Thinking about Christmas with an eating disorder

The run up to Christmas can be really exciting: preparing for holidays, time with family and friends, parties, presents and often lots of food. But that excitement can be equalled and even overshadowed by worry, guilt, resentment and panic when you know there’s going to be an unwanted guest present who is going to be resistant to your polite requests for them to leave. This is what Christmas with an eating disorder can feel like. For both the sufferer and their loved ones.

While I’m sorry to say there is no fail-safe solution to this seeming contradiction in emotions, I have tried to come up with a few pointers to help you get ready for and get through the day. They won’t all be applicable to you and your situation, but might help you get started…

1. When someone is an inpatient, they may not have leave granted at Christmas. Although most units will endeavour to allow some leave, it’s important to think about how you might manage Christmas if you are going to be visiting someone in hospital on the day or taking them back for meals. By speaking with the care team, you should be able to anticipate the likely pattern of the day, but remember that recovery from an eating disorder is not a linear journey and it doesn’t make Christmas an exception. Try to be flexible.
2. Whatever the eating disorder diagnosis, there is bound to be a lot of emotion tied up with food and the idea of a Christmas feast may have quite different associations to those it once did. At the height of my anorexic thinking, I couldn’t stand to be in the same room as food. This created a conundrum when my parents were having to feed everyone else in the house. They wanted me to enjoy my time at home and so one thought was to try and avoid dinner table conflict by just having a day off from trying to battle this demon and not put any food in front of me. But an eating disorder is not just present at the dinner table (although it sometimes makes itself more obvious at these times). It can feel like a little voice in your head or a false friend on your shoulder. Avoidance can send you backwards and persisting with a meal plan in a prepared way will see you in good stead. Food is also a necessary and normal part of every day and everyone else needs to eat too.
3. Think about how a meal plan could fit with your usual Christmas meals. Are they adaptable? Can the menu for the day be pre-agreed with advice from a dietician, nurse, OT or therapist? Sticking to pre-set meal times can be really helpful. Finding out meal times in hospital could be a good guide and a yardstick to go back to when disagreements happen.
4. A buffet may seem like a good idea because it would mean someone could pick and choose more easily. Certainly, this may help some people but personally it filled me with terror. SO MUCH FOOD! If worried about urges to binge (be this a component of bulimia or binge eating disorder) it may be easier to have, instead, a serving table or area where you can get your plate filled that is separate from the eating area. Sitting down at a table to eat you then don’t have the panic of someone putting extra unwanted food on your plate or asking about the food on the table as a conversation starter. It also allows you to supervise the portion size before sitting down, and the task ahead is known. Knowing things does make them less scary, even when still terrifying.
5. You could ask the person to help with the table planning, so they know who they will sit next to and have chosen napkins, crackers and candles etc. so they feel a part of a meal they may not have been able to prepare. Another good idea is to have some games at the table for during the meal to distract from the act of eating or have the radio on. We used a set of liar dice to pass around while other people were finishing their food. A pre-rehearsed response to chat about food is also a good idea so you can cut off what may be a tricky subject. An agreement not to talk about food at the table before the meal often helps and is again a guideline to stick to.
6. Having a set time in which to complete the eating the meal (or being sat at the table) can also be really helpful. If this is set at 30-45 minutes, then you change the setting when the eating is done by going into another room away from the table and food. This change helps prompt a change in emotional state. If going out for a meal, think about where you are going and check the menu and portion size ahead of time to save extra anxiety and negotiation on the day. It may be harder to leave the table if at a restaurant, so post-meal distraction is really important. A classic Christmas game like charades focuses thought away from the food, and giggling challenges the distressing feelings post-eating.
7. Now I’ve just used the word ‘distraction’, and I say it with caution because it used to make me furious when someone suggested that a game of scrabble would help me manage the overwhelming negative voices in my head. I like the idea of ‘distress tolerance’ from the Dialectical Behavioural Therapy model. This is the idea of accepting that you can’t make something better straight away, and rather than getting tangled in the distress of it you do something that will not make the situation worse. Thinking of a list of things that would work at different times during Christmas Day means you’ll always have an idea to go to at a time of distress. These could be games to play, people to video-call, films to watch, a Christmas quiz or other activities that you enjoy or interest you. For me, decision-making when in an emotionally charged moment seems impossible, so I think of ideas ahead of time and write them on slips of card, then shuffle them and do whatever the top card suggests. I would agree this with my family and we all did the activity together.
8. Another anxiety of my family was not wanting to upset me. It can be really paralysing for everyone involved. Concern about causing upset can lead to you saying nothing, but then that upsets someone too because they feel ignored. You cannot control the emotions of another human being, be this a friend, a child or a partner. You are not responsible for what they are thinking and how they react – this is especially important when an eating disorder takes over and often prompts extreme and intense emotional responses. Team games are a brilliant way to involve everyone without signalling one individual person out as a winner or loser; means emotions of elation or disappointment are shared and therefore you can feel close through shared experience. Working together with the same goal can also be really positive and refreshing if you spend a lot of time acting as an enforcer of a meal plan that is met with resistance, arguments, and everyone feeling rubbish afterwards.
9. A quick note on presents: extra thought may be required this year. If someone is an inpatient and will be returning to a unit, try to make sure they have some presents they can take back (a list of what is and isn’t allowed on the unit should be available from the staff). Clothes are not necessarily a no-no and likewise with food. If you are always given chocolate money in your stocking, then you may feel left out if there is none this year. An offer from someone else to collect your food items for you once opened might be a way of still getting to open them. With clothes, the offence of the ‘wrong size’ may be equal to the disappointment of not getting the usual jumper you ‘always’ get. And that is another one of the things we can forget about an eating disorder: it is not just about food and appearance, although that is what we see from the outside looking at someone who is internally battling difficult emotions.
10. Also think about helping your loved one if they want to buy presents but are too ill to go to the shops or have no internet in hospital as an inpatient and cannot leave. I made all my Christmas presents one year as I was an inpatient and while not what I would have usually gifted they were accompanied with equal measures of love. Also providing Christmas cards and stamps for someone can help them to feel a part of Christmas.
11. Christmas is not about the eating disorder. An eating disorder tries to take over every aspect of life and by doing some of the things you normally do on Christmas day you can reduce its power and grip. Feel the fear and do it anyway! If you normally have mince pies at tea time, still have them, but clear them away and don’t leave them on the side with the aura of fear floating over them. As a family, try to model a healthy relationship with food yourselves. This means eating your meals and having a pudding if you want one, and definitely if your loved one is having to have one.
12. Time out is not failure. A gift in a stocking like a craft activity, colouring or reading book can provide a break and some rest time in a stressful day. The person with the eating disorder may need time to themselves. So a set of headphones and a favourite album, playlist or podcast can be helpful, as supervision can continue while they still have some break. Curling up on the sofa and watching a film together can be a cherished time. If they have timetabled rest-time, a planned film to watch is even better. A hug, and to be with you, is free, and can be the greatest comfort on this day. The day does not have to be perfect or to go as you planned. That is okay. It is not a failure and going back to hospital earlier than planned (if an inpatient) or not doing everything on the list is fine too. If as parents, partners or siblings you are taking someone back to hospital, anticipate you might be really upset afterwards and plan in some self-care for yourself. The same idea of distress tolerance can be applied to your life stresses too.
13. And finally, I just wanted to add a note about one of my favourite Christmas memories. I was an inpatient at the time and had not been out of hospital without a member of staff for over four months. I was allowed leave on Christmas Day and I didn’t last the whole day at home, going back to the unit early, totally exhausted and unable to come out again on Boxing Day. But what I remember with fondness of that day was the usual Christmas family things we would do. My mum picked me up in my pyjamas so I could come home for stockings in bed with my little sister. We went on a short dog walk in the snow with me wrapped up in a million layers. I brought the decorations I had made at hospital home to put on the family tree. We sang carols in the car on the way back to hospital. And I got to have a few moments of normal me. A few glimpses of what I had to live for. It didn’t fix everything or make everything better, but those moments put a smile on my face at a difficult time.

Contributed by Lucy