Authors: Randy K. Hardman, PhD and Michael E. Berrett, PhD
For most people, the holiday season is a wonderful time of year. It is often a time of family reunion, socializing, and celebration – a time when families, friends, and coworkers come together to share good will and good food. The season is meant to be bright, happy, and full of the best of relationships. Yet, for many who suffer with eating disorders, this is often the worst time of the year. For those who are trapped in the private hell of anorexia, bulimia, or binge eating disorder, the Holidays often magnify their personal struggles, causing them great internal pain and turmoil.
At Center for Change, we have asked many patients over the years to share from their private experiences what the Holidays have been like during the years they suffered with an eating disorder. The women quoted in this article are of different ages, but all suffered with the illness for many years. As you read the following passages you will feel something of the agony of suffering with an eating disorder at this festive time of year.
“Unlike any other normal teenager, I always hated it when the holiday season would roll around. It meant that I would have to face my two worst enemies – food and people, and a lot of them. I always felt completely out of place and such a wicked child in such a happy environment. I was the only person who didn’t love food, people, and celebrations. Rather, holidays for me were a celebration of fear and isolation. I would lock myself in my room. Maybe no one else gained weight over the holidays, but just the smell of food added weight to my body. My anorexia destroyed any happiness or relationships I could possibly have had.” -Nineteen-year-old woman
“The holiday season is always the most difficult time of year in dealing with my eating disorder. Holidays, in my family, tend to center around food. The combination of dealing with the anxiety of being around family and the focus on food tends to be a huge trigger for me to easily fall into my eating disorder behaviors. I need to rely on outside support to best cope with the stresses of the holidays.” -Twenty-one-year-old woman
“Over the past few years, during the Thanksgiving and Christmas holiday season I have felt horrible. I felt trapped and like the food was out to get me. I lied on endless occasions to avoid all of the parties and big dinners that go along with the holidays. I felt horrible about my body and did not want anyone to see me eat for fear they would make judgments about me.” -Eighteen-year-old woman
These quotes from those suffering from anorexia, bulimia, and binge eating reveal the emotional intensity they feel during the holiday season. Their fear of gaining weight and becoming, in their minds, fat, gross, and disgusting, is the monster they deal with every time they partake of any of the foods that are so wonderful and common to the holidays.
Starving for the Holidays – A Tale of Anorexia
Those struggling with anorexia are terrified of the holidays because they have no idea what a normal amount of food is for themselves. Most of them feel that anything they eat will mean instantaneous weight gain. In fact, some of them have said that just the sight or smell of food is terrifying to them because their fear of being fat or becoming fat is so ever-present in their minds. For some, just thinking about food is enough to create intense turmoil, pain, and guilt. Anorexia creates tremendous guilt about any kind of indulgence involving food. The eating of food becomes evidence, in their mind, that they are weak, out of control, and undisciplined. Anorexic men and women are often terrified of being seen eating food or of having people look at them while they eat. One client felt that every eye was on her at holiday gatherings. Many suffering with anorexia have shared their feelings of being immobilized by their fears about food.
“My life with an eating disorder during the holidays is a living hell – constant hiding and fear, confused about life and hating every moment being surrounded by food. There was so much pressure, so many stares and glances, and days with endless comments. My whole life was a mess. There was so much pain and guilt inside of me and I didn’t know where to turn, except to my eating disorder. I hated the pressure of eating the food, the constant worrying of offending others.” -Twenty-two-year-old woman
“It’s hard to be around all the food and festivities. When I’m hurting inside and struggling with what “normal” food portions even are, I need the help, emotional understanding, and support of family and other people. “Handle with care, but please handle.” Accept me the way I am. Let me back in the family” -Twenty-three-year-old woman
The importance of these quotes from clients in treatment for anorexia is found in their honest expression of the tremendous pressure and conflict they feel inside in response to the normal food and social activities of the season. Their internal suffering and pain are sometimes revealed to others around them by their continual remarks about “being fat,” or their suffering may be hidden in their patterns of avoidance and withdrawal from social involvements.
The Hidden Beast of Holiday Feasts – Tales of Bulimia and Binge Eating
On the other end of the eating disorder spectrum, a person with severe bulimia or binge eating disorder often finds the holidays are a genuine nightmare because there is so much emphasis on food that they become preoccupied with it. Binge eating and subsequent purges become even more prevalent because many of the foods and sweets that are associated with holiday celebrations are very enticing to them. The holidays can be a time of convenient indulgence, but also a time of great shame and self-reproach because of their secret life. Some even use the binge eating and/or purging as a form of self-punishment throughout the holidays.
Those who suffer with binge eating or bulimia often live out this painful eating disorder hell in private and in secret, and often feel great self contempt. To many of their family and friends things may look positive and normal even while the sufferer feels significant despair and negativity about their loss of self-control. Those whose family members know about their eating disorder carry this awful feeling that they are the main attraction at the holiday dinner, where every trip to the food or to the bathroom is seen as a major defeat and disappointment to their family.
“Christmas is the hardest time with my bulimia. So much food, so much love, and so much joy, but I could not feel the love or joy, so I indulged in the food as a replacement. It was hard to see everyone so happy before I made the trek to the bathroom. I felt unworthy to be happy. I didn’t deserve the love and joy. I’ve discovered that if I can focus on the love and joy, everything else falls into place” -Eighteen-year-old-woman
“The secrecy and lying make it very difficult for me during the holiday season. I have to decide whether to restrict my food or to binge and then sneak away to purge.” -Twenty-two-year-old-woman
Some of the painful consequences of binge eating and bulimia are found in the time, planning, and dishonesty that is required to protect and cover up their eating disorder during the holidays. They often feel hatred for themselves for the ongoing deception to family and friends to excuse or explain their behaviors. In addition, they live in constant fear of being “found out” by their significant others, or in fear of continually letting others down because of their inability to stop their compulsive behaviors.
Family and Friends – Turning Potential Triggers into Gifts of Support
Holiday ideals epitomize what is good about family and other personal relationships. Activities during this time of year can involve family members and friends in intense and often emotional ways. Unfortunately, those with eating disorders can find it terrifying to be emotionally close with other people. In such situations they may feel vulnerable and unsafe, and then revert to their eating disorder to restore a sense of control and self-protection.
Some family dynamics, such as conflict, can be triggering to those with eating disorder difficulties. Struggles with perfectionism, feelings of rejection, disapproval, and fear of being controlled, are all cited frequently by women who suffer with the illness. Harboring strong feelings and beliefs that parents, family members, or friends find them unacceptable, inadequate, or disappointing is challenging for anyone, but is particularly devastating to someone with a painful eating disorder. Being immersed in a family setting during the holidays has the potential to dredge up old issues, fears, conflicts, and worries about family relationships. The resulting emotional disruption can feed the eating disorder and exacerbate the problem.
“Having an eating disorder during the holidays presents quite a contradiction in my mind. I anticipate all the food and get excited, while at the same time I dread the many family members around. I feel that the family is over to “watch”. I know that they simply want to reach out and help, but I feel that a big help would be to make a concerted effort to shift the holiday focus from the food to the underlying purpose. I wish the food could be a minor deal, just an accessory to the holiday, rather than the focus.” -Twenty-year-old woman
“Holidays, with all the food and family commotion, are pure hell when you have an eating disorder. For me, when the focus isn’t on food and is on the real reason for the holiday, it’s a big help. My family helped me out with this one, but I had to do most of it internally. Remember, it’s just food, and we have more power than food.” -Thirty-nine-year-old woman
The following suggestions resulted from a survey question we asked patients in treatment: “What three suggestions do you have for family and friends who want to help the holiday season go a little better for a loved one suffering with an eating disorder?” The women offering these suggestions ranged in age from fourteen to forty-four, and their suggestions offer some valuable insight and understanding that could be helpful to you as a friend or a family member. Being compassionate about the struggles in the eating disorder illness can help make the Holidays less of a battle for those you love. The suggestions are:
- Do not make a big issue about what your loved one is eating. A little bit of encouragement is okay.
- Do not focus too much on food, it may only fuel the eating disorder.
- Ask her how she is doing and see if she needs any help.
- Do not become angry about how the she feels, just do your best to support her.
- Offer a lot of support and be aware of what may be creating anxiety and try and understand what she feels. Be understanding, kind, and supportive.
- Spend quality time with your loved one.
- Make sure that the primary focus of the holiday is not on the food but rather on the family and the valued time you will share together.
- Allow for other activities that do not involve food, such as games, singing carols together, opening gifts, decorating, and spending time just talking together.
- Allow her to make a dish that she would feel comfortable eating.
- Before the Holiday itself, and before family gatherings, make agreements about how you can best help your loved one with food. Honor the agreements you make.
- Do not give her loud and attention drawing praise when she does eat.
- Do not talk about diets, weight loss, or weight gain. It causes great anxiety and may increase a felt need to engage in eating disorder behavior.
- Do not stare.
- Learn enough about the illness and the triggers to help your loved one develop skills as well as strategies to defy eating disorder thoughts and urges.
- Know something about her struggles, triggers, and behaviors. Then, if you see those, you can approach her in private after a meal and suggest ways she might be helped in some of those behaviors and learn ways you can be helpful and supportive.
- If you see her struggling, ask if she wants to talk, but ask this in private.
- Focus on how she is feeling inside, what issues she is worrying about, what her fears are, what she needs, rather than just how much she is eating or not eating.
- Try not to focus too much attention on the eating disordered behaviors.
- Be patient and nurturing.
- Treat her with love and respect no matter what is going on.
- Let her know that she is loved.
- Help her take her mind off of food by generating a conversation with her about general or important topics.
- Don’t allow her to excessively isolate.
- Be there for her emotionally with messages of love.
There are several themes that are evident in these suggestions for loved ones and friends by those suffering with eating disorders. One of the most important is to keep the primary focus and interest on the family member or friend – the individual beyond her eating behaviors or eating disorder. Consider well these suggestions, they are actually heartfelt requests.
How Family and Friends Can Help During the Holidays
Family members and friends need to know ways to help a loved one suffering from an eating disorder during the holidays. In addition to those suggestions offered above, the following suggestions from clinical professionals may also be helpful:
- If your loved one is a child or adolescent in treatment, and/or if you are involved in Maudsley/Family Based Treatment, then continue with your regular outlined treatment plan through the Holidays.
- If your loved ones is a child or adolescent with anorexia, then learn about the Maudsley/ Family Based Treatment approach. It is important to give this approach consideration.
- If your loved one is in acute medical or self harm risk then arrange for intensive medical/psychiatric care immediately.
- Get professional help for your loved one with those who have experience and expertise with eating disorder treatment.
- It is important for everyone to be honest and direct with each other. When going into a family or social event, especially if people are aware of the eating disorder problem, it is helpful that everyone talks honestly about what will help and what will not help during the event. Armed with this knowledge, family and friends can set up some structure around holiday activities that is agreeable to all parties involved. Give reassurance about your desire to “be supportive” of them without trying to control every problem. You can respond to their feedback about what may be helpful to them by making positive adjustments. It helps to express love, gratitude, respect, and acceptance for your loved one.
- It is important to emphasize the purpose for the celebration of the holiday and focus less on food or meals.If the focus is on the holiday itself and its true meaning and purpose rather than on the food or eating disorder, it will be easier for your loved one to focus less on it herself. Emphasize time together, activities, and traditions that transcend meals and eating. Let food become a support to the holiday rather than its central focus.
- It is important for family and friends not to feel responsible and guilty for the eating disorder.There is no need and there is no good time to feel guilty or at fault for your loved one’s eating disorder. The Holidays are especially not the time. Eating disorders are complex illnesses that are not caused by a person or a relationship. It is also important for the eating disordered person not to feel responsible for their family and friend’s emotional response to the eating disorder. One helpful agreement around the holiday season is, “We will spend time focusing on the need for nourishment as previously agreed upon, and primarily, we will spend time focusing on each other and the things that are available and that are meaningful in our family or social setting.” Let them know that you can look beyond the outward manifestations of the eating disorder because you are also concerned about the hurt, pain, fear, and guilt they are feeling inside. In acknowledging the pain inside, no one has to be at fault or to blame for the eating disorder, allowing positive family associations and caring to become the emphasis. There is no need to “walk on egg shells”, especially when everyone understands and acknowledges the underlying needs associated with the eating disorder. Compassion is a wonderful holiday gift for someone with an eating disorder.
- It can be helpful during the holiday season to break activities into smaller numbers of people, when possible.It is easier and less overwhelming to deal with five people than fifty people. Invite your friends or family members to participate in smaller, quieter, and less chaotic social activities and events. Simple talking and sharing as a small circle of family members or friends can do much to increase the sense of belonging and safety for someone with an eating disorder.
- Encourage your family member or friend to gather extra support around themselves during the holidays.Additional support can come from extended family, other friends, community, and even treatment team members. If you recognize the benefit of these additional support people during the holidays, you can encourage this extra involvement rather than be hurt and offended by it. Sometimes, a person with an eating disorder might not be ready yet to receive the full love and support family and friends offer, but support and love them anyway! You can send the message, “We’re here to support you and it’s okay if others support you as well. We want you to have all the help you need during this time.”
- It is important for family and friends to remove any unreasonable behavior expectations or pressures of performance.Sometimes you want so much for things to be better that you do not realize how your disappointed hopes and expectations actually play out as triggers for the eating disorder. Letting go of these specific expectations in your own mind frees you up to respond to and enjoy whatever your loved one is capable of during the holidays. It would be more helpful to express a lot of warmth, love, kindness, and acceptance toward the person – “There is no pressure to prove anything to us during the holidays. We just want to focus on being together the best we can.” Eliminating specific, overt, or implicit expectations will be more beneficial than almost anything else you can do.
- It is important to offer care “giving” and not care “taking.” Being a self declared nurse, dietitian, therapist, or detective takes you out of your most important role – “loved one”. It is not your job to fix or solve the eating disorder. It is your job to assure nourishment of the body in young family members and encourage nourishment of the body in adult family members and provide nourishment to the soul. Working too hard to stop the eating disorder behaviors during the holidays can fuel dishonesty and defensiveness which actually feeds the problem. You are not responsible to say or do everything right. Nothing you do or not do will take away your friend or family member’s own responsibility to overcome and recover from their eating disorder. She/he is the only one who can do that job, but you can care, empathize, encourage, and share the process with them. The good intent you express is often more helpful than what is actually said or done. If your friend or family member knows that your heart is on their side, then you become a source of comfort, support, and safety to them.
These general holiday suggestions by patients and professionals are not a complete list, but they do emphasize some positive approaches to help and support someone suffering with an eating disorder. The specific ideas, strategies, and agreements that can come out of your interactions with your loved one before and during the holidays will allow these ideas to be personalized and unique for each situation. Remember also, that the person struggling with the eating disorder has her own list of positive things that she can do to help her through the holiday season as well. We hope this article is helpful in better understanding the significant and difficult ordeal those who suffer from eating disorders will face at this season of the year. We hope this awareness and understanding will help us identify the best gifts of the holidays for those we love and care so much about at this time of year.
Written October 2006, Revised and Re-edited July 2014