Tips for Navigating the Holidays with Eating Disorders

The holiday season can be especially difficult for people living with an eating disorder. Expectations about the holidays, changes to routines, and obligations to eat and socialize can add to the stress, anxiety, and conflicting emotions. The following advice is based on my twenty years of experience treating patients with eating disorders, with the majority of suggestions coming from the patients themselves.

Key takeaways:
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    The holiday season can be especially difficult for people with eating disorders.
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    Changes in routine and the obligation to socialize and eat can lead to stress, tension, and conflicting emotions.
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    Plan ahead of time and enlist the assistance of at least one friend or family member whom you trust for support.
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    Don't be too harsh on yourself if you are feeling overwhelmed.
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    Be mindful of what your harsh inner critic is saying to you.

Eating disorders during the holidays

A person struggling with an eating disorder can find the holiday season to be especially difficult. Anxiety levels can skyrocket due to the customary emphasis on eating as a key part of festivities.

There is a common perception that overindulgence is fundamental to the holiday season. This time of year makes it almost impossible to refrain from eating, and the pressure from others to "indulge" may be frustrating or upsetting. It increases the pressure to eat and heightens the anxiety about binging and purging. Changes to your routine, whether they were established as part of your eating disorder or as part of your recovery, may also be challenging. The holidays can also be upsetting for families who are supporting a person with an eating issue.

1. Make a plan with someone you trust

It is hard to reach out for help when eating disorder cravings become overpowering, and it may be much more difficult around the holidays when time is spent with family around the table. Naturally, extra pressure to eat can lead to fears of binge eating. However, events need not spiral out of control. Choose someone you can trust and make a plan with them. When you feel a craving or anxiety building in your stomach, agree on a "signal" that lets them know you're uncomfortable or need to leave the situation. This could be as simple as sending a text message, making a gesture, or saying a certain word.

"Fear foods" abound over the holiday season, including butter, sugar, fat, and even more carbohydrates than usual. Make your trusted friend aware of your “fear foods," and put yourself in close proximity to them. Communicate your worries to them at several points during the day. Inform them how they may be of most use to you in your recovery on that specific day and how they can do it in the way that works best for them.

2. Maintain a balanced perspective

Be conscious of "all-or-nothing" ways of thinking that can lead to excessively high and rigid expectations. Maintain a balanced perspective, listen to your inner voice, and remind yourself that it's okay to eat what you like, that it's only one day, and that nothing terrible will happen if you break the rules. You may be tempted to overexercise, restrict, and purge to make up for eating more than usual. This might trap you in a vicious cycle of punishment that is difficult to stop.

3. Pay attention to hunger cues

Dietary restrictions place the body under continual stress and significantly alter natural hunger and fullness signals. You can feel extremely hungry and want to binge eat. Even if you eat until you are completely satisfied, you may feel as if you could eat more. Due to delayed gastric emptying, food stays in your stomach for a long time after you eat, which can make you feel overly full, bloated, sick, and just generally unpleasant. Feeling too full and bloated after a meal can be a real trigger. Keep in mind that this is a temporary discomfort and that distractions, such as going for a walk or engaging in an activity, will help. Also, utilize positive self-talk; attempt to soothe your inner critic by replacing negative, critical thoughts with more soothing, comforting ones.

4. Avoid drinking too much alcohol

It's best to avoid drinking excessive amounts of alcohol. Alcohol usually plays a major role around the holidays, which can be problematic since it is a known risk factor for the perpetuation of an eating disorder – in particular, bulimia. Drinking large quantities of alcohol may lead to purging since alcohol is more easily eliminated from the body than food, particularly when the stomach is empty. People with an eating disorder may drink to relieve their hunger and improve their mood. Stay hydrated, and remember to eat while drinking. Alcohol is also a depressant. Be aware of the negative thoughts that come up when you have a hangover, like the "sad feeling."

5. Make a deal with family

Ask your family not to comment on your looks, weight, or what you are eating. Set it up so that whoever is cooking knows you need to have some say in what you eat. If you are not in charge of cooking, try to say that, if possible and appropriate, you would like to have some say in how the food is made.

6. Eat breakfast - set up yourself for success

Breakfast on Christmas morning in particular is important and will set you up for success. Having regular meals can help you control your blood sugar, which will keep you from feeling hungry before your big meal. If you eat breakfast and small snacks throughout the day, it will be easier to tell when you are hungry and when you are full.

7. Set boundaries

Establish good boundaries. Be assertive and say NO to anything that causes you discomfort. In the early stages of recovery, assertiveness can be difficult because of a desire to please others. If your grandmother gets upset because you didn't eat enough of her pie, that's not your fault. Do everything YOU think is necessary for your health and recovery while you are getting better. Stay on track with your plan, but don't be too strict with yourself if you feel like branching out and trying something new. It's OK to give in to your cravings and have another cookie if you feel like you need to.

8. Take some time to collect your thoughts

There might be some interactions or conversations with family members that can become problematic or even harmful to your recovery. It is OK for you to make your excuses and leave the room. Alternatively, change the subject or hang out with the younger members of your family, play with the family pet, or step outside for some fresh air. This will give you some time to collect your thoughts and keep you from becoming involved in the possible tricky interaction.

9. Practice self-care

Most people, even those who are not in recovery, have difficulty sticking to their diets over the holidays. Be gentle with yourself. Every day, you are doing your best, and you will do your best over the holidays. You won't be perfect, and that's okay. It gets easier to control mealtime anxiety and eat instinctively with each passing year. You'll get there in the end. However, in the meantime, offer yourself the same kindness and compassion that you would show to someone that you love.

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