Relapse in Eating Disorders: A Systematic Review and Thematic Synthesis of Individuals' Experiences

Relapse is common in eating disorders (EDs); however, it has received significantly more attention within quantitative research. This systematic review aimed to synthesize qualitative findings regarding the experiences of relapse for people with EDs.

A search for studies reporting qualitative data that included experiences of relapse in individuals with EDs was conducted. This included a systematic search of MEDLINE, CINAHL, PsycInfo, Scopus, SSCI, and PQDT Global along with supplementary searching. A total of 1594 titles and abstracts and 168 full texts were screened for eligibility. Sixteen studies were included in the review. Quality appraisal was conducted using the CASP checklist. Data were extracted from each paper and thematic synthesis of relevant data from study findings/discussion was completed in NVivo.

Most included studies involved female participants in the United States, Canada, and United Kingdom with anorexia and bulimia nervosa. Five analytical themes were generated: 1) "I wasn't letting go": Relapse as enticing; 2) "Bound to lose": Relapse as unstoppable; 3) "If the going gets tough I've always got this": Relapse as protective; 4) "Coming back with your tail between your legs": Relapse as destructive; 5) "So much of this journey … is learning": Relapse as instructive.

Findings highlight the gap between psychological and behavioral improvements that precede relapse, and the contrasting ways relapse is described and experienced. They support a focus on motivational factors and underlying psychological difficulties in treatment, extending beyond a behavioral focus. Further research is needed to understand relapse experiences among males and individuals from the global majority.

Individuals with EDs who relapsed described desiring or feeling powerless to control relapse. Findings suggest the need for greater emphasis on developing intrinsic motivation and self-efficacy in order to sustain recovery. Residual ED cognitions and unaddressed psychological vulnerabilities were implicated in relapse. Findings caution against premature discharge before sufficient cognitive and emotional progress has been made. In response to relapse, clinicians should aim to foster hope, compassion and tailor treatment to address the recovery needs revealed by relapse.