and highlights areas for continued therapeutic focus.
Another critical aspect in leaving for college is having your accountability safety net. A helpful form this can take is that of a recovery contract. A recovery contract should be a written document that you, your team, and your supports can all agree on for what actions you will take to foster continued forward movement in your recovery (including who your team will be when you are school and frequency of sessions), what initial actions you will take if relapse behaviors start occurring, and what next steps are if those initial supports are not enough and behaviors continue. This is very individualized and needs to consider the therapeutic approach you and your team have been using, how far you are in your recovery, resources you have access to, and behaviors you struggle with. Your recovery is continually evolving and so should this contract. Work to create an initial one for the first month of school and then everyone should reassess at a month for any changes that may need to be made to it. This is an important tool in the recovery process as a whole and not just for the college transition. I will do a blog post dedicated to this in the future but for now encourage you to work with your team to create your recovery contract for the fall.
While we hope relapse doesn't happen, spending some dedicated time towards relapse prevention assignments and planning can support continued forward progress and lessen the time spent back in the eating disorder if a relapse were to happen. Starting college is a time where there is a heightened vulnerability to relapse in eating disorder behavior so make sure you have your plan in place prior to leaving. The next post in this series is going to be on navigating food fears and changes to current eating patterns when starting college.