By Melainie Rogers, MS, RDN, CDN, CEDRD
The Holidays are often said to be the most wonderful time of year. For many, it is a time to see loved ones, eat delicious food and celebrate the New Year. But for the 30 million Americans struggling with eating disorders, this time of year can be stressful and overwhelming.
For those in recovery from Anorexia, Binge Eating Disorder, Bulimia or other eating disorders– it is anything but easy. Whether someone is a year into stable recovery or 10 years into his or her process of healing, there are many components that can still make the holidays an ultimate challenge.
As a dietician and the owner of BALANCE eating disorder treatment center in New York City, I know how crucial it is to prepare clients in our program for this difficult period. In an effort to shed light on these struggles I wanted to come up with a comprehensive arsenal of tips & coping strategies to help those recovering from eating disorders. Therefore, at BALANCE we recently hosted a Twitter Chat with leading eating disorder professionals and organizations dedicated to helping those who suffer from this complex illness. With our experienced co-hosts, we discussed the struggles that arise and explored various ways to address specific concerns related to recovery during the holiday season.
I am pleased to be able to share with you the responses we received from experts in the field. We hope that together we can help to make this holiday season a happy and healthy one!
What makes the Holidays so difficult for those struggling with eating disorders? Why is there often an increase in eating disorder symptoms during this time?
Brian Pollack LCSW, who is currently the only male Certified as an Eating Disorder Specialist in the entire state of NJ and on the board of The National Association for Males with Eating Disorders says, “The holidays are a time when the social expectation to connect and "love one-another" is all over the television and media. Many of us with eating disorders struggle to find comfort in doing this on any other day - but when there is pressure to love and be loved, we want to hide and use whatever we can to remain safe. Additionally, with the holidays often surrounding food, we often can feel like sheltering ourselves in is a safe way to avoid all the expectations, anxiety, and judgment of our love ones.”
What normal day-to-day recovery challenges are amplified during the Holidays? What kind of preparation is effective?
Norman Kim, the Director for Program Development at Reasons Eating Disorder Center and Center for Change comments as follows; “For many people in recovery, one particular challenge that is amplified is how to manage your own and others’ expectations that one ought to be filled with the joy and happiness of the holiday season. During those moments when how you are feeling internally may not match the festive nature of the holiday season, that discord can amplify your internal struggle as well as increase the pressure you might feel to put on your “happy” face for others. Even when that is true for you, because you are also struggling with the daily challenges that come along with the process of recovery, it may be difficult to be as expressive about it. In terms of trying to prepare - you can practice whatever skills help you to ground yourself emotionally, and find meaningful ways to practice giving yourself compassion and grace to relieve some of the pressure. I cannot imagine a better and more deserved present you can give yourself than that.”
Many people feel an immense pressure to appear perfect, especially with family members or friends they haven’t seen in a while. Do you believe perfectionism plays a role with eating disorder struggles during the Holidays? What are ways to overcome this?
We asked Megan Bruneau for her input on this question- Megan is a mental health therapist and Forbes podcast host who has personal experience of recovering from perfectionism-fueled depression, anxiety and eating disorders. She told us “Perfectionism always plays a role in eating disorder struggles, holidays or not! Remember that what drives the desire to "appear perfect" is a fear of uncomfortable feelings. We think that in creating a false sense of control and predictability, we'll protect ourselves from anxiety, insecurity, hurt, loneliness, etc--that we'll protect ourselves from vulnerability.
Difficult feelings are a part of the human experience, and the more we avoid them the more power they have over us. Perfectionism-fueled ED behaviors often ramp up over the holidays because the holidays tend to be more triggering of those difficult feelings and vulnerabilities--for example, lack of structure and routine, complex family dynamics, triggering foods, alcohol, etc. My advice would be to really ramp up the self-compassion, trying to acknowledge, make space for, and validate as many of the difficult feelings as possible.”
The use of behaviors like restricting, purging or binging arise when there is immense stress. What self-care and stress management tips would you give to someone struggling to help them overcome the overwhelming Holiday season?
Project HEAL’s Director of Communications, Brian Kearney, told us, “Some tips to help navigate the holiday season for those struggling would be to use healthy coping skills that you find are already working for you. Just because it’s the holiday season does not mean you need to change how you handle stress and triggering situations. Participating in family conversations and basking in the love that’s surrounding you can also be helpful.”
Megan Bruneau also added, “Anticipate triggering and vulnerable situations, and ask yourself what you need for support; but also recognize that a slip-up or relapse means you probably stepped out of your comfort zone in some way. Consider it an opportunity to learn more about yourself and what you need to have a more serving response to a triggering situation the next time around. Finally, connect! ED will tell you to isolate; to go to the gym, skip a family meal or holiday party, etc. While it's important to set boundaries and take time for self-care, be honest with yourself about what's driving your desire to isolate.”
Often times it can be helpful to distract oneself from the Holiday craziness. What are some festive, yet non-food related activities someone struggling could plan to do during this season to distress?
Stacey Lorin Merkl, founder and executive director of the organization Realize Your Beauty shares these thoughts, “reliving a happy childhood holiday memory can bring joy and take the focus away from food. For example, looking at lights, ice skating, singing holiday songs, or playing a board game. As an adult, this can also be an opportunity to create those memories with your own family and friends.”
How do treatment professionals like therapists or nutritionists assist eating disorder clients during the Holidays? How can someone struggling apply this information on their own?
Being a clinician myself, I think it is critical to have a qualified treatment team in place is essential to providing a solid foundation of support to navigate the often unpredictable holiday stressors that someone struggling may encounter. Therapists help identify emotional triggers and can help explore feelings that otherwise may be repressed and acted out through eating disordered behaviors. While dietitians can help with setting up an appropriate meal plan and reinforcing mindful eating practices.
Unfortunately families can sometimes disappoint and not come through in meeting expectations. Having a strong team backing you up can make all the difference in the end and can often counter-balance negative family conflict and strife. If you find yourself alone and trying to cope with recovery issues there are many supports available to you and it is essential that you take advantage of them.
College students return home during this time for Winter break and are quickly thrown out of structured routines. Why is this a prime time for relapses to occur? And in what ways can parents/families help a loved one with an eating disorder while they are home from?
Ginny Jones, the founder of More-Love.org, a website providing information to parents who have children with eating disorders told us, “The disruption of a break from college can make sticking to recovery plans even harder. The added stress that typically surrounds Holidays make it a prime time for relapse. If your college student has previously or is currently recovering from an eating disorder, then it is so important as a parent to plan ahead as much as possible to keep recovery on-track. For example, talk to your college-age child in advance about how best to structure the break. It’s been a while since she or he lived with you at home - what should you know about what works and doesn’t work now that she lives apart from you?
Also, consider carefully and discuss how holiday plans with extended family and friends might impact recovery. Remember that sometimes it’s best to downsize the holidays to focus on recovery, especially if holidays typically involve traveling to and staying at other people’s houses. Most of all, be sure to find ways to truly listen to your child when they are home from.”
Many people struggling avoid treatment and higher levels of care, like residential treatment, during this time to be with family. What is your advice to people opting to delay treatment due to the Holidays?
Jenn Friedman, a singer-songwriter, eating disorder activist, speaker and mental health advocate says, “As someone who has recovered from eating disorders, I understand the pain that accompanies the inability to participate in the celebrations of life due to receiving treatment. While in treatment, I wanted nothing more than to be out in the world and so being in a hospital unit seemed like ultimate contrast to the freedom that seemed to lie just outside the door. That is where I was wrong. Being inside those doors was in fact my freedom. I was not ready to co-exist with triggers that would have inevitably presented themselves all around me.
You are building a muscle in treatment - the muscle that will let you live your life, participate in the holidays, be around people, be in various types of food situations - all without conditions. Treatment in the short-term is a means toward benefiting from recovery in the long-term. When you're strong in recovery, not only will you be "allowed" to participate in the holidays - you will whole-heartedly CHOOSE to be PRESENT during them. That is worth waiting for.”
There are so many food-focused events during the Holiday season. What are some ways to plan ahead for challenges around meals that may arise?
Crystal Karges, a San Diego based dietician who is the Director of Content at Eating Disorder Hope told us, “Definitely work with your treatment team to go over possible scenarios you may encounter that could potentially be triggering. Talking through these situations ahead of time and brainstorming effective ways to cope can be a helpful way for preparing for challenges that may arise around meals and other food related events. Have your support and/or accountability system in place - whether someone you can text or call before/after a meal or someone you trust that you can periodically check in with during an event that may be potentially triggering. Consider being involved or participating in non-food related activities around meals to give you the opportunity to engage with family and friends in a more relaxes setting. Keeping a relaxed and flexible perspective on food/meals can also help you keep a situation more neutral.“
What are some positive and healthy New Years resolutions to support recovery? And what are effective ways to shut down the inevitable and triggering "diet talk" at holiday dinners?
Diana Denza, the Communications Associate at the National Eating Disorder Association says, "General resolutions like learning a new skill, spending time with family, participating in a book challenge, or planning a vacation can take the focus off of weight and calorie-related goals. Avoid putting too much pressure on yourself in the New Year by holding yourself to unattainable goals. It’s one thing to say, “I’ll read more books than I did last year.” It’s another to try and break a near-impossible record. Remember – your well-being should always come first!”
Christy Harrison, a registered dietitian and certified intuitive eating counselor and host of the popular Food Psych podcast series based in Brooklyn says, “There are two main strategies, and the one you decide to use will depend on the family and friends you are surrounded by, and your own comfort level discussing recovery and anti-diet topics. The first approach is the most direct: assert your needs, and explain to friends and family why comments about weight, calories, "cheat meals," or "working off" holiday food are so damaging. The other approach is simply to change the subject, and leave any conversation you don't feel comfortable in. If you go that route, you could consider calling or texting a compassionate friend for additional support. Remember that you have the right to remove yourself from any and all triggering situations, no explanation required! Use whichever one of these approaches makes you feel empowered and safe, and consider it an essential part of your holiday self-care practice.”
I want to thank all of our wonderful co-hosts for sharing their comments and advice via Twitter and by contributing to this article. We look forward to connecting with you and welcome further discussion on this important topic. Wishing you all a warm & peaceful holiday season!
About the Author:
Melainie Rogers, MS, RDN, CDN, CEDRD is a Certified Eating Disorder Registered Dietitian and accredited supervisor in the treatment of eating disorders. She is the Founder and Executive Director of BALANCE eating disorder treatment center™ and melainie rogers nutrition, llc in Manhattan. Among her many affiliations Melainie is the founder and recent past President of the New York City Chapter of the International Association of Eating Disorder Professionals (IAEDP) and currently an Advisory Board Member at the Center for the Study of Anorexia and Bulimia (CSAB). Melainie has earned a strong reputation among her colleagues as an expert in the field of eating disorders. She is a dynamic speaker and has been invited to present nationally and internationally on the latest scientific discoveries and treatment approaches within the eating disorder profession.
Eating Disorders Holidays
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