Red Flags for Relapse

I struggled with using this image.  In the end I decided to use it because I promised to keep things real.
I have been here.  Far too many times to count.  Heels, pearls and a pretty dress never kept me from purging or sadly, from passing out later in front of family and loved-ones.  This post serves to ensure that I never, ever feel so insecure that I resort to this measure to cope.
Ever again.

Relapse doesn't happen overnight.  

It is a series of decisions that I make in the face of stress or anxiety, to use eating disorder behaviors to cope with emotional pain.

The more consistently I choose them, and the more of them I employ to numb the emotions that I am determined to avoid, insecure of my ability to live through them, the more my Anorexia picks up steam and before I know it, I am back in Olivia's clutches~ biologically hog-tied and dragged back to a way of living that will only assure me a shortened version of it.

It is one thing for someone in recovery from Anorexia to look inside of themselves and take an honest inventory of what their own personal red flags are that would signal a slide towards relapse.

Sharing these embarrassing secrets with someone (or the entire blogosphere for that matter) is a step only one who is serious about staying in recovery would take.

It is in this spirit that I offer to you, an honest and uncensored list of behaviors I (used to) engage in that are clear (and sometimes subtle) signs I may be (am) relapsing.

Can it happen again? 

Yes, absolutely.

My recovery is still very much in its Spring Season.

But the likelihood of relapse decreases with each passing day that I choose not to engage in any of these self-destructive coping behaviors to deal with stress/anxiety, instead of the healthy alternatives that I am learning to employ in their place.

I have been doing everything differently this time.  I have never gotten this far in my recovery and I am nothing if not dedicated, tenacious and well...maybe a little stubborn.

I refuse to let my daughters down ever again.

I refuse to let my family and loved-ones down ever again.

I refuse to let myself down.

Ever again.

I am sharing this list knowing that people who know me will be reading it, building in accountability that one who lives without another adult isn't afforded.

I shared it privately with my co-worker who asked upon my return from treatment, how she could support me.

I shared it with my two running partners, one of which weighs me each morning to determine whether or not I should be allowed to exercise that day.  (If my weight dips even a few ounces, I will take the day off.)

I am sharing this list knowing that the people who love me will be on the lookout for any glimpses of a backslide, to keep me healthy and safe from the clutches of a potential relapse.

I am sharing this list knowing that some will shy away from me, or maybe even judge me a little after reading it.  I am not proud of any of these choices I once lived.  

I am risking sharing this list with all of you because I am serious about recovering.

For good.

1).  Skipping meals and snacks (even just one) claiming, "I'm not hungry" or "I already ate".

I might not be hungry, but this early in recovery, I have to eat on a schedule anyway.  I can't yet trust those internal cues.  They might be coming from a more sinister place.

2).  Messing with the timing of meals, saying that it is too late for dinner or putting off breakfast past 9am.

I need to stay on the following schedule:

7am-9am: Breakfast
2 hours later: Mid morning snack

12:00pm: Lunch
2 hours later: Mid afternoon snack

6-8pm: Dinner
(dessert is optional)

When I am pushing the timing of these meals and snacks, or skipping them all together, you can be certain that I am restricting and heading for relapse.  This is one of the biggest danger-zones for me.  

Red-flags numbers 1 and 2 will start the slide almost immediately, if I let these things happen even once.  

And if coupled with #8 (Exercising to the Extreme) these three behaviors are literally deadly to me.

3).  If the portions on my plate become increasingly smaller in size and/or I consistently do not finish what looks like a reasonable portion of food to you, I am beginning the road to restriction again.

4).  Avoiding entire food groups (i.e. carbohydrates, fats, sugar) stating that they aren't healthy for me.  

For many who don't have eating disorders, this is a logical thing to do.  For someone like me, with some very rigid food-rules, it is the top of the hill which slides quickly to relapse.  

In treatment, we learn that foods are not "good" or "bad", they are just food.  We are encouraged to eat a variety of foods, including those many consider "bad" foods, to face our fears and normalize our eating.

This is another one of the most certain signs I am relapsing.  It's tricky, because I love to eat healthy like most people, I just take it to the extreme.  One way to tell if I am engaging in this behavior is to watch that I am not cutting out the foods that I love (i.e. ice cream) again.  

It's an extremely slippery slope.

5).  Another sign of relapse that centers around food is that I eat the same foods for the same meals every day.  

Every single day. 

I do this because they are "safe" foods.  I don't fear them and since I have to eat, I gravitate towards foods I know the calorie counts for (because they are the lowest possible choices).

While this behavior doesn't represent restriction or purging necessarily, it serves to allow me to have one foot on the boat (recovery) and one foot on the dock (Anorexia).  

It's short living and it prevents me from living a full life of recovery.

It is the remnant of Olivia's voice whispering through the door, "just hold on to this one thing..."


6).  Leaving the table after a meal before 20 minutes have passed since my final bite.

If I couldn't purge within a 20 minute window, I wouldn't bother to do it.  If I get up from the table right after eating and make a determined dash to the bathroom, you might want to follow me.  

Purging is one of the things that I got really good at.  I could be very sneaky/quiet. 

 I did it at restaurants, my office, your house, the side of the highway, etc.  

In the clutches of Olivia, if the urge struck, I had zero power over her and before I could even think about trying to talk myself out of it, I would find myself in a trance-like state, bent over the toilet, and bringing up whatever I ate by gagging myself with a toothbrush.

Note:  I DO brush after meals, but when I do that, you can hear me brushing my teeth...

This is almost always followed by 100 push-ups, right there in the bathroom on the often-dirty floor.

Look at my eyes when I leave the bathroom.  I really can't cover up the glossiness that ensues, the puffiness around my glands and the suddenly-missing eye-makeup.

I'll probably tell you I had a sneezing fit.  I might even fake one, to explain away the toll purging takes on my appearance.

7).  If I am in the bathroom and you hear the water running for an extended period of time, or I flush more than once, I am probably up to no-good.

8).  Exercising to the extreme.

If I start running twice each day, or doing a high intensity interval training workout in the morning and then a run in the evening, I am heading quickly and decidedly for relapse.

Exercise is my drug of choice.  

It is second only to restricting.  

It brings me to the state of negative energy balance faster than restricting or purging alone.

I can drop weight faster than you can read this blog when I use exercise to cope with anxiety.

If you see me in the gym in the morning and then running again in the evening,  I am running headlong, straight into the lap of relapse.

I cannot teach spin class any longer because it triggers me faster than any other exercise, including running.  I miss teaching because I loved it.  I had a reputation for being  a "tough" instructor, but in reality, I am lucky that my students weren't injured.  

I took it to the extreme and brought my students along with me.  

During treatment, I was given a compulsive exerciser test.  I "passed" with flying colors.

"Do you exercise even when you are ill or injured"?  YES
"Do you organize your day around exercise?"  YES
"Do you feel low or depressed if you miss a workout?" YES
"Do you miss or arrive late for important family events because you have to exercise first?"  YES
"Is exercise a chore?"  YES
"Do you exercise to compensate for calories consumed?" YES
"Do you exercise during (ridiculously) inclement weather?" YES

There were a few more on the list that I can't recall, but the Recreation Therapist at Mercy told me one was considered a "compulsive exerciser" if they answered "yes" to only three of the questions.  

I checked "yes" for ALL of them.

And in my true, perfectionist, enough-is-never-enough form, I added some bonus points that weren't the list: 

I exercised in the middle of the night.  

I exercised 2 or more hours at a time (more than once a day).

I exercised on a completely (700 calories the day before, all purged at some point)  empty stomach...to dull the pain of it.

I exercised to be someone special~ for it became my identity and took away my "softness" so that I could become intimidating or at least, invisible to men.  

I am a classic compulsive exerciser.

Of all of the red flags for relapse, this is the one I have to fight the hardest.  

The one that can take me down the quickest.  

The one I need my dearest friends to hold my running-shoe-clad feet to the fire without ever giving me an inch.  

9).  Drinking with the sole purpose of becoming intoxicated.  

Like I am on a mission.

Considering that I hardly ever drank anything at all until I began trying to numb the pain of what I had done to my family when I lived in Carrabassett Valley, this one takes even me by surprise.  

I only do this when I am restricting/purging/over-exercising.  

Or rather, the detrimental effects of drinking are exacerbated (for me) when I am restricting/purging/over-exercising.

Or, maybe I start to restrict/purge/over-exercise when I am drinking heavily.

I'm still figuring this one out.  

All I know is that each time something really, terribly awful happened in my life since I developed Anorexia, it was the result of a long chain of events that included restricting/purging/over-exercising AND drinking.  

When my body-weight is restored and someone else (who is a professional) decides it's ok for me to have a glass or two of wine with dinner again, I will consider it.

Or maybe not.  I haven't decided yet.

For now, I will keep abstaining.

10).  If I start treating meal-times like a mathematical equation (i.e. you find little pieces of paper or odd numbers scribbled in the margins of books or on the backs of envelopes), I am counting calories. 

I only do this when I am trying to restrict and be below the magic number that keeps Olivia's tirades in check.  

11).  Body-checking.

This is the process by which Olivia berates me for my appearance, or for being the "biggest" girl in the room... (or praises me for being the thinnest...depending on where I am in my recovery).  

It is accomplished by catching a glimpse of my body shape/size as often as possible, making sure that nothing has changed weight-wise, since the last store window, or car-mirror that reflected back the distorted image which threatens to catapult me back to subscribing to Olivia's corrective plan.

"Body-checking" is dangerous for those of us with eating disorders because we didn't see what you saw when we were at the height of our disorders and even less so,  once our weight is restored.

For now, it is best for me to check out my outfit in the morning (making sure I didn't stuff my skirt into the back of my hose) with a quick glance and a positive affirmation at the ready.  

For now, I fight the urge to look when I pass by a reflective surface, as often and as hard as I can, relying instead on the input of people whom I love and trust.

12).  Comparing.

Body-checking and comparing are difficult for you to notice because they are battles being waged inside my head.

However, now that you know I might be doing this, I might as well tell you that passing by someone who is naturally thin almost never bothers me.  

Passing by someone who is likely Anorexic is another story all together.  

You can tell when this bothers me because I cannot hide it.  

You will notice the change in my demeanor because it (can) cause Olivia to throw her sharpest swords directly at my resolve, desperately looking for a way back inside. 

You will see the stress on my face.

13).  If you continually invite me out to do things that I once loved to do, and you find that I am always busy (especially if it involves dressing up or eating), I am probably isolating because I am relapsing into old behaviors.  

I share these Red Flags for Relapse with you in full disclosure.  

I spilled all of them.  

I didn't do that the first time through, holding back the "special" ones like exercising in the middle of the night, body checking and doing push-ups in the bathroom because I was not fully-committed to recovery.

I (Olivia) didn't want you to know everything.

When I am starting down the path of relapse, I (Olivia) want(s) to do it without your interference.  

This is why I am sharing these secrets.  

I don't want them to be secrets anymore.

I want nothing short of full recovery.

Take that, Olivia.