Addressing Eating Disorders During the Holiday Season

When I think back to some of my favorite holiday memories, many of them include food and family. I remember spending an entire day baking Christmas cookies and bread with my mom and grandma. My mother makes stuffing that is out-of-this-world.

Each year around this time, I begin to crave some of these favorite foods and the memories that come along with them.

However, for some individuals—specifically the clients I work with—this isn’t the case.

Many of them report dreading family get-togethers, especially all those that revolve around a meal.

How to address eating disorders during the holidays

For individuals struggling with eating disorder behaviors, the holidays can be overwhelming and stressful.

We know that eating disorders are complex in that they have a widespread impact on a client’s mental, emotional, physical, social, and spiritual wellbeing.

Anxiety and depression are also often seen in conjunction with eating disorders.

So, it makes sense that at a time when individuals are navigating varying family dynamics, busy social calendars, and financial strain that we would see an increase in behaviors associated with eating disorders around the holidays. 

Some behaviors are triggered by the social expectations and pressures that come along with this time of year. I often hear clients say that they become more aware of their physical appearance and struggle with body image around the holidays. Not only do they fear the judgement and comments from others, but it’s also an opportunity for their harsh inner critic to insert its demeaning jabs as well. 

Other clients report feeling triggered by the fact that food is often the centerpiece of holiday gatherings. My clients may report “starving for the holidays,” or restricting so they can later eat what may appear to be a normal amount in front of other people. Others have told me they “eat their feelings,” or binge-eat to cope with any uncomfortable feelings that arise because of social gatherings. 

Some clients become so overwhelmed with panic and anxiety that they choose to withdraw and avoid the situation entirely instead. Often this isolation leads to further depression and eating disorder behavior. While many of these scenarios are not solely unique to the holidays, they are exacerbated by the environment associated with the holiday season. 

Tips and strategies for those with disordered eating during the holidays

A couple years back, I was working with a teenage girl* who was overwhelmed with the holiday schedule of family meals that she was facing. She had recently been discharged from residential treatment and was struggling enough as it was to adhere to her meal plan. She had gone so far as to create a plan to pretend that she was sick the day before Christmas so that she could avoid back-to-back days of extravagant family gatherings. 

She appreciated that her well-meaning mom wanted to support her in her recovery, but was embarrassed that her mom had called her grandmother and aunt to let them know in advance why my client might act awkward during mealtime. In my client’s mind, it would be easier to avoid the situation altogether, even if it meant not being able to see family members that she genuinely loved. 

The challenge in this case was two-fold.

First, I had to create a plan with my client, including coping skills she could utilize to make the schedule and meals more manageable.

We also had to work with her support system—in this case, her parents—to give them effective strategies to support their daughter, and cope themselves.

We were able to collaborate and come up with an effective plan with which both my client and her parents felt comfortable, confident, and supported as they went into their holiday gatherings. 

Here are some tips and strategies you can incorporate into plans you’re creating with clients and their support systems to address eating disorders around the holidays:

• Create an environment that doesn’t make food the focus, but rather one aspect of the gathering. 
• Make memories by engaging in activities that don’t involve food, like volunteering, exchanging gifts, singing carols, or watching movies together. 
• Don’t make comments about food or portion sizes during the meal, or in front of other people. 
• Discuss expectations before the gathering, and then stick to them. 
• Discuss appropriate food choices and portions before the gathering (This may not always be necessary, depending on the severity of the eating disorder.)
• Be aware of signs that the client is struggling and needs extra support. You can come up with a code word or signal that your client and their support team all agree on. 
• Use effective coping skills to manage anxiety and depression, rather than using food. 
• Engage in mindfulness activities to ease anxiety, and create a positive mind-body connection. 

Lastly, encourage your clients to utilize the support of their counselor, and engage in a family session if needed. 

Working with clients with disordered eating beyond the holidays

Eating disorders are complex, and treatment requires specialized training. Evidence-based treatments for eating disorders include Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). These models lend themselves well to treating eating disorders and comorbid anxiety and depression by addressing maladaptive thoughts and behaviors. 

DBT specifically integrates mindfulness and acceptance strategies to help clients address the emotional dysregulation that is often present. CBT is effective in addressing perfectionistic tendencies that are often present with anorexia nervosa.

While perfectionism often carries a negative connotation, the individual’s desire for high achievement can be harnessed in treatment. It’s important to work with clients to quiet their harsh inner critic and help them begin to practice self-compassion. Encouraging cognitive flexibility and moving away from black and white thinking is also important in eating disorder treatment.

While some eating disorder symptoms are prominent and a clear diagnosis can be made, many clients struggle with some level of disordered eating that may be presenting at a sub-clinical level.

As counselors, it’s essential that we assess for disordered eating behaviors and their use as a maladaptive coping skill. When we stay alert in watching for these behaviors, and pursue professional growth opportunities to help address them when they arise, we’ll stay prepared to offer our clients the best possible care. 

* To protect client confidentiality, some details have been changed or aggregated.

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