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Eating Disorders And The Holidays

Surviving a food-centric season isn't easy for friends and family who've struggled with anorexia, bulimia or compulsive eating. Here's how to make it easier.

 

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The holidays can be the most stressful time of year for people with eating disorders. So many of the family gatherings throughout are focused on breaking bread or eating pie that it can be overwhelming, says Lynn Grefe, CEO of the National Eating Disorders Association. This emphasis on food can impair recovery or even trigger a relapse, so compassion and sensitivity are key to helping those with disorders navigate the holidays. A few tips:

1. Strategize: Many people who are being treated for their eating disorders have meal plans that they can follow and feel safe about following, says Dr. Craig Johnson, director of the eating disorders program at Laureate Psychiatric Clinic & Hospital in Tulsa, Okla. Holiday dinner foods throw that off track (sometimes just having such an abundance of food can trigger bulimic episodes.) So plan ahead. Whether it's making some foods available or just making others less obvious. "Hopefully, people who have eating disorders have treatment teams that they've been able to speak with about strategies for getting through the holidays without raising the risk of relapse," he says. "Hopefully, the families have had the opportunity to be part of that strategy as well."

2. Don't Force: In many cases, eating disorders are linked to issues of control or abuse, Johnson says. Insisting that an eating-disordered family member attend the big Christmas brunch or pile on another few slices of ham can be very harmful. "It can trigger them into an oppositional and defiant stance" and enhance the negative effects of the disorder, he says. "If they're telling you that the setting is going to be uncomfortable for them, more bad things will happen as a result of trying to force them into that setting."

3. Don't Focus on the Food: Some people with eating disorders dread holiday meals so much that they'll make excuses to get out of going home at all, Grefe says. The season's focus on food and cooking means that people with diagnosed disorders feel that their eating habits will be watched closely, and people who are trying to hide disorders will be especially worried about being caught. "Don't be watching, don't be monitoring [how much they're eating]," Grefe says. "Talk to them about what's going on in the world. Don't put the eating disorder on the main platter of the table."

4. It ' s Not Personal: The rest of the family will dig in, so if you're a host or hostess, don't be offended if a particular guest has a light plate. "A lot of people just don't get it," Grefe says. "An eating disordered person isn't trying to hurt anybody. They're not eating a little bit to hurt their mother or their father." The key to making sure friends or family members with eating disorders get through the holidays without too much stress is making them feel like it's safe to come home, and that they won't be criticized, pressured or put under a microscope, she says. "All of this needs to be done with kindness and love."

© 2008

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Member Comments

  • Posted By: skinnyminny2 @ 12/26/2008 11:12:57 AM

    As someone 'recovering' from anorexia, here's my take on what happened over the holiday: I was re-triggered 3 times by people watching every liitle thing that went in my mouth. I will not eat in front of people (again) because they're always watching and causing me a great deal of stress over trying to eat even modest portions. I've already begun further restriction and am only doing coffee in front of people.

  • Posted By: anne55 @ 12/17/2008 6:20:50 PM

    Part 2 anne
    As regards sexual abuse, I do believe that research re: this is mixed:
    ??? Eating disorders and sexual abuse: Lack of confirmation for a clinical hypothesis
    Stephen E. Finn, Ph.D. 1 *, Marilyn Hartman, B.A. 1, Gloria R. Leon, Ph.D. 1, Loralie Lawson, M.A. 2
    1University of Texas at Austin
    2University of Minnesota

    *Correspondence to Stephen E. Finn, Department of Psychology, Mezes 330, University of Texas, Austin, TX 78712

    Abstract
    Undocumented clinical reports have suggested that, among women in psychotherapy, women who have been sexually abused manifest an increased prevalence of eating disorders. The relationship between these two phenomena was investigated in a sample of women (N = 87) who were receiving group psychotherapy. Individual interviews were used to document the presence of a sexual abuse history. Diagnoses of anorexia nervosa and bulimia were based on DSM-III criteria. Rates of abnormal eating patterns in the absence of a fully diagnosable syndrome were also assessed. The following rates of eating disturbance were found in the total sample: 21% bulimic, 1% anorexic, and 82% with at least moderately abnormal eating patterns. Comparisons of women with and without histories of sexual abuse suggested no association between the occurrence of eating disturbance and a history of sexual abuse. The frequent co-occurrence of these two phenomena in female therapy clients may be sufficiently explained by their high base rates in this population but may have led clinicians to perceive a relationship where none exists.

    ??? As regards the control issue in eating disorders, I view this more as a difficulty with self-regulation. Anyone that vastly over or under eats, induces weight control through extreme measures such as vomiting, laxative abuse or extreme exercise is not in control, but more aptly out of it. Really, it seems to me more an extreme difficulty with self-regulation is the appropriate term.

    4) It is personal when your child is very ill. It is personal when your child could die. It is exceedingly personal, you???d better believe it. Feeding your child/adolescent/teen/young adult and even loved older one is a very personal. It is at the heart of parenthood. It is at the heart of caring. I realize that my child didn't think she could die (although occasionally she said herself she was scared of her own behavior). With love and klndness, to the best of my imperfect ability, I said, "I cannot, will not allow this to happen. I love you too much. Period.

    I took it very personally. I'm glad I did. I would encourage all family members to do so.


  • Posted By: anne55 @ 12/17/2008 6:19:13 PM

    Part 1 from anne

    This article is a disappointment to me. I believe it reflects "old school thinking". My understanding is that current research puts eating disorders squarely in the "moderately heritable" category of mental illnesses. This means they are biologically based illnesses with factors in the environmental that may 'set them into motion' or 'maintain them' but do not cause them. Here are my concerns about this article:

    1. "Strategize": While I'm glad to hear that families should be included in talks about the holidays, families should be included as much as possible the rest of the time too. Families are often the best source of support a sufferer may have. For younger patients in particular, I recommend looking at the Maudsley based approach (also known as family-based therapy or FBT). Here the family is actively encouraged to "take charge" of their loved one's meals until the return of full health, both physical and mental. While most Family-based treatment currently centers around younger people still living at home, research trials are going on to see if this approach is feasible for older patients with longer duration of illness (e.g. support by a spouse, for instance). I am very hopeful that it will be.

    2 and 3) Don't force and Don't focus on the food: Okay, common on. That is like ignoring the elephant in the room. I was told this when my 14 year old lost 40 lbs. in 4 months. You tell me what sane parent is easily able to listen to this advice. The Maudsley approach takes a different view. IT IS ABOUT THE FOOD. FOOD IS MEDICINE. YOU MUST EAT. LIFE STOPS UNTIL YOU DO. This don't/do focus and don't/do force is at the heart of much conflict in the ED world. It is bewildering to parents. I want to shout to all ED professionals out there, this issue must be address and consensus built. And the above approach--FBT-- just makes such common sense to me as a parent and human being. I am not negating talk therapy for anxiety/depression at all either. This can be extremely helpful. But, food is first.



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