• Christmas celebrations can be ‘terrifying’ to someone with an eating disorder, when the emphasis is all on food
• Enquiries for Priory’s private eating disorder services were 36.6% higher between January and November 2021 than during the same period in 2020
• The pressure of organising festivities can mean that the needs of loved ones with eating disorders are not sufficiently understood or accounted for
• A Priory expert shares her experience from treating those with eating disorders

Christmas is a time associated with copious food and celebration, with families coming together around the dinner table. But for those playing host to a friend or relative who suffers with an eating disorder, the festive period can be tortuous to navigate.

Priory consultant psychiatrist Dr Lorna Richards, an eating disorder specialist based at Priory's Life Works rehab clinic in Surrey, says the focus on food as integral to celebration can in itself be “extremely anxiety-provoking”.

She says: “For someone who struggles to eat enough, and fears weight gain, the expectation of eating in this context is terrifying. For those who have difficulties with compulsive or binge eating, the abundance of food is equally frightening.”

Sadly, there does appear to have been an increase in the number of people suffering from eating disorders this year. Enquiries for treatment at Priory’s private eating disorder services between January and November 2021 were 36.6% higher than during the same period in 2020.

Since the festive period can be a stressful time for everyone, to some degree, the needs of those with eating disorders can get overlooked. Dr Richards says; “Christmas is an unusual time of year that promises great happiness and ‘good cheer’ but also raises expectations that may not be realistic. A frenzy of images depicting the ’perfect Christmas’ saturate the media, including social media platforms.

“For those trying to support someone with an eating disorder, this conflict between the pressure on everyone to be having a ‘fun’ Christmas and the challenges that it presents can be overwhelming.”

It is not just ‘excess’ and over-indulgence at Christmas that makes the festive season hard for eating disorder sufferers. News about New Year health and slimming resolutions have become ubiquitous, and are a frequent topic of Christmas conversation. This narrative can be triggering for some people.

Dr Richards says; “Festive gatherings of friends, family and colleagues can feel like a minefield in terms of the topic of conversation. It is not uncommon for people to talk about their over-indulgence, and their plans for weight loss through strict diet and exercise regimes in January. This focus on food and weight-related issues can fuel eating disordered thoughts. People with eating disorders dread comments about their appearance from family and friends who may not have seen them since the last Christmas gathering. Whether it is concern about ‘looking unwell’ or even praise for ‘looking well’, this can fuel eating disordered thoughts. Feeling watched and scrutinised is another common fear.”

Dr Richards offers answers to the following commonly-asked questions:

1. Christmas can feel like a minefield. What can I do to alleviate the pressure?

Plan and prepare for all of these issues I have mentioned, as well as those which are particularly pertinent to you or your loved one, in advance. This means talking openly and honestly about expectations and what will be helpful and unhelpful

2. Last year didn’t go very well and I want it to be better this year, especially given the pandemic. What can I do differently?

Take the opportunity to rethink the Christmas period with activities and moments that you can all enjoy. Others might welcome a chance to do things differently too

Plan family walks, games and other activities that don’t involve food

3. Given we are all seated around a table heaving with food, how can I help someone who may be triggered by this?

Discuss a seating plan so that someone supportive can be next to someone likely to struggle. Think about how much information to share with visitors; everyone’s different on how they feel about this

4. What about topics to avoid?

Avoid conversations that revolve around food, weight and weight loss strategies or appearance

5. A family member has an eating disorder. What advice can I give or take into account?

If they are working towards recovery from an eating disorder, help them not to abandon or put on hold the parts of their routine that keep them on track. Encourage them to use any support they can, be it family and friends, professionals or helplines. Allow them to take time out on those days which they can predict will be most challenging; enable them to plan something relaxing, comforting or just routine for them