The risk of cross-addictions in early recovery
A leading cause of eating disorder relapse is getting into a relationship too early in recovery. Early recovery is emotionally volatile; add in the additional ups and downs of a romantic relationship and you’ve got a recipe for relapse.
In the vulnerable early stages of recovery, there is an increased risk of cross-addictions, one of which may be the “high” of romance, sex, and relationships. An individual may recover from an eating disorder only to find that they compulsively pursue romance, sex, or relationships to feel validated and worthy.
Dr. Carolyn Ross(link is external) is a nationally known author, speaker, expert, and pioneer in the use of Integrative Medicine for the treatment of Eating Disorders, Obesity, and Addiction. She is the former head of the eating disorders program at Sierra Tucson. Dr. Ross consults with treatment centers around the country to help them develop successful eating disorder programs with the focus on treating dually diagnosed eating disorder clients.
Editor: Saad Shaheed
Why Cross-Addiction Happens
A Brain Programmed for Pleasure-Seeking. In early recovery, there are times when people simply don’t feel good. For those in recovery from eating disorders as well as addictions, a depletion of receptors in the reward center of the brain can make it difficult to gain pleasure from simple rewards like a beautiful sunset or favorite song. Depression or dysthymia can linger for the first few years of recovery.
As a result of these changes in the brain, people who have given up their primary coping skills (an eating disorder or addiction, for example) may be left looking for another way to feel good. Unless they remain focused on their recovery program and draw on the skills they learned in treatment, they may find an addictive outlet for that high, whether through drugs, alcohol, sex, relationships, food, or some other compulsive behavior.
Just as eating triggers the dopamine reward system in the brain, “limerence,” or the feeling of falling in “love,” can be a euphoric experience that drives people to extremes. An eating disorder, which was once the individual’s sole focus, may be replaced by a relationship or the pursuit of “love.” Sex, love, and relationships become a distraction or escape that prevents the individual from working through the deeper issues underlying their addiction. Love addiction becomes their new escape.
Most treatment centers and 12-Step programs advise people in recovery to avoid romantic relationships for at least the first year. Although people don’t always heed the warning, this is smart advice, not only because a relationship diverts attention from recovery but also because it takes the brain at least a year or two to return to normal functioning. It’s also wise to stop smoking and other addictive habits because they continue stimulating the dopamine system in the brain, fueling cravings for another high.
Inability to Tolerate Distress. During the difficult early phases of recovery, people must learn to tolerate the stresses of everyday life and give themselves time to work through their issues. Years ago, I was part of a research team that tracked clients’ level of emotional dysregulation after completing a treatment program. If the client scored high on emotional dysregulation at discharge, they had almost a 100 percent risk of relapse compared to clients who had made improvements in their ability to self-regulate.
Stunted Emotional Growth. Because eating disorders can begin as early as age 10 or 11 and continue through adolescence and into adulthood, emotional maturity may be arrested early in life. Whereas teenage relationships often are explosive and unstable, these same characteristics may define an individual’s relationships into their 30s, 40s, and beyond. Without completing each developmental milestone, the individual may lack social skills and ego strength, which involves knowing who they are and what is best for them.
Low Self-Esteem. Eating disorders are strongly correlated with low self-esteem. Because they don’t feel deserving of more, people in recovery may gravitate toward relationships that are harmful to them. Those who have suffered emotional trauma (related to rape, assault, or prostitution, for example) may not feel worthy of genuine love and intimacy or they may misidentify sex as love/intimacy.
Is This Relationship Toxic?
When cross-addiction occurs, women tend to act out with relationships and romance while men’s symptoms are more likely to manifest as sex addiction, though both genders can struggle with any of these issues. Someone who is addicted to romance or relationships may:
• Be excessively needy, clingy, or smothering in relationships
• Fall in “love” quickly and easily, feeling powerless over their emotions
• Fantasize constantly about a partner or the future of the relationship
• Feel compelled to always be in a relationship, even one that is harmful or requires them to lower their standards, rather than be alone
• Mistake sex and romance for love
• Focus on the relationship to the exclusion of all else (including friends, family, and interests)
• Choose partners who are addicted, abusive, or otherwise unavailable, often resulting in repeated failed relationships
• Use sex and/or romantic intensity to cope with loneliness or unhappiness
• Use sex or seduction to get or keep a partner’s interest
• Try to attract or hold onto a partner through excessive dieting or exercise
• Return to an unhealthy relationship despite promises to self or others
• Do things they’re uncomfortable with to maintain the relationship
Any relationship that takes the individual away from working their recovery program is toxic to eating disorder recovery. They may stop attending 12-Step meetings, cancel counseling sessions, or give up on school, work, or other goals to suit their boyfriend/girlfriend. Some try to use their newfound knowledge to “save” others who suffer from addictions and mental health issues and end up exerting so much energy to help a boyfriend/girlfriend that they put their own recovery in jeopardy. When the people closest to the individual in recovery express concern about their choice of partner or the intensity of the relationship, it may be time to re-evaluate the purpose the relationship is serving in the individual’s life.
New relationships aren’t the only ones that merit scrutiny in early recovery. Pre-existing relationships, whether with a romantic partner, family member, or friend, may also need to adjust in order to be supportive of the individual’s recovery.
When someone struggles with an eating disorder, their loved ones may grow accustomed to dealing with them as what we call the “identified patient.” The relationship may be defined by distrust and dysfunctional patterns of caretaking and/or enabling rather than support and encouragement. When the patient gets well, the focus shifts to the loved ones, often revealing flaws and weaknesses that require treatment of their own. As a result, loved ones must be prepared to address their own emotional issues and adjust their roles to avoid being “toxic” to their loved one’s recovery.
People in recovery may have lost friends because of their eating disorder and gravitated toward friends who struggled with similar issues. While some old friendships may be supportive of their recovery, others may not. Part of recovery is making the difficult decisions concerning who stays and who goes.
There is so much involved in eating disorder recovery — healing the brain and body, addressing underlying trauma and low self-esteem, learning basic life skills, and mending relationships — it’s no surprise that there’s no 30-day miracle cure for eating disorders or other addictions. While loving, supportive relationships are an important part of life, the early years of recovery are best spent building a strong sense of self. Only then can men and women in recovery be healthy and whole for themselves and their partners.