Why Eating Disorders Return

A Clinical Review of Habit Learning, Relapse, and Recovery

Abstract

Eating disorders are often described in terms of their symptoms; however, the feature that actually defines them is the duration of their symptoms. Despite the awareness, motivation, and symptom-focused treatment individuals receive, eating disorder behaviors frequently recur, showing that existing models are not capable of comprehensively explaining why these behaviors are so challenging to change. This narrative review approaches eating disorders from an action-control perspective, separating goal-directed and habit-like forms of behavior. Using this framework, restrictive binge-eating and compensatory behaviors are viewed as learned action patterns. This review integrates research theories, transdiagnostic models of compulsivity, and clinical outcome studies to explain why eating disorder behaviors are challenging to modify and prone to relapse. Clinical findings related to ambivalence, limitations in evolutionary control, relapse patterns, comorbidity, and generalizations in treatment demonstrate why short-term, symptom-based treatment methods are ineffective. Viewing eating disorders as habitual behaviors is crucial for relapse prevention, long-term monitoring, and identifying behaviors, context, and clinical factors that need to be addressed in treatment.