By Sadie L. Dye
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 those 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.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 women 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 must 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.
A person suffering from bulimia can get the same effects as a person suffering from anorexia since both disorders involve the loss of major and rapid weight, which leads to very unhealthy changes in the body. Symptoms between anorexia and bulimia sufferers differ in the way that sufferers of bulimia would eat a lot of food in a short amount of time and then force themselves to throw up, when people with anorexia just don't want to eat altogether. People with bulimia also misuse laxatives and go on strict diets of fasting and rigorous exercising. Sufferers from eating disorders in general are affected emotionally, psychologically, behaviorally, and socially. Emotional and psychological changes include increased anxiety, depression, suicidal thoughts, guilt, and low self esteem. Some changes in behavior of a person suffering from an eating disorder include dieting, frequent visits to the bathroom after eating, a change in fashion, and constantly checking their weight. Some social changes of a person suffering from an eating disorder may include isolation, being anti-social, avoiding social gatherings where food is involved, and a loss of interest for hobbies. Other physical signs of eating disorders in general include edema, a reduction in metabolism, sore throats, stomach problems, heartburn, and hypoglycemia; which leads to irrational thinking, shaking, confusion, irritability, and comas.
Women 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
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 one person or one 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.
So many celebrities suffer and have died from eating disorders. Singer Karen Carpenter was struggling with anorexia and bulimia and after she went to treatment for years, everyone thought that she had recovered and was doing better. After that, she was found dead on the bathroom floor in her parent's house. She had a heart attack and it was said that the result of it was because she had abused the drug Ipecac for years. Ipecac is a liquid that is used to induce vomiting, and it is often abused by anorexics and bulimics.
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 range 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 of 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 after a meal in private 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 and physically with hugs and 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 an 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 up front with each other. - 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. 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"
A lot of people are confused about what "normal eating" is so they need nutritional counseling to help them get back on track. Not that many people who suffer from an eating disorder go to get treated for it. According to the South Carolina Department of Health , only 1 out of 10 people who suffer from an eating disorder go to get treatment. The cost of treatment for an outpatient is very expensive. Costs for outpatient treatment can be over $100,000. In the US, the cost of treatment for an eating disorder per day is anywhere from $500 to $2,000. On average, a person in inpatient treatment has to pay $30,000 a month. People with eating disorders need approximately 3-6 months of inpatient care in order to recover. The cost of treatment for an eating disorder is ridiculously high, and the high costs might be a reason that people do not go to get treated. It is very hard for most families to pay for the treatment of their illness, especially when insurance companies don't usually cover eating disorder costs. Another way to help reduce the number of people with eating disorders is to educate people about the dangers of eating disorders through media. The media is a good tool to help educate people on the dangers of eating disorders, but it is also a tool that hurts people by condoning the appearances of skinny people who suffer from such disorders. Another way that eating disorders can be treated and minimizes is through the "Doll Experiment". People were shown that if a human being had the same attributes as a Barbie doll, the body would not be able to hold itself because of its awkward shape and structure. This is a good way to show people that a Barbie doll isn't necessarily what women today should aim towards looking like. In the same way, the celebrities we see on TV are not people who we should try to look like either.
I believe that as long as the media continues to idolize thin celebrities, the effects of education about the dangers of eating disorders through the media will not be effective. For each step that they take forward to solve the problem, they take two steps back by continuing to idolize thin celebrities. It is not a question of what effects have a greater likelihood of causing an eating disorder, but it is a fact that media does contribute to people developing and maintaining eating disorders. There are other causes of eating disorders, such as interpersonal or biological factors, but if the problem of media influencing eating disorders can be changed, there will be fewer cases of eating disorders. We have to take one step at a time in order to solve this very serious problem of eating disorders, and a great place to start is to change the fact that media influences eating disorders. There is not one cause of eating disorders, but media is a big influence to them since media reaches so many people. Personally, I think that group therapy very helpful in the treatment process of an eating disorder. Victims of an eating disorder are able to ask questions and receive answers in order to better understand their situation.
