Season's eatings: Holidays extra stressful for people with eating disorders
The holidays can be stressful for everyone, but for individuals with eating disorders, added stress, anxiety and worry come along with the turkey and stuffing or the cocoa and candy canes.
"It really takes away from what makes the holidays great - spending time with people you love, actually getting to enjoy the special treats or presents of that time," says 22-year-old Emma Johnson, who suffered from anorexia nervosa and over-exercised from ages 15 to 19.
In America, Thanksgiving and Christmas are centered around food, candy and drink, which can aggravate an anorexic or bulimic's preoccupation with what and how much they consume or don't consume.
"You're so inundated with this stress that it becomes more of a task than a celebration," says Johnson, who grew up and attended school in Fargo but currently lives in San Francisco, where she works for a tech company.
Tricia Cook Myers, psychologist with the Sanford Eating Disorders & Weight Management Center, says her patients report feeling more out of control during the holiday season.
"Maybe they're used to having specific patterns of eating that helped them feel comfortable, and that kind of goes out the window when the holidays come in," she says.
Myers and fellow psychologist Kelly Kadlec say there are certain expectations surrounding holiday food. Family members will say things like, "This is your favorite food, why aren't you eating it?" or "You might hurt someone's feelings if you don't act like you're enjoying this."
Patients who overeat, binge, or binge and purge express fear that they'll lose control when faced with an overabundance of food, particularly foods they label as "bad" or "trigger" foods.
To make matters worse, not only is overeating accepted during the holidays with comments like, "Oh, it's Christmas, it's OK," it's encouraged.
The day of a holiday party or event, Johnson would obsess over whether she'd be offered something special, like eggnog or a cookie, and how she'd respond.
"I would think about it all day. It would consume my mind. It was like I had to make adjustments to my day if I was even thinking of indulging in one of those things," she says.
The food itself is only part of the problem. Being around family members - who may or may not be aware of the disorder - and worrying about what they'll think adds to the anxiety.
"You always feel like you're under a magnifying glass. Whether that was true or not, I always felt like people were watching me at these holiday dinners, or they were judging me," Johnson says.
Offhand or even well-meaning comments like, "Emma, you're looking so good, you look healthy," can backfire, psychologists Kadlec and Myers say.
"When you have an eating disorder, every comment, whether they want it to be helpful or not, you somehow in your mind manipulate it to be negative," Johnson says.
And avoidance isn't the answer. Kadlec and Myers warn against falling into that pattern.
"Unfortunately, if you avoid everything, that just reinforces your fear. You isolate, you become depressed, you feel guilty. It's a vicious cycle," Kadlec says.
At family get-togethers, Johnson turned to her older sister, who also struggled with an eating disorder, for perspective. They'd step outside, take a deep breath, and re-evaluate the situation together.
"She was very good at helping me think rational thoughts," Johnson says of her sister.
Her parents were behind her, too.
"They were there with me throughout all of my therapy, so if I was having a panic moment, I luckily had that support there," she says.
Johnson also credits her Sanford medical team, which included an eating disorders therapist and a nutritionist, for her successful treatment.
They helped her develop tactics for handling uncomfortable situations, especially during the holidays, when she says her eating disorder was "ramped up."
"The holidays were incredibly stressful, and basically every holiday, not just Christmas or Thanksgiving," she says.
The Stanford University grad made the most progress in college, where she formed a supportive group of friends who helped her realize what she was missing.
"I don't really think twice before I eat something now. I eat when I'm hungry, I love going out to eat with my friends, and it really is so freeing," she says.
Now that she has a healthy relationship with food, Johnson's looking forward to coming home for Thanksgiving and Christmas and enjoying Upper Midwest holiday staples like lefse and green bean casserole.
"These holidays really aren't about the food, they're about great company and family, and those are the things you miss out on when you're focused on the food, and now, luckily, I can enjoy both," she says.
Readers can reach Forum reporter Meredith Holt at (701) 241-5590