Relapse Prevention Plan

This is from a post I originally wrote in May, but I mean to go back to it at least once a month to check how many of the relapse warning signs I am experiencing.

Relapse prevention plan (adapted from the WRAP by Mary Ellen Copeland)

When I feel well, I am:
Able to concentrate on studying/reading, still anxious but able to cope with it, quite sociable, curious about everything, patient and not easily frustrated, able to keep myself occupied.

What do you need to do for yourself every day to keep yourself feeling as well as possible?
Eat regularly, sleep at least 6-7 hours a night, exercise – walk/run/poi, talk to people in person rather than just online, have time to relax on my own, read or work on something – be productive.

What do you need to do regularly to keep your overall sense of wellbeing?
Have short and long term goals to work towards, have contact with a therapist, create things to look forward to, address problems and practical matters as they arise rather than avoiding them.

Identifying your triggers: external events or circumstances likely to set off a chain reaction of behaviours, thoughts or feelings.
Feelings of hopelessness or helplessness in response to stressful situations/low mood, arguments with people, not getting enough sleep, not eating enough (stating the obvious 😛 ), being too isolated or around people too much, being too busy or not having anything to do, being physically unwell and accidentally losing weight.

Avoiding your triggers: what can you do to avoid or limit your exposure to possible triggering events?
Go to bed at a sensible time, eat regularly, leave my house at least once a day, be assertive and mindful, let people know how I am feeling, socialise, stay on top of practical stuff, don’t weigh myself for at least a week after recovering from a bad cold or stomach bug.

Warning signs: what are the signs of change which indicate that you may need to take action?
Behavioural:
-Continually eating fewer calories than the previous day/week
-Weighing all my food, even very low calorie vegetables
-Weighing myself every day
-Reading diet/triggering articles in magazines and looking at triggering websites online
-Laxative/diet pill abuse
-Increase in thinking about food and weight
-Lying to people about what I’ve eaten
-Lying to people about my behaviours
-Not being honest about my thoughts and feelings
-Avoiding certain foods
-Cutting down on portion sizes
-Cutting down on calorie dense foods, having ‘meals’ which consist of only vegetables
-Walking for hours whatever the weather is doing
-Going to bed earlier than 9pm (or even just wanting to) most evenings even if I can’t get to sleep until very late
-Not socialising if it interferes with food/mealtimes/rituals, becoming less sociable in general
-Buying food I don’t intend to eat, throwing food away unnecessarily

Emotional/cognitive:
-Becoming more rigid and obsessive in general, losing my temper easily around mealtimes
-Feeling hopeless
-Feeling helpless and like I have no control over my life
-Wanting to be alone when I’m with people but feeling lonely when on my own
-Feeling too big/uncomfortable in my body
-Feeling numb all the time
-Loss of concentration, particularly ability to read
-Loss of interest in everything except food
-Feeling like losing weight is more important than anything else, becoming complacent about health risks

Physical:
-Feeling cold all the time
-Not being able to sleep because I’m hungry, sleeping less than 3-4 hours a night
-Not getting my period (got to get it back again before this one is any use though 😛 )
-Increased anxiety and hypomania (usually a sign that I have decreased the amount I am eating in the last few days)
-Coming down with every virus going
-Poor circulation – blue fingernails
-Bruising easily
-Difficulty getting comfortable in bed because the mattress hurts my hips/back/knees
-Losing much more hair from my head than usual but getting furrier everywhere else 😛 (darn lanugo, not exactly attractive!)

Response to relapse warning signs:
-Maintain basic level of function – eating/sleeping/going out
-Talk to therapist/CPN/GP
-Tell a close friend or member of the family (important to not only tell professionals what is going on)
-Work out why symptoms have worsened – what is it in my life which has triggered this response
-Remind myself of negative consequences of low weight and restriction – only postpones bad feelings rather than solving them, osteoporosis, poor general health and worsened IBS/digestive problems, depression and anxiety, loss of motivation, energy and pleasure in life, loss of function, having to gain weight again eventually!
-Remind myself that I have felt differently in the past, read things I have written whilst in recovery
-Increase calories slowly, cut back on exercise
-Create things to look forward to in the near future
-Set targets and rewards for reaching these
-Look through the early posts in this blog, particular from February this year. It’s crystal clear how badly my cognitive processes were affected and how terrible I felt from the short posts and rather zombified tone
-Remember that I am not my eating disorder – it’s an illness, and all these thoughts and behaviours are symptoms, not things which I want or value

May  2009
Behavioural 1/16 – weighing food
Emotional 1/9 – feeling uncomfortable in my body
Physical 4/9 – no period, hair falling out still, cold a lot of the time, bad circulation

June
Behavioural 2/16 – weighing food and reading diet/weight related articles
Emotional 1/9 – feeling uncomfortable in my body
Physical 1/9 – no period still, alas!
July goals – no weighing snacks or anything under 100kcal per 100g, stop reading diet/weight related stuff

July
Behavioural 0/16 – yay! July goals met 🙂
Emotional 3/9 – feeling uncomfortable in my body and in the last few days occasional panics over feelings of helplessness and hopelessness
Physical 0/9 – period returned mid-July!
August goals – no weighing any food other than dry ingredients like pasta and rice; no using behaviours which may not be physically harmful but I know are still not conducive to recovery; address in therapy the trigger of feeling helpless/hopeless

August
Behavioural 0/16 – August goals met 🙂
Emotional 1/9 – still a bit uncomfortable but have stamped on the helpless/hopeless feelings
Physical 0/9
September goals – continue to work on previous goals, start to think about maintaining my weight, be sensible about the gym!

September
Behavioural 2/16 – weighing food (only a little more often than last month but still need to keep an eye on it) and reading diet/weight related material. Crept up on me AGAIN. Still, 2/16 isn’t bad 😉
Emotional 0/9 – finally lost the uncomfortable feeling, actually feeling surprisingly OK about my weight now!
Physical 0/9 – yay!
October goals – no weighing food other than dry ingredients like pasta and rice, no reading articles/looking at websites related to diet or weight; stick to current intake for maintenence; continue to go to the gym three times a week – no escalation!

October
Behavioural 1/16 – stopped weighing everything other than dry carbs again and have avoided printed diet/weight material, but I keep ending up on Calorie Count when I’m bored. Damn you CC!
Emotional 1/9 – having a bit of problem with body image, but beating it to death with logic
Physical 0/9 – el hormones were rather late but turned up eventually
November goals – guess 😛 stay away from food/weight related websites! Otherwise I have a surprising lack of anorexia-related goals to work towards at the moment. Take that, ED *mwahahaa*

November
Behavioural 1/16 – same as last month, doh. But I have noticed that the websites I end up now are ones that affirm that I am doing the right thing in setting my target weight where I have and in stating the importance of physical recovery. It’s still not good that I lose myself in those places to kill time and reduce anxiety, but it only happens about once a week so I’m going to stop trying to ban myself from doing it this month and just make sure I stay on the positive websites and don’t end up doing it every day. I am sure that I’ll stop doing it when I have something better to do with my days anyway!
Emotional 0/9 – last month’s problem was explained when I got my period two days later. PMS, how I love thee. Rather PMS than osteoporosis though (this has been a mantra since my period came back!)
Physical 0/9 – everything going OK on that front!
December goals – don’t let the remnants of eating related anxiety get in the way of having fun at Christmas! Last year I was restricting and terrified of Christmas food. This year I am hoping that the Christmas food will take care of the last 3-4lbs between me and my final goal weight 😉 AND I bought a vegan chocolate advent calendar. I haven’t had an advent calendar for years…

December
Behavioural 1/16 – dittooo. One day I will have so many exciting things going on in my life that I will only be able to get online long enough to check my emails and update my blog 😉 unfortunately today is not that day!
Emotional 0/9
Physical 0/9
January goals – start running again after break due to injury, 30 mins three times a week maximum. Also, DEFINITELY getting to the bottom of my target weight range this month, I’ve been faffing about a few pounds below it for far too long. Take that, eating disorder!

January 2010
Behavioural 1/16
Emotional 0/9 – major freaking out ensued after hitting my target weight, but I stuck with it and it passed within a week. Yay!
Physical 0/9
February goals – I met both my January goals, so this month I want to focus on maintaining within my target weight range, no slipping out of the bottom again now I’ve finally made it here! I did start running again, I’ve been doing 30 mins every three days, so a grand total of 2-3 times a week. When I was going to the gym three times a week for 90 mins each time in October my period disappeared and refused to turn up until I skipped the gym for a week and ate an extra couple of hundred calories every day, so I know that’s too much exercise for me. I thought 60-90 mins a WEEK of cardio would be OK and my hamstring problem has completely gone away, but lo and behold, my period is late again. No more running until it turns up. This is very frustrating, it’s not like I’m running marathons! Still, I will do whatever it takes to stay healthy. No excuses 😉

February
Behavioural 0/16
Emotional 0/9
Physical 0/9
March goals – I just realised that I have stopped the one niggling ED behaviour that I had so much trouble with – I haven’t been anywhere near diet/weight related websites for weeks! Wow, that is the first time I’ve had three zeros 😀 OK, so for March I just want to keep everything as it is right now 😉 food, weight, exercise, etc. It’s all good. Maintenence is a goal in itself, maybe next month I will think of something concrete to work on.

March-June
Behavioural 0/16
Emotional 0/9
Physical 0/9
I thought it was about time that I updated this! I have maintained within 3lbs of my target weight since January, which is a major achievement. Like a lot of people with eating disorders I always found maintenence difficult, but so far it’s all going okay. I have started exercising again but it’s not become compulsive. So hopefully I’ll be able to update this again in another three months saying exactly the same thing 🙂
Goal – maintain my weight during the stress and excitement of moving up north!

June-December
Behavioural 0/16
Emotional 0/9
Physical 0/9
Oops, I should check this more often than every six months! I have had a few minor lapses over the last few months, all when I have either been extremely stressed out or after stomach bugs. I’ve bounced back really quickly each time though, which is the main thing. Looking through my warning signs I’m not showing any of them this week and haven’t been throughout the majority of the last six months, but there have been maybe four periods of about a week each time where I would have scored (…counting…) around 12/16 behavioural, 7/9 emotional and 2/16 physical. It would be a good idea to do some more work on my coping mechanisms so I can cut back on those dodgy periods even further.

January-March 2011
Behavioural 0/16
Emotional 0/9
Physical 0/9
Much easier than the first six months living by myself! January was quite hard because I was feeling homesick after my trip to Dorset at Christmas, but February and March have been great. Very few ED thoughts and no behaviours at all, and I’ve passed the two year mark for the start of my recovery. Yay!

March-June 2011
Behavioural 0/16
Emotional 0/9
Physical 0/9
It’s been six months since my last minor lapse, which was right at the beginning of January. My weight remains stable, I don’t use any behaviours, and even if I am very stressed out and do get the odd sneaky ED thought creeping in, I ignore it automatically. I quite like my body. I have loads of energy. I eat when I’m hungry. I eat whatever the hell I want to eat. It’s allll good 😉

11 responses to “Relapse Prevention Plan

  1. howimashpotato

    This is absolutely fantastic and I’ve bookmarked it – such a useful tool! ❤ Thank you for posting this!

  2. thank you so much for bookmarking this. i need this right now!!!

  3. I hope you don’t mind but Jemima forwarded this link to me. She’s talked alot about you and your determination to recover. You are obviously an amazing person who deserves to have a bright future and enjoy everything good that life has to offer. You have been a real inspiration to J and I thank you for that. Stay strong – We don’t know each other but reading the above gives me such hope (as Jemima’s mother) and I really believe and have faith in your ability to recover. Take care Jess

    • themilkfreeway

      Thank you so much, it’s really sweet of you to leave me a comment! That just about made my day 🙂

  4. determinedtoshine

    love this page!

    katie rocks. end of story 🙂

  5. ahhh this page rocks!!!!! there is SO MUCH FOR ME TO LOOK FORWARD TOO!!!!!!! i think im a mix of August and October at the moment lol

  6. Pingback: Binge Off « Nurse Converse

  7. haha anson would disagree with you about 6-7 hours of sleep. He thinks more like 9-10 hours is what is “needed”…LOL! boys….

    • Haha yeah! 6-7 isn’t good for me in the long term, I usually get 7 but feel better after 8 🙂 I can’t sleep for 10 hours unless I’m absolutely exhausted though! My partner is the same, thinks sleeping is some kind of long distance sport 😛

  8. I might have to do my own version of this, I have found yours extremely helpful today. I have continued to come here and look at your tips throughout recovery, and now that I’ve only a tiny amount of pounds left to reach my initial medically healthy weight (but I’m going to go up to my set point) I feel something like this is important for me.
    One of mine is, “not liking space anymore” totally and utterly obsessed with it again now whoop! Bring on “the sky at night”. Thank you, again, for writing these. I have found it incredibly helpful. I’ll track back here if I do it as a post 🙂 x

  9. I’m with Roxy. I did my own too, and it did help. For me I still score high on the behavioural (still not getting periods, may be something to do with it.) I cling on to some weird food rituals (weighing things, not eating certain foods, having to eat at certain times and counting calories, includung fruit and veg!) however I eat a healthy amount and now am a healthy weight! Oh eating disorders! Why do you make no sense! Ok, that’s my moan out the way 😀

    However it really made me understand my disorder more (and most the physical was gone! That was nice to know! Doesn’t seem that long ago I couldn’t open my own front door, I was that frail.

    So yeah, thanks for that, it’s been very helpful!

    x

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