When Christmas cheer becomes Christmas fear
Coping with the festive season when you have an eating disorder
By Dr Katherine Shanley
Despite all the hype, the advertising and cheery carols in shopping centres, the Christmas season is far from festive for many people. Have you ever considered how difficult it can be for people with eating disorders to navigate their way through a time of year when the focus is on food, on eating with others and often on overindulgence?
A 2012 study estimated that nearly one million Australians are living with an eating disorder. This figure includes anorexia and bulimia along with binge eating disorder and “eating disorder not otherwise specified”. These conditions can affect men and women of all ages and backgrounds. There are many complex factors that contribute to the development of an eating disorder, including genetic vulnerability, psychological factors such as perfectionism and low self-esteem, and socio-cultural influences, including media images promoting certain body shapes as desirable or ideal. The common features amongst those affected are that they have disturbed eating behaviours and distorted beliefs about weight, shape, eating and body image. The Australian National Eating Disorders Collaboration wants us all to understand that eating disorders are serious mental illnesses – they are not a lifestyle choice. (1)
For those with an eating disorder, anxiety around food and the festive period can be overwhelming. The types of food on offer tend to be high calorie items which they would usually avoid. Some people may be anxious that if they start to eat such foods they might not be able to stop. Many struggle to eat at all in front of other people. Often they have a sense of shame, and worry about receiving unwanted comments or observations about what they are eating, how much they are eating, or how they are looking. Meal-time routines are different at Christmas and the loss of structure can be anxiety-provoking for sufferers. It can very hard for those around them to understand just how frightening and isolating these experiences are.
While these challenges cannot be eliminated, there are many strategies that families and friends can put in place to reduce this anxiety. In 2017 the British NHS produced some useful guidelines:
• Minimise the social expectations of people with eating disorders over the holidays – don’t pressure them to attend events that they will find difficult. It can be helpful to break social gatherings into smaller numbers of people, where possible
• Treat meals on Christmas day as routinely as possible
• Serve food as a buffet rather than a sit-down meal
• Plan ahead and think about how food features in the festivities. It can be a good idea to encourage the person with the eating disorder to provide/prepare/choose at least one dish that they will be comfortable eating
• Once Christmas lunch or dinner is over, shift the focus promptly to other activities such as playing games, watching a film, or going for a walk. (2)
Some of the most useful advice on this topic comes directly from sufferers themselves, such as Rhiannon Morgan and Habiba Khanom, who are quoted in a 2015 article (I have summarised their points):
• Advance planning is the number one key to creating a sense of security
• Be honest with your family about your difficulties. Sit down and negotiate your strategies for managing food and emotions
• Remember that you do not need to eat what everyone else is eating. Do what feels comfortable to you. There does not need to be any pressure. If you choose, prepare a dish for yourself that is quick and easy to cook
• If you are feeling overwhelmed, take yourself out of the situation. Go outside, take a break, but do not isolate yourself. Stay around other people and focus on something other than the food
• Remember that Christmas is not just about food, it’s about having a fun time with friends and family
If you or someone you know is struggling with an eating disorder this Christmas, see/encourage them to see their GP and get a referral to a psychologist and a dietician who have expertise in the management of eating disorders. Here at Milton Village Medical we work closely with some excellent professionals who are skilled in this area. Medicare will partially fund treatment through the GP Mental Health Care Plan and the Enhanced Primary Care Plan. Some people may need referral to a psychiatrist as well. In Australia there is a national phone and internet support service called the Butterfly National Helpline (see details below). This service provides support, brief counselling and referrals for those experiencing eating disorders, their carers, families, friends and health professionals.
Phone: The Butterfly National Helpline Ph: 1800 ED HOPE/ 1800 33 4673
• Eating Disorders in Australia, National Eating Disorders Collaboration, Australian Government Dept of Health and Ageing, www.nedc.com.au
• Eating disorders: coping at Christmas, National Centre for Mental Health (UK), www.ncmg.info/2018/12/17/eating-disorders-coping-at-christmas/
• Four young women reveal what it is like to have an eating disorder at Christmas time, by Lucy Sheriff, www.huffingtonpost.co.uk/2015/12/21/this-is-what-its-like-to-have-an-eating-disorder-at-christmas-time_n_8853814.html