It is difficult to attend a holiday party or family meal without encountering tables laden with lavish feasts and decadent desserts. While this may be considered a standard part of the celebration, for some it’s far from a pleasant experience.
For those with an eating disorder, the scene can lead to psychological and physical pain.
Eating disorders such as anorexia nervosa, bulimia nervosa, Avoidant Restrictive Food Intake Disorder (ARFID) and binge eating have their origins in severe anxiety and are often misunderstood, said Michael A. Strober, PhD, an emeritus distinguished professor of psychiatry at the David Geffen School of Medicine at UCLA and former director of the Eating Disorders Program at the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA.
There is no quick fix for these conditions, and holiday gatherings are no place to pressure a loved one to eat or to stop eating, said Dr. Strober, who has nearly 50 years of experience in the field of anxiety and eating disorders. He said treating a person with an eating disorder involves a long process of addressing their anxiety.
Adding to the challenge of holiday gatherings, he said, is that someone with an eating disorder might feel they have to hide their anxiety and distress for fear of shaming and disapproval.
Love and support, understanding and empathy, are what they need most from friends and loved ones, he said.
"You are not going to solve this at that moment. You are dealing with a very deep psychological condition of anxiety, that is a part of human evolution," Dr. Strober said. "You have to understand that some people are not comfortable with the food that most people look forward to at a time of celebration. Those dealing with this condition can be helped by careful treatment, but the holidays are not the time to resolve this."
Advice for the holidays and beyond
To make holiday gatherings as comfortable as possible for the person with an eating disorder, families should have a plan in place before they arrive, Dr. Strober said.
Sometimes the plan can be as simple as allowing a person to eat at a different time than the main family holiday meal, since other guests filling their plates with food can leave the person feeling overwhelmed and increase their anxiety, he said. Or maybe it’s better for the person to even skip the meal if it seems overwhelming.
He offers some other suggestions for those with a friend or loved one with an eating disorder:
- Do not force food on a person. A parent might think that a child who is very skinny shouldn't fear having a big plate of turkey and fixings, but that can be like "trying to tell someone to ingest arsenic" if they have a fear of calories and body mass, Dr. Strober said.
- Put together a meal plan with a professional. "We need to be sensitive to that person's needs. They should be on a meal plan as part of their treatment, and that meal plan should be followed, even during the holidays," he said.
- Be sensitive to the fact that this is not just about food. It is a deep psychological issue that is rooted in human evolution — certain fears are part of why humans survived on this planet. Pressuring a loved one, even by well-meaning family members, can trigger more anxiety and worsen the problem.
- For parents, talk to siblings about being sensitive to the feelings of the person suffering from this condition. Don't expect that person to be as comfortable as you are with a holiday meal.
- Focus on the holidays as a time of closeness and bonding. That can build the kind of trust and security that can help a person make progress in the future with addressing their own mental health.
The anxiety connection
Eating disorders typically are a symptom of "early life anxiety" stemming from low self-esteem and feeling "under attack" from others, Dr. Strober said.
People with these conditions develop a "fear of body mass," he said, and will starve themselves in the case of anorexia, or vomit or exercise excessively in the case of bulimia, to avoid gaining weight, which they fear will bring negative judgment from others.
"Studying this for nearly 50 years, I can count the number of treatment programs that really understand it on one finger — and I am familiar with all of these programs," Dr. Strober said. "It is somewhat unfortunate to call it an eating disorder, since that is a symptom of the real problem, which is deeply held anxiety.”
During the holidays, friends and loved ones need to be sensitive to the anxiety that these feasts pose to someone with an eating disorder, and act accordingly, he said.
"It is very important for loved ones to reassure the person before and during meals, and make it clear that they don't have any obligation whatsoever to eat in the way that other people are eating at the holiday table," Dr. Strober said.