Counseling a Woman Through an Eating Disorder Relapse

Counseling a Woman Through an Eating Disorder Relapse
by Marie Notcheva ©

One of the most maddening and disheartening things about overcoming a particular life-dominating pattern of behavior is the ease with which a believer can slip back into old patterns. When talking about ‘addictive’ behaviors such as eating disorders, we’d term this going-backwards a relapse. For a woman overcoming anorexia or bulimia, relapsing is much more common than for someone overcoming drug or alcohol abuse. Eating is necessary for survival; therefore, the temptation to use food in a self-destructive way or as an emotional crutch is much greater than with a substance from which she can totally abstain. Of course, this is not to say that quitting drugs is easy, or that one will never “fall off the wagon,” but for someone struggling to renew her mind from the grip of an eating disorder, relapse is a daily danger.

There are several excellent resources on this topic, apart from my own book Redeemed from the Pit: Biblical Repentance and Restoration from the Bondage of an Eating Disorder. Please see Dr. Mark Shaw’s book, Relapse: Biblical Prevention Strategies (Focus Publishing), and Brad Hambrick’s Gaining a Healthy Relationship with Food seminar.

The topic of relapse during the process of repentance and transformation is too big to adequately address in a single blog post, but we may outline some principles the counselor will find helpful to keep in mind as she dialogues with a discouraged woman. (Bear in mind that when a woman finds herself struggling with failure over and over with the same besetting sin, she often will question her salvation. Regardless of where she is in the counseling process, it will be helpful to re-cover groundwork regarding her salvation before moving on to changing her behavior).

What is a Relapse?

The definition provided by Brad Hambrick is a helpful one: Relapse is the recurrence of self-destructive behaviors related to our desired change. In eating-disordered counselees, this takes the form of either reverting back to the binge-purge cycle, or restricting calories/over-exercising again once a healthy food plan has been established. It is rarely deliberate. More commonly, fear will set in over weight gain or amount of food consumed in one sitting. “I’ve already blown it; I may as well go full-out now!” is the escape-latch thought. What starts as a one-time slip, if not examined and repented of, may turn into a slide right back into the eating disorder.

Why Do Believers Relapse?

At all times during the frightening journey out of an eating disorder, our role – whether as counselors or just as Christian friends – is to give hope. Logically, we might ask, If we are no longer slaves to sin, and especially if the counselee has made strides against her addiction, why would she fall back into it?” Here, we are asking the same question Paul asked rhetorically in Romans 7 – but a better question would be, “What is the counselee gaining from this behavior?” (Self-starvation, gluttony, drunkenness,etc.) The simple answer is comfort. She has resorted to her “drug of choice” so many times for so long to escape pain that, even as a redeemed child of God, she will still default back to this habit if she does not seek comfort, fulfillment, and joy elsewhere. An eating disorder is truly the empty cistern from which no satisfying water can be found.

Helping Her Out of the Pit

As Hambrick points out in his study guide, “More dangerous than relapse are dishonesty and hiding.” When a counselee is transparent enough to admit she has fallen, she is already on her way to overcoming the struggle. She first needs to be honest with herself, then with you (as the counselor), and with God so that she can see the relapse for what it is – a temporary setback that can be put in the past. She needs to know she doesn’t have to beat herself up over it. Shame leads to despair, which in turn will lead to her seeking solace in the behavior again. Eating disorders are vicious cycles. Hambrick outlines four pre-cursers of relapse: Complacency; Confusion; Compromise; and finally, Catastrophe.[1]

How do we give hope, at any stage of her relapse?

The first place to begin is with a discussion of God’s grace, freely available through Christ’s finished work on her behalf. She likely knows that her sin was covered at the cross–past, present, and future–but intellectually understanding this truth does not help a woman who is drowning in shame. She needs to hear it again, applied specifically to this sin, and to know that even if she slips again in an hour, “He is faithful and just to forgive and cleanse” her (1 John 1:9). One of the most crucial verses for an eating disordered counselee is, “…and if he sins against you seven times in the day, and turns to you seven times, saying, ‘I repent,’ you must forgive him.” (Luke 17:4). Remind her of God’s faithfulness, and that His mercies are new every morning (Lamentations 3:22-23). Ask her to journal about times in the past when God has proven Himself faithful in her life.

Once she understands (or is reminded of) the ongoing grace and unmerited forgiveness of Christ toward her individual struggle, it is a good time to be proactive and help her shore up her ‘action plan’. Remind her of past successes; the sure knowledge she had that the Holy Spirit was with her at all times. This is a good time to focus on the outworking of 1 Corinthians 10:13.

In subsequent counseling sessions, assuming she has not regressed further into relapse but is putting these truths into practice, you can again visit the thoughts and behaviors to “put off/put on” (Ephesians 4:22-24) specific to an eating disorder. (See chart below for specific examples):

“Put Off” “Put On”
Number on scale determines my value I am made in the image of God (Gen. 1:26) and my purpose is to glorify Him (Ps. 86:9; Isa. 60:21)
Counting calories Food is necessary to sustain life; receive with gratitude (1 Tim. 4:4)
Fear of gaining weight God created my body; I can trust Him as I eat the way He intended (Psalm 139:13)
Some foods are forbidden or “dirty” 

 

No particular food is unclean (Acts 10:15)
No one cares about me; I may as wellcomfort myself with a binge God cares about me, and I can turn to Him (1 Peter 5:7)

 

[1] http://www.bradhambrick.com/responding-to-relapse-in-an-unhealthy-relationship-with-food/

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