Eating Disorder Recovery and the Holidays: a Tough Time for All, Part 2

The holidays are a time to celebrate and be together. Despite the pull towards old and often difficult dynamics, most families crave an easy, calm few days. The presence of a chronic illness that is difficult to treat makes the time much more challenging. This isn't the time to stage an intervention or ignore the member with an eating disorder completely. Instead, the goal is to comfort her and provide support and love and try to create an environment of celebration while acknowledging and being sensitive to this family member's struggle.

Preparing for the holidays with openness and communication also opens the door for education. It's very likely that the family is not aware of the details of their daughter's treatment and recovery and, without clear proof of a full and instant recovery, i.e. completely normal eating, assumes that she is not doing what it takes to get better.

The path to recovery is often long and slow, and families may use the holidays as an annual marker of disappointment. When family members express these feelings, the result is a damaging conversation that casts a pall over the entire time together.

Any concerns are best addressed at another time and often with help from the person's therapist. This is not a time for a complete referendum on the treatment process and path to recovery. Families can broach that large topic without the added pressure of the holidays. In fact, if the person with the eating disorder can ask the family to avoid the topic of recovery in advance, the holidays will proceed much more smoothly. 

But complete avoidance of the topic is just as uncomfortable. Pretending that nobody is aware of the ill person's struggle with food isolates her from the family too. The result is feeling alone and unloved, a very common trigger to return to the eating disorder symptoms for comfort. The typical pattern for families is to reach a state where every conversation about food and the eating disorder leaves anger, disappointment and hurt in its wake. Left without other options, the family resorts to silence and allows the sick one to suffer alone with her illness.

Is a family stuck when discussing treatment or ignoring the illness aren't viable options? What can caring family members do to use this time together to show her they are on her side and want to help? What can make this time easier and perhaps even enjoyable?

The most caring approach a family can take during the holidays is one with love and compassion. Eating disorders are relentless and punishing illnesses. The intense, internal pressure to follow the rules of the eating disorder weighs heavily on the patient's mind and is followed by powerful, degrading thoughts. The imperative to try to avoid any symptoms during the holidays ends in even more punishment and a sense of failure unless everything is perfect. Countering the internal pressure with kindness and love is the foundation to hopefully create a different holiday together.

In practice, the role of other family members is straightforward. Ask her if she is ok and then wait patiently for a response. If the answer is "I'm fine," then ask again until she understands you wanted a real answer. Ask if she needs anything and when she says no, offer something small, such as going for a walk or watching a show together. When the meal comes around, take her aside and let her know which foods have been included to help her feel more comfortable. Offer to make her plate or to sit next to her during the meal. Extending a hand of comfort, solace and love will mean the world to her and will reinforce in action, not just words, that she isn't alone.

If a family can suspend fear, anger and judgment and remember an eating disorder is a difficult illness, the holidays can be a time of peace and love. Spending some time discussing in advance both what food could be available and how to approach the meals can help avoid much of the pressure felt at the most pivotal moment. Similarly, advance planning around appropriate discussions during the holidays will go a long way to bridge the isolation caused by the eating disorder. Most important, kindness, love and compassion, all facets of what the holidays mean, are critical ways to treat the sick family member to help her feel loved and less alone.

Eating Disorder Recovery and the Holidays: a Tough Time for All

The holidays are perhaps the hardest time of the year for people in recovery from an eating disorder. The combination of time with family and the focus on food with little distraction makes for a very challenging few days. Working hard to follow a meal plan and enduring the internal struggle between eating and trusting the eating disorder is hard enough. The next two posts will present guidelines to take some of the stress out of the holidays for people with eating disorders and their families.

Families tend to return to old dynamics this time of year. Living together once again under the same roof, often where the children grew up, immediately brings back the experience of times past. Accordingly, instinct and circumstance triggers familiar situations and emotions for all.

An ill-timed comment or an off-kilter glance can ignite old reactions in a split second. The process of forming new, adult dynamics takes time and isn't ever foolproof. Usually only the introduction of new family members, the aging of the older generation or a serious family illness, like an eating disorder, are sufficient to break these patterns.

None of the family dynamics bode well for the family member home for the holidays while in the throes of recovery. It's much more common than not for someone with an eating disorder to have lived at home at some point in the first few years of being sick. Lost in the illness, the patient was inevitably restricting or binging and purging at home and hiding the symptoms as much as possible, a painfully difficult time for someone with an eating disorder.

Families, clearly scared and worried, in all likelihood monitored their daughter's eating constantly and tracked progress or slips, all the while hoping their vigilance would help. Often any previous dynamic transformed around such a devastating development in the family and all attention shifted to the ferocious illness in their midst.

All together again, the family is likely to adapt its interaction around the eating disorder once again.

The scenario during the holidays is predictable. Families will check every morsel of food their daughter eats while trying to gently urge her to eat a little more. Trapped, she will get angrier and angrier and feel terribly judged: a situation that always worsens symptoms. Faced with the prospect of no privacy, no access to alternate coping mechanisms and food as the sole emotional outlet, she will feel the powerful tug towards disordered behaviors. All well-meaning plans and actions to start the holiday will be quickly challenged within the first few hours of the family reunion.

The real question is how to address the concerns in advance, including backup plans when things go awry, rather than fall into a tense situation with nothing but old patterns to fall back on.

The first and most critical step is to be sure the issues are up for discussion early and often. Without a forum for openness, the holidays will inevitably return to old form.

It takes courage for the ill person to acknowledge her fear and state clearly what she needs to make the visit more successful, especially when there's no guarantee how well a conversation will go. She is typically so used to hiding symptoms at home that this default scenario feels like a much easier route to take, despite the inevitable pain, anger and confusion that will follow.

Acknowledging how difficult the trip may be will make her feel vulnerable in many ways: exposing continued risks for slips or relapse, risking offending family members, and opening avenues for unsolicited opinions about her treatment. Still, the conversation is crucial to head off the likelihood of misunderstanding and anger in the moment and of reinforcing the emotional distance after the trip is over.

A few parts of recovery will need to be out in the open to make a more honest discussion possible. The person has to speak about what food is possible to eat and what isn't. She has to explain to some degree that, holiday or not, it's critical for her to follow her meal plan because straying is likely to lead to worsening symptoms. She also has to try to ask for support and help in preparing either the food available, her plate at holiday meals or both. The stress of facing a table of food all of which is too scary to eat or of serving herself food while everyone watches what she takes is overwhelming. A family member can easily lower the stress by planning in advance to have food she can eat and to offer to help arrange a plate of a safe amount of food. Spreading the word for the family to work hard not to monitor and comment on her food can go a long way to make the visit more successful. These practical steps send a message to the family as a whole that things will go differently this year.

Once the ground rules about food are set, the family needs to agree to which conversation topics are appropriate for a holiday visits and which ones are better left to a less emotional time. That's the topic of the next post.