Binge (in the context of an eating disorder)

“Flare-up” is a term used in everyday language, not a diagnosis. Parents use it when their child’s symptoms become more severe again after a calmer period: mealtimes become a struggle once more, their mood takes a turn for the worse, and their anxiety increases. Professionals tend to refer to this as a worsening, a new episode, or a recurrence of symptoms.

The term fits because it describes the wave-like nature of the condition. Mental illnesses such as eating disorders, depression, and anxiety disorders rarely follow a straight line. Weeks of clear progress are sometimes followed by days when old patterns return. In the case of a depressive episode, this fluctuation is actually part of the clinical picture: Many courses of the illness come and go in phases.

A flare-up does not indicate that the treatment was ineffective. It is part of the course of the illness and is often temporary.

These three words have different meanings, even though parents often use them interchangeably in everyday life.

• Normal fluctuations: a bad day, a loss of appetite after an argument, a low mood after a disappointment. Everyone experiences these kinds of ups and downs. They usually subside on their own.
• Flare-up: Symptoms noticeably worsen over several days, even though the child had recently been more stable. The pattern of the illness returns, often in a milder form.
• Relapse: The symptoms return to the full severity of the illness, often lasting for weeks. For more on this, see “Relapse from a Parent’s Perspective.”

The boundaries are fluid, and no one at home needs to make a precise classification. What’s more important is the trend: If the signs become more pronounced over the course of several days, it’s worth involving the treating professionals. Sometimes even a genuine improvement can feel strange; see the article “Ambivalence Toward Improvement” for more on this.

Most flare-ups give warning signs. Parents know their child well enough to notice small changes before they become major ones.

• Withdrawal from social interactions, canceling plans
• In cases of eating disorders: more rules around eating, skipping meals, frequent weighing, going to the bathroom immediately after eating
• changes in sleep patterns, difficulty getting out of bed in the morning
• more irritable, quiet, or prone to tears
• Increased preoccupation with weight, performance, or the future

Typical triggers are stressors that upset the balance: exam periods, conflicts, changing schools, illness, a new diet trend among friends, or pressure from social media. In eating disorders, stress is often seen as an aggravating factor because behaviors such as fasting or binge eating are then used to cope with anxiety, despair, or loneliness. Such triggers show what to look out for earlier next time. They are not evidence that someone has failed.

During a tantrum, staying calm helps more than quick fixes. The child can sense if the parents are panicking.

• Stay calm and describe what you notice without blaming them: “I’ve noticed that the last few days have been harder.”
• Involve the care team: Inform the therapist, child and adolescent psychiatrist, or pediatrician instead of waiting. It’s better to call early than late.
• Use the crisis plan: Many families have made arrangements with their treatment team for difficult days. The article “Crisis Plan at the Family Level” describes what such a plan looks like.
• Maintain structure: regular meals, sleep, and a reliable daily routine. This provides stability.
• Don’t forget about yourself: A relapse takes a toll on parents, too. Short breaks and having someone to talk to help you maintain your own strength.

A relapse doesn’t mean progress is lost. The skills the child has learned during treatment remain. Things often start looking up again after a difficult phase, sometimes with an adjusted treatment plan.

There are certain signs that should prompt parents to seek immediate medical attention. Medical help is necessary in cases of severe weight loss over a short period of time, fainting or a racing heart, persistent vomiting, or signs of self-harm or suicidal thoughts. In an emergency, call 112 or go to the nearest hospital.

For emergencies at home, a prepared emergency kit with important phone numbers and clear instructions can be helpful.

Rückenwind Parents support and coach families during such phases, but they do not make diagnoses or replace treatment. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist and works without a medical license. Only a child and adolescent psychiatry department or a medical or psychotherapeutic specialist can determine whether a flare-up indicates a deterioration requiring treatment.