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Eating Disorders and the Holidays

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, when families, friends, and co-workers 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.

We asked several women who are currently in treatment for anorexia and bulimia at Center for Change 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. Then, 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 compulsively exercise. Maybe no one else gained weight over the holidays, but just the smell of food added on weight to my body. My anorexia destroyed any happiness or relationships that 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-one-year-old woman

These actual 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 common to the holidays.

They 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 to have somebody 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 saying 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 at 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

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 eating-disorder hell in private and in secret, and feel great self-contempt. 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

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.

Unhealthy family dynamics can be a major contributor to eating disorders in women. Perfectionism, feelings of rejection, disapproval, and fears of being over-controlled, are all cited frequently by women who suffer. Harboring strong feelings 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 these 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 to the situation 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 life to assume this role, but in our own family, 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.”
Thirty-nine-year-old woman

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 ones 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 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 that the one with the eating disorder also has her own list of things to do that can help her through the holiday season.

SOURCE:- Randy K. Hardman, Ph.D. Center for Change, Incorporated – 1790 North State Street, Orem, Utah 84057
Center for Change is a subsidiary of UHS.
Copyright 2005 – Universal Health Services, Inc.

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