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Contributor: Norman Kim, Ph.D. – National Director of Reasons Eating Disorder Center
When we think about some of the particular challenges of struggling with an eating disorder over the holidays, the first thing most people might think about is the food, and understandably so. Food is a central part of the holidays for all of us.
Getting together with family over food and drinks is a big part of celebrating Thanksgiving, Hanukkah, Christmas, New Years, and many of the other holidays that happen around this time of year.
The ways in which the dominant role of food in holiday celebrations makes the experience treacherous for those with eating disorders are clear. There are also elemental aspects of the illness that make the holidays such a confusing and potentially painful time.
Understanding Eating Disorders
Let us start by broadening our understanding of what an eating disorder is. While some of the primary characteristics of the eating disorder obviously involve eating behaviors, we also know that the more core defining characteristics go well beyond that.
This other kind of conceptualization of what an eating disorder is has a lot of relevance to this topic of the holidays. For example, one of the core elements of all eating disorders is anxiety and fear, which are central to the perpetuation of eating disorders.
This can manifest in behaviors such as avoidance of feared foods, ritualistic and compulsive behavior around things like food and exercise, somatic symptoms, and an irrational belief system that contributes to the use of accompanying dysfunctional behaviors.
Anxiety and Isolation During the Holidays
There are a number of reasons to think about anxiety as being very central to the presentation and manifestation of eating disorders and the overall course of the illness. We also know that the overlap between eating disorders and anxiety disorders is quite high.
The pattern of overlap seems to suggest that they are much more one and the same as the way eating disorders may overlap with other disorders like depression or substance use. During the course of illness, there are significantly high rates of anxiety disorders present.
We know that anxiety almost always precedes the onset of eating disorder symptoms, and anxiety is usually what is left over towards the end of the illness’s trajectory.
Anxiety is also a lot of what comes up for many people during the holiday season. The type of anxiety may differ from person to person. However, even in the best of circumstances, there is a measure of anxiety that goes hand in hand with the joy and all of the other positive things that come during the holiday times.
The role of loneliness in eating disorders plays a predominant role as well. Eating disorders are fundamentally disorders of disconnection on a number of levels.
They disconnect you from relationships, from the sense of the full experience of existence, from your own emotional state as emotions become overwhelming, from your authentic self, and of course, they disconnect you from things such as hunger and fullness cues.
One can become hyper-aware of certain types of sensations, particularly stimuli that have some level of threat associated with them, and simultaneously unaware of other sensations involving self-care and other essential drives such as breathing, the drive for sleep and rest, and self-compassion.
Shame and Eating Disorders
Eating disorders are also disorders of marginalization and shame, separating you from the rest of the world in a very fundamental way, in large part because they are excellent at activating our shame. Simply put, eating disorders do not exist without shame.
The resulting desire with that level of shame is to wish to not occupy any space, to not exist, to not give off any sort of smell, to not make any noise, to disappear. This is a key driving factor for many behaviors that we see, and the affected person is often profoundly convinced that they were born broken or incomplete.
The voice that tells you that this is who you are and that you need to disappear also tells you that these things are intrinsic, not something you have acquired, a core belief that makes for a difficult recovery journey. Shame is also impactful when looking at the overlap between eating disorders and suicidal behaviors.
We see this very much during the holidays, as this time of year can be a potent exacerbator of not only pathology but also hopelessness and suicidality. A key trigger of these beliefs, especially around the holidays, is often loneliness.
Connection to Other People During Eating Disorder
Being socially connected is a core, defining characteristic of us as a species. It is what drives almost every trait we possess and is an inherent component of our ability to survive. We possess all sorts of mechanisms that force us to be interdependent on one another.
The understanding that we are all interconnected can make one feel quite vulnerable, and if operating from a place of insecurity, that can be a very threatening idea to hold. Given that human beings’ social nature is essential to our survival as a species, it is no wonder that loneliness is such a painful thing to experience and something that most of us will go to extremes to avoid.
With acute loneliness, the person tries to stop feeling altogether and attempts to live solely by employing some kind of cognitive control rather than having an emotional connection to one’s world. That attempt at controlling and operating from a place of detachment is also what happens during the course of an eating disorder.
Loneliness and eating disorders are linked by the experience of attempting to avoid the painful experience of feeling disconnected, resulting in a profoundly impaired sense of self-worth and perceived competence in the world.
This can look like a willingness to sacrifice one’s own desires to please others, a desire to bury one’s own needs in order to maintain relationships, and that one can feel lonely even within the context of relationships because of the belief that their true selves are too ugly or grotesque to show to others. Feeling lonely reflects the distance one feels between self and others and between self and inner self.
Struggles During the Holiday Season with Eating Disorder
For those in recovery, just out of treatment, or actively living with an eating disorder, another challenge this time of year is managing your own and others’ expectations that you ought to be filled with the joy and happiness of the holiday season.
This can be a significant obstacle for many people. Feeling the pressure to express gratitude, a sense of community, perhaps the need to have a romantic partner, all of these can amplify the negative feelings and the sense of loneliness associated with the season.
Any of us with social anxiety or a tendency towards introversion know the experience of being surrounded by people but having that situation only serves to make us feel even more alone. This can range from being slightly uncomfortable to being extremely painful.
For those with an eating disorder, the experience is rooted in a sense of being inadequate, unlovable, and plagued by anxiety, and is magnified during those times that one “should” be happy, one “should” feel connected and loved by others.
These are the moments when how you feel internally doesn’t match with the nature of the holiday season, and that discord can amplify your sense of internal struggle and subsequently increase the pressure to perform. This cycle is one we often hear people describe when it comes to the holidays.
In addition, we cannot ignore the impact of the COVID-19 pandemic this year. We have been in this place of not being able to see people in the ways we are accustomed to seeing people for a significant stretch of time, and those of us in the mental health community are seeing the anticipated impact of the very necessary restrictions due to COVID-19.
We’re all isolated with the pandemic, and many of us have made the heart-wrenching decision not to see our families over the holidays.
Even though we can feel good about our choice to keep our loved ones safe and collectively do something that we know to be good, it can still be very painful. For those already struggling with a feeling of isolation and loneliness, it can feel like the last straw.
So in the Face of All This, What Can be Done?
First and foremost, it is incredibly important to show some self-compassion and show yourself some grace. It is ok to struggle and feel overwhelmed, but trying to give yourself compassion and recognizing how difficult the holidays can be will help you preemptively prepare to manage some of the feelings that may arise.
Setting healthy boundaries is also an essential part of self-care and self-compassion. Knowing where your boundaries are and who the people are in your life who can respect those boundaries and who the people are who cannot is a key piece to prepare for in advance of holiday gatherings.
Having a plan in place for what situations feel safe and what situations don’t feel safe is another area in which to plan with supports. Your support system may comprise professionals such as a therapist or dietitian, community-based like a support group, or simply a friend or family member that you can be open with about where you need help.
Specific to eating disorders, give yourself permission to eat what your body might be telling you to eat. “Indulging” in something is a natural and healthy part of the holidays and a natural and healthy part of eating in general.
Using some of the ideas that come from intuitive eating can be extremely helpful in this, such as removing judgment and labels. Ideally, this will come from a place of making a conscious decision to listen to your body as a way of demonstrating self-love, self-care, and self-respect.
Reminding yourself that there is no such thing as good food and bad foods, as well as knowing that it takes work to remind yourself of that, is especially important and true during times like the holidays.
Remember to tell yourself that feeling satisfaction from people, situations, or food is also healthy and important. Give yourself permission to feel good, to feel loved, to feel cared for.
Often times, the process of self-love means coming to a place of acceptance with the discomfort of loving yourself more than you feel like you deserve to be loved.
Finally, ask for help and internalize the knowledge that there is no shame in asking for help. It is a step that requires courage and is important to set out as an intention during this time.
About our Sponsor
Reasons Eating Disorder Center offers a full continuum of care for patients struggling with anorexia, bulimia, binge-eating disorder, and co-occurring issues such as trauma symptoms, substance abuse, bipolar, borderline personality disorder, anxiety, obsessive-compulsive disorder, or depression.
About the Author:
Norman Kim, Ph.D. – National Director of Reasons Eating Disorder Center completed his B.A. at Yale University where he studied music and psychology, and was the recipient of a Mellon Fellowship for Research in Psychiatry. He completed his Ph.D. in Clinical Psychology at UCLA, where he was the recipient of an individual National Research Service Award from the National Institutes of Health to study the neurobiologic underpinnings of emotion recognition and understanding in Autism. Most recently he has been involved in a multi-site, longitudinal study of children and adolescents at risk for developing bipolar disorder.
In conjunction with his research, Norman has developed an expertise in treating and teaching about psychiatrically complex populations, multi-modal treatment, and diagnostic assessment. While rooted firmly in empirically supported approaches, he has incorporated practices emphasizing somatosensory integration and that draw from eastern and traditional medicine with our current knowledge of the neurobiologic and cognitive processes underlying anxiety, mood, trauma and eating disorders.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published December 24, 2020, on EatingDisorderHope.com
Reviewed & Approved on December 24, 2020, by Jacquelyn Ekern MS, LPC