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Coping With An Eating Disorder During The Holidays (2004)
Five years ago, I researched and wrote an article on eating disorders and the holidays based upon my experiences working with women of different ages who were struggling with anorexia and bulimia. They provided me feedback concerning aspects of the holiday season that were difficult for them, from which I developed suggestions designed to help family members during the Thanksgiving and Christmas holidays. I recently asked women currently in treatment at Center for Change who are actively engaged in the recovery process to share their suggestions and ideas about how to help someone suffering with an eating disorder better approach the holiday season. It is important to note that although five years have passed since the original article, the painful feelings and struggles and the issues that complicate the eating disorder during the holiday season are very much the same. This article includes many new quotes related to these difficulties as well as ideas and suggestions to help families and friends help a loved one who is suffering with an eating disorder to get through the holiday season a little better.
For most people, the Thanksgiving and Christmas holiday season is a wonderful time of year. It is often a time of family reunion and celebration - a time when families, friends, and coworkers come together to share good will and good food. The season is to be bright, happy, and full of the best parts of relationships. Yet, for women who suffer with eating disorders, this is the worst time of the year. For these women, trapped in the private hell of anorexia or severe bulimia, Thanksgiving and Christmas magnify all of their personal demons, causing them great internal pain and turmoil.
I asked women who are currently in treatment for anorexia and bulimia at the Center to share from their private experiences what Thanksgiving and Christmas have been like in recent years.
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, take lots of laxatives, and exercise compulsively. 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. No matter how much I tried to deny it, I couldn't get better on my own. My only wish is that I could have gotten treatment or help so much sooner, so I wouldn't have wasted so much of this precious life I have found. - 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-oneyear- 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. - Seventeen-year-old woman
Holidays have been one of the most difficult times for me while I've been in my eating disorder. Often the anxiety is overwhelming. I feel like running and hiding from everyone. It is so hard to be surrounded by food, family, and the pressures these two things create. One Christmas I was so worried about having to eat in front of my family that I purposely had my wisdom teeth taken out on December 20th, just so I would have an excuse not to eat. On other holidays I have waken up early just to run extra long so that I'd be able to eat what other people were eating and not be traumatized. - Twenty-two-year-old woman
These quotes from women suffering from anorexia and bulimia describe 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 must deal with every time they partake of any of the foods that are so wonderful and common to the holidays.
These women are also terrified because they have no idea what a normal amount of food is for themselves. For most of them, and in particular for an anorexic, they 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 is so ever present. For some, just thinking about food is enough to create intense turmoil, pain, and guilt. An anorexic feels tremendous guilt about any kind of indulgence involving food. To them, that is evidence that they are weak, out of control, and undisciplined. Anorexic women are often terrified of being seen eating food or of having people look at them while they eat. I have had patients remark that they would rather jump off a cliff without a parachute than have someone watch them eat. These women feel that every eye is on them at holiday gatherings, and at the same time feel ashamed and 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, and what's worse, my body was always freezing cold. I could never stay warm and I feared to say I was cold because of the response I would receive from others. - Twenty-two-year-old woman
Social pressures are hard. I feel like everyone is watching. It's easy to avoid social situations to avoid the pressure of all the food and all the comments like, "I ate so much," or "I've gained this much weight during the holidays," or "My New Year's resolution is to drop so many pounds". It's hard to know how much food is appropriate. What would help during the holidays is don't watch and don't push the food. - Twenty-eight-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
I would fake being sick much of the time to get myself out of family and social gatherings. - Twenty-two-yearold woman
Trying to eat in large groups and experiencing anxiety being around a lot of people - I feel like I'm being watched and compared and I feel fat, ugly, and inferior. - Fifty-six-year-old woman
All I wanted to do was isolate myself and have nothing to do with my family. When I had to be with them, I felt paranoid that they might find out or judge me. - Twenty-one-year-old woman
It was and still is hard for me to interact even with my family. I'm very withdrawn and hesitant to make a wrong move or say a wrong thing, so I say nothing at all. It's hard to communicate with someone when you speak an unknown language, a secret language. - Fourteen-year-old woman
Food and family, that's what makes the holiday season miserable for those of us with eating disorders. This is a time where practically every activity is focused on the two things that are most difficult to deal with. It is especially hard to get along with family when they are constantly watching your every eating habit, which is so much worse during the holidays when the types and amounts of food are a nightmare for anyone with an eating disorder. - Twenty-two-year-old woman
All of the food, so much fattening food. Everyone expects you to eat but you will do anything to make them think you've eaten when you really haven't. All of your relatives will notice how withdrawn, sad, and gaunt you are and how you don't eat or talk to people. They may tell your parents or family who have not noticed because they have become accustomed to this behavior. - Fifteen-year-old woman
Because of the many dinners and parties, there are many lies told and it is very difficult to keep my eating disorder a secret. I am forced to eat dinner in front of people and could be judged about what I eat and what I don't eat. - Seventeen-year-old woman
On the opposite end of the eating disorder spectrum, a severe bulimic finds the holidays are a genuine nightmare because there is so much emphasis on food that they become preoccupied with it all. 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 a bulimic. The holidays can be a time of convenient indulgence, but also a time of great shame and self-reproach because of the bulimic's secret life. Some even use the binge eating/purging cycle as a form of self-punishment through the holidays.
Those who suffer with bulimia live out this painful eatingdisorder hell in private and in secret, and feel great selfcontempt. To many of their family and friends things may look normal even when the opposite is true. On the other hand, bulimics whose family members know of their disorder may have the feeling that they are the main attraction, where every trip 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 holiday season draws out awareness of the eating disorder. It is harder to be deceptive over the holidays because much more is expected of you by your family. - Twenty-one-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
Holiday ideals epitomize what is good about family relationships. Activities during this time can involve family members in intense, emotional ways. Unfortunately, women with eating disorders find it terrifying to be emotionally intimate with other people. In such situations they feel vulnerable and unsafe, and so they revert to their eating disorder to restore a sense of control and protection.
Family dynamics can be a major trigger and contributor to eating disorder difficulties in women. Struggles with perfectionism, feelings of rejection, disapproval, and fear of being over-controlled, are all cited frequently by women who suffer. Harboring strong feelings and beliefs that parents or other family members find them unacceptable, inadequate, or disappointing is challenging for any person but is particularly devastating to women with eating disorders. Being immersed in a family setting during the holidays can dredge up all of the old issues, fears, conflicts, and worries about family relationships. The resulting emotional disruption feeds the eating disorder and exacerbates 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" the "freak" as I pig out. I know that they simply want to reach out and help, but it seems like the food police are out on patrol. I feel that a big help would be to make a concerted effort to shift the holiday focus from the food to the underlying cause and purpose. I know that it is not possible for people in our everyday lives to assume this role, but in our own families, I wish the food could be a minor deal, just an accessory to the holiday, rather than the focus. - Twenty-year-old woman
Holidays are pure hell when you have an eating disorder, with all the food and family commotion. For me, when the focus isn't on food and it's focused on the real reason for the holiday being there, it is 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. - Thirtynine- year-old woman
I always make myself really busy so I don't have to eat. I just stay busy and keep helping the little kids and making sure that everything is filled and refilled to meet everyone's needs, making myself scarce. Then when everyone is through, I just start to clean up things and stay busy in the kitchen. If I see stuff I like, I put it in individual Tupperware bowls and hide them so I can go on a binge later and then no one really notices me because everyone is in the other room talking and laughing. No one seems to notice I'm not anywhere around so I can clean up, feel resentment, and then just go do my own thing and no one even misses me.- Forty-five-year-old woman
After a while I began to isolate myself because I couldn't handle all of the confusion. Even though it was a holiday, I fell into a deep depression and had a lot of anxiety. I slept a lot and exercised. I did anything by myself to give me a distraction. - Seventeen-year-old woman
Almost all holidays are hard for people suffering with eating disorders. My situation is made extra hard because I don't get along well with my Dad so I usually take my anger out on my food. - Twenty-one-year-old woman
The following suggestions resulted from a survey question that patients were asked: 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 range in age from fourteen to fifty-six, and I believe their suggestions offer some valuable insight and understanding that could be helpful to you and helpful to your family members.
- Be a help with the preparation of food, decoration, shopping, etc.
- Do not make an issue about what your loved one is eating.
A little bit of encouragement is okay.
- Offer a lot of support and be aware of what creates anxiety and try to understand what the person feels.
- Do not focus too much on food, it will only fuel the eating disorder.
- Ask the family member how she is doing and see if she needs any help.
- Do not get angry about how the family member feels, just do your best to support them.
- Be understanding and supportive.
- Spend quality time with your loved one.
- Get her help if she is ready for it.
- Make sure that the 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, etc.
- Allow the one suffering to make a dish that she would feel comfortable eating.
- Do not be the food police.
- Do not judge or create shame and guilt about the eating disorder.
- Be aware and notice behaviors and identify healthy from unhealthy behaviors.
- Do not pressure someone to eat. This will make the eating disorder worse.
- Do not give her tons of praise when she does eat. The last thing a person with an eating disorder wants is attention.
- Do not talk about diets, weight loss, or weight gain. It causes great anxiety and makes the sufferer's behavior even worse.
- Talk with your family member about their fears and anxiousness and see how to ease the meal or day for them.
- Do not stare at her.
- Learn enough about the illness and the triggers to help them to develop skills as well as back-up plans.
- Know something about the person's struggles, triggers, and obsessions. Then, if you see those behaviors you can come up after a meal, pull them aside and tell them how they can be helped in some of those behaviors and discuss ways to be helpful and supportive.
- If you see her struggling, ask if she wants to talk, but do not say something in front of everyone - just do it in private.
- Just be supportive and kind.
- Do not mention the eating habits in large groups but individually ask what you can do to help.
- Focus on how the person is feeling inside, what issues they are worrying about, what their fears are, and what they need rather than how much they are eating.
- Treat them with love and respect no matter what is going on.
- Let the person know that she is loved.
Try not to focus too much attention on the eatingdisordered behaviors.
- Do not let yourself get in a fight with the one struggling with an eating disorder.
- Try to be as patient and nurturing as you can to your loved one.
- Encourage her and tell her she did a good job even when she eats a small amount.
- Do not make her feel bad about not eating.
- Do not comment on how much or how little they eat. They are more likely to do better if you let them be.
- Be there for them emotionally and physically with hugs and expressions of love.
- Take the person's mind off of food by talking about something else: sports, gifts, movies, T.V. shows, etc.
- Never leave the person alone.
- Always care no matter what because these people feel alone in their lives, but if you are there at least they will have someone.
Family members of a woman suffering from an eating disorder need to know how to help their loved one during the holidays. The following suggestions may be helpful.
1) It is important for family members to be honest with each other.
When going into a holiday or family event, especially if the family is aware of the eating disorder, it is helpful that family members talk honestly about what will help and what will not help. Armed with this knowledge, the family can set up some structure around holiday events that is agreeable to all parties involved. Give reassurance about your desire to "be there" for them without trying to control every problem, and 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.
2) It is important to emphasize the purpose for the celebration or 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.
3) It is important for the family not to feel responsible and guilty for their loved one's eating disorder.
It is also important for the eating-disordered person not to feel responsible for the family and the family's emotional response to the eating disorder. One of the agreements that needs to take place around the holiday season is, "We will not spend time focusing on the eating disorder or what you are eating or not eating, but we will spend time focusing on each other and the things that are available and that are good in our family setting." Let them know that you can look past the outward manifestations of the eating disorder because you are more concerned about the hurt, pain, fear, and guilt they are feeling inside. By acknowledging the pain inside, no one has to be at fault for the eating disorder, allowing positive family associations and caring to become the emphasis. No family members will have to "walk on egg shells" if everyone first acknowledges the underlying emotions associated with the eating disorder. Compassion is a wonderful holiday gift for someone with an eating disorder.
4) 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. Gently invite your loved one to participate in smaller, quieter, and less chaotic family activities and events. Simple talking and sharing as a small circle of family members can do much to increase the sense of belonging and safety for someone with an eating disorder.
5) Encourage your eating-disordered family member to gather additional support around themselves during the holidays. Additional support can come from extended family, friends, and even therapists.
If the family recognizes the benefit of these additional support people, they can then encourage their involvement rather than be hurt and offended by them. Sometimes, a woman with an eating disorder might not be ready yet to receive the love and support of her family, but at the same time she may be afraid of hurting her family. The message the family needs to send such a person is simply, "We're here to support you and it's okay if others support you as well."
6) It is important for the family 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. For the family, it would be more helpful to express a lot of warmth, love, kindness, and acceptance toward the person, with a message saying, "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 for the woman suffering from an eating disorder than almost anything else you can do.
7) It is important to offer care "giving" and not care "taking." Being a self-declared nurse, dietitian, therapist, or detective only puts you in a position you will later regret.
You are not responsible to say or do everything right. Nothing you do or do not do will take away your family member's own responsibility to overcome and recover from their eating disorder. They are the only one who can do that job, but you can care, empathize, forgive, encourage, and share the process with them. The good intent you express is more helpful than what is actually said or done. If your eating-disordered 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 for family living are not a complete list, but they do emphasize some positive approaches to help your eating-disordered family member. The specific ideas, strategies, and agreements that can come out of your interactions with your loved one during the holidays will allow this plan to be personalized and unique for each family. Remember also that your loved one suffering with the eating disorder has her own list of positive things to do that can help her through the holiday season as well.