Coping with Eating Disorders at Christmas

PREPARATION

It may be helpful to begin by acknowledging how different members of the family feel about Christmas including their fears, concerns and hopes. For a person with an eating disorder, there may be raised anxiety about the abundance of rich food during Christmas, the Christmas meal itself and the need to eat together with relatives or large groups. It is important also for parents to try to acknowledge and share their feelings around Christmas. Parents may feel under pressure to create a ‘perfect’ day or feel very emotional about how the eating disorder is likely to impact upon the whole family’s Christmas experience. Social media and the pressure it creates for both parents and teenagers to be seen to have a ‘perfect’ Christmas can be harmful.

During these discussions, these steps may be useful:

  • Try to emphasise Christmas as a season of your own traditions and for the people you care about to get together. Try to set the context of the Christmas meal and food being a smaller part of this whole. What traditions does your child enjoy (short walks with the family, games, choosing a Christmas tree, watching a film together)? These traditions can be particularly important for a young person who is struggling with the food aspect of Christmas, but still may be able to find joy and comfort in activities and rituals from previous Christmas experiences. This may help the child to feel loved and secure despite the eating disorder.
  • Your child and your family may be in a very challenging place with the eating disorder and feel great anxiety about Christmas. If this is the case, it may also be helpful for everyone to try to consider Christmas as one of 365 days in the year and to focus on keeping it in perspective: not to perceive it as a reflection of your family well-being nor to compare it to previous Christmases before the eating disorder

RELATIVES

A significant aspect of Christmas is the emphasis upon getting together with relatives and friends. From the perspective of a young person with an eating disorder, this may be very challenging. If they have not seen relatives for several months or longer, they may feel anxious simply about seeing them and particularly about comments they may make (however well meaning). An individual with an eating disorder is likely to feel particularly anxious about eating with people who they do not share meals with on a regular basis.

These concerns and issues can become a source of conflict: the young person with an eating disorder may have strong views on what they feel they can and cannot cope with while other family members may feel your Christmas should not be dominated by the eating disorder. These steps may be useful:

  • Perhaps invite only close relatives or friends to your Christmas meal, which is likely to be a major pressure point. Who does your child feel most comfortable with, particularly when eating?
  • Consider getting together with wider family and relatives in a way whereby food (particularly sitting down for a meal) is not the primary focus, for example, going for a short family walk together, or a more informal ‘drop-in’
  • Talk to your relatives in advance about what may help and what may not be helpful. Explain that any comments about appearance, even “you look well” could be misinterpreted by a person with an eating disorder (to suggest weight gain/fatness) and it is best to avoid any comments about appearance. It is also best to avoid any comments about anyone else’s appearance and certainly to avoid discussion about New Year diets. Comments about how much food is being eaten are also unhelpful (“I’m stuffed”/ “aren’t you doing well”)
  • If relatives feel worried they will ‘say the wrong thing’, reassure them that people with eating disorders usually welcome talk during mealtimes as distraction. General talk about all subjects not related to food/body imagine/eating disorders are helpful. Straightforward statements like “I’ve been really looking forward to seeing you” are a positive way of starting conversation. Relatives may need to be aware that the young person may be less chatty than they have been on previous occasions.

THE CHRISTMAS MEAL

It is very helpful to discuss and agree portions and strategies in advance. At Newbridge House, we have a Christmas meal early in December. This helps young people prepare and we also share portion sizes (weights and photographs) with the families we work with. It is worth considering, for example, how will you organise your Christmas meal, what might help?

  • It may be useful to have an agreement such as: parent will plate up the meat and potatoes for the young person and perhaps do the same for others. This way, the young person has an agreed portion of protein and carbohydrate, has a choice of vegetables and is not ‘singled out’ as having their meal in a different way to others
  • Think about how you plate up, considering your child’s personal triggers for anxiety and how to balance addressing those and the way your Christmas meal is served overall
  • It may be helpful for the young person to sit next to a designated supporter who they trust and knows them well. Some people find it useful to copy their supporter’s portions, which is helpful if people are serving themselves
  • It is often helpful to have an activity planned for after the Christmas meal as a distraction, such as a board game or watching a film

“I think it is really important to prepare and make a plan for Christmas with your loved one, then to be prepared for your plan to go off course. Try to be flexible and be aware of your own expectations; it is probably better to lower them a little. If your teenager needs some time out in their own room it may be better to allow that than to have a big fight. My daughter is in recovery from anorexia and certainly has issues with food still, but she loves Christmas. She loves the traditions and as she moves into her early twenties, she really values the time together with family and that certainly outweighs the food anxieties, even though they are still there.”
– Parent of young person who was treated for anorexia at Newbridge House

This article was compiled by Samantha Grigg, dietitian, Newbridge House, Rachel Matthews, clinical manager, Newbridge House, Professor Hubert Lacey, Medical Director, Newbridge House and a parent of a young person who was treated for anorexia at Newbridge House. December 13th, 2016.