How do you know if you have to go back to treatment?

How do I know when it might be time to go back to treatment? What are my signs of relapse and recovery? How do I know when to ask for extra support? What behaviors do I engage in at the beginning of a relapse? What are my triggers that may lead to a relapse? What are my thoughts related to when I am entering a relapse? Who can I call when I am struggling? How will I know that I need to seek treatment again? What steps can I take to get myself the help I need?

I had to fill out a 5 page discharge packet when I left treatment asking me all of these questions above. Lately, I've been looking back at it, because I can feel myself falling into a relapse.

It started slowly. I have felt for months now that the medication for my heart condition has not been as effective as it had been, even while I was in treatment. I saw a cardiologist, who was less than helpful, who recommended that I don't "reinvent the wheel" by changing my medication. So, I just decided rather than pumping medication into my body that isn't really helping, I would just stop taking it. This is typically one of my first relapse steps, as my medication slows my heart rate down from the normal resting rate of 120-ish.

What behaviors do I engage in at the beginning of a relapse?

Then, I caught myself providing excuses to skip meals, especially during the work day. "Sorry, I can't come too, because I just have too much work to do." "I am in the middle of something, so I can't go eat lunch now." "I need to sleep, so I will just skip breakfast to sleep in more." Any bullshit reason that was there I would use; however, I was eating larger meals at dinner of particularly unhealthy food aka take out to make up for some calories and the occasional snack during the day. I can always hear the voice of my last dietician in my head when I skip meals. "Do we need to place a tube?" No really. I would rather feel like shit eating all this food than feel like a failure for having a tube placed. But my ED mind takes over and those words fade away and I feel safe and warm in my restriction. The empty feeling in my stomach is like fuel to a fire to continue these patterns.

What are my triggers that may lead to a relapse?

All of a sudden on Friday night, I found myself waking up to the middle of a panic attack during the night. I had been having a nightmare when it started, and I woke up to hyperventilating, which is in my top 5 most terrifying experiences. Since then, I have been restricting often. I did eat at all on Saturday; however, I knew I needed to try and eat dinner. So, I ordered a sub from Jimmy John's, which feels safe and would be easy on my already anxious stomach. Then, I did something I swore I would never do. I purged. My M.O. has always been restricting. As I once told a psychiatrist who had placed me a 45 minute waiting time after meals before entering my room, "Does a serial killer change their M.O.? No, because it works. I'm not all of a sudden going to become a purger." Well, then that happened and it was totally overwhelming. I had a very difficult time eating all day yesterday with the amount of guilt I was experiencing. So, again, I ate very little yesterday. I don't own a scale, but I can tell I am down weight, and I love it. There's just still some fraction of a healthy mind left that says don't do it.

What steps can I take to get myself the help I need?

Last night, I went out with my brother and his fiance, because I have been isolating so much lately. I told them what has been going on, and they agreed that maybe going back to McCallum Place isn't to worst idea right now, especially with how off track I've gotten and my thought process that's telling me to keep going. So, I spoke with my boss this morning, who agreed to work with my schedule to allow me to do an IOP after work. Then, I made the call that I didn't really want to make. I called the same girl that I had done my intake with to say that I needed to come back and get some maintenance before things get so bad that I need to go back to a PHP like 6 months ago. This is a step that I really hoped I would never have to take.

How will I know that I need to seek treatment again?

When you realize that you're out of control and just can't keep doing this, I know that I need to go.