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Supporting Your Loved One with an Eating Disorder During the Holiday Season

Suggestions for biological family, chosen family, kinship group members, partners, friends, carers, and loved ones of a person with an eating disorder

By Rosie Elwyn

Committing to Diet-Talk Free Holidays

Conversation should always be diet-talk free. However loved ones of a person with an eating disorder can decide together to renew their focus and commitment to eliminating diet-talk from conversation during the holidays. This makes conversation emotionally safer for everyone, not just the person with the eating disorder.

It can also mean curbing diet talk with gentle reminders for visitors during the holidays to change the conversation. For example:

· “Let’s just enjoy ourselves!” *change topic*

· “Food was made to be enjoyed.” *change topic*

· “We only have one beautiful life. Let’s enjoy it.” *change topic*

· “I’m so thankful that we’re here together, and sharing this experience. Let’s enjoy our food.”

· “You don’t need permission to eat. We all deserve to enjoy ourselves.” *change topic*

· “You don’t need to earn food. That’s just diet culture and industries preying on us. We all deserve happiness. Our lives and happiness are so precious. Let’s enjoy our food.”

· “There’s no such thing as good, bad, naughty, or guilty foods. Just diet culture that wants to make us feel bad about ourselves. And I don’t want to live like that.” “Cheers” or “this looks delicious” “Let’s enjoy or food” or *change topic*

 LGBTQ+ Safety with Visitors

This goes for supporting any loved one, with or without an eating disorder. However, research has also consistently shown that LGBTQ+ people have significantly higher risk and rates of eating disorders, which is often closely related to discrimination, bullying, abuse, and trauma survival, and social expectations of gender and sexuality. Supporting a loved one who is LGBTQ+ by increasing their emotional support around their identity can be incredibly powerful in helping them to heal.

Your loved one with an eating disorder may identify as transgender or gender diverse, or have a diverse sexuality. They may not be out to other people yet. They may also be out, but you may have visitors who do not or refuse to understand or use their name or pronouns. It’s important to check in with them beforehand, to see how they are going.

·         It’s important to affirm their identity with them, and to acknowledge that relatives/friends/visitors may be speaking to them using pronouns and names they do not identify with, and that this may be painful and alienating for them.

·         Ask them what they would like to happen in this situation. For example, the use of a nickname, that you could say “oh, we call ____ by ____ which is our pet name”. They may not be ready to take any action yet, so it’s important to help your loved one feel as safe as possible.

·         Reassure them that you recognise who they are within themselves, and that you support them.

·         You might like to organise beforehand that they can call or text LGBTQ+ hotlines throughout the holidays if it gets too much, or discuss that they might text or call a friend they feel safe to

·         You might like to decide on ‘covert signals of support’ with your loved one to show them that even if others do not know or understand their identity, that you do.

o   You could, for example, decide that you will both put small rainbow or trans/gender diverse colours or symbols around the house. Like putting rainbow lights or baubles on the Xmas tree. You could wear rainbow or trans/gender diverse colours (light blue, pink and white) on your person as a show of solidarity: clothes, jewellery, eyeshadow, nailpolish, tie, shoelaces, or drawing some rainbow on your hands.

o   If you are not in your own house for the holidays, you could also choose to wear rainbow somewhere on your person as a show of solidarity. This could appear simultaneously as a festive display and help your loved one feel safe. It can take the hurt out of comments that others make for your loved one to feel that they are surrounded by support and acknowledgement in other ways.

·         You may like to discuss responses with them in case they get upset or overwhelmed with a question or comment, or if they might like you to step in, for example:

o   If a visitor says: “So do you have a girlfriend/boyfriend?” or “when are you going to get a girlfriend/boyfriend?”

· A response for them might be: “I was too busy (reading/playing/doing) my favourite (book/game/hobby) to worry about it! Have you been reading anything good lately? I really like…” *changes topic to favourite book/game/hobby etc*

· A response from you might be: “oh goodness, I’m just glad we’re all here and happy and well. I’m so proud of how well we’ve come through this.” ‘

o   If a visitor says: “When are you going to start (looking/acting) like a ‘proper’ girl/guy?” “When are you going to start (*insert socially-prescribed gender expected expression here*)?”

· A response from them might be: “Life’s too short not to be an individual. Most people thought the world was going to end this year. I love who I am.”

· A response from you might be: “Life’s too short not to be who you are. (To loved one): We love who you are.”

·         Your loved one may be out about their LGBTQ+ identity. However visitors may make mistakes about or refuse to acknowledge or use their pronouns, name, or acknowledge their relationship and identity.

·         Ways you can respond to support your loved one:

o   If a visitor makes a mistake with a name or pronouns and doesn’t correct themselves:

· Gently correct them

· If they try to argue: “Her/His/Their name is____. That is the end of this discussion.” “She/He/They/Ey/Ve/Xe/Zie are she/he/they/eirself/verself/xemself/hirself. That is the end of this discussion.”

· If they continue to misuse your loved ones’ name and pronouns, continue to correct them. If they try to argue the point, interrupt them and say “You don’t get to decide. This conversation is over.” You may also decide to tell them that they need to respect your loved one, or they can leave (if they are in your house). If you are visiting this person’s house, or you are visiting another place together, you may also decide to tell them that they need to respect your loved one, or they can leave.

o   If a visitor states things like: “When she/he/they gets a boyfriend/girlfriend” (erasing the person’s LGBTQ+ sexual identity or current relationship):

· Some example responses might be:

·         “Actually ____ would have a girlfriend, because she identifies as (queer/a lesbian/gay). And we love that about her.”

·         “Actually ____ would have a boyfriend, because he identifies as (queer/gay). And we love that about him.”

·         “Whether or not ____ ends up with a girlfriend or a boyfriend, we just want them to be happy and to have someone that loves them like we do.”

·         “Whoever ____ ends up with, we just want them to be happy and to have someone that loves them like we do.”

·         “Actually ____ has a girlfriend, and they’re a great couple!”

·         “Actually ____ has a boyfriend, and they’re a great couple!”

·         “Actually ____ has a partner, and they’re a great couple!”

·         “Actually ____ has partners, and they’re great!”

· If the visitor then responds negatively, some responses can be:

·         “I hope you become more compassionate in time. But it’s not up to you.”

·         “Love is beautiful. I hope you come to see that. But it’s not up to you.”

·         “Love is beautiful. I’m not going to debate that.”

·         “Love is beautiful. I’m proud of ____. I’m not going to discuss this with you.”

 Video Calls and Phone Calls

The holidays can mean a lot of phone calls and video calls, particularly during the COVID-19 pandemic. For a person with an eating disorder, phone calls and video calls can bring a lot of anxiety, particularly for video calls which can be a source of heightened anxiety due to seeing oneself onscreen. It can be helpful to discuss with your loved one how they would like to approach video calls and phone calls. Some examples might be:

 ·         Saying hello on the video call and then excusing themselves and leaving partway through

·         You (or another person) saying to the person on the phone or video call that your loved one can’t come to the phone/video chat right now, but sends their love/happy holidays greeting

·         You (or another person) saying to the person on the phone or video call that your loved one can’t come to the phone/video chat right now, but can send a text later

·         Calls from someone your loved one may not wish to speak to, or if they no longer feel up to a call or video chat:     

o   Mouthing to them the name of the caller. If they shake their head or otherwise indicate that they do not want to talk, say to the caller that they can’t come to the phone or video chat, but send their love/happy holidays greeting

Emotional Time-Outs

The holidays can be overwhelming at the best of times. But for a person with an eating disorder, they can be extremely stressful and triggering. It can be helpful to discuss with your loved one if they would like to think about ‘time-outs’ if they start to feel overwhelmed, triggered, or upset, and what this might look like. This can be particularly helpful if the person is neurodivergent (i.e. autistic, ADHD). For example:

·         Excusing themselves, leaving a conversation, table or area to go outside for a while

·         Having their phone, music, a book, a puzzle, colouring book, knitting, or other activity

·         Taking a pet for a walk (with someone, without someone), or playing with a pet

·         It may be important to discuss safety here, in a very gentle, non-judgmental way if you have concerns about your loved one’s safety regarding eating-disordered behaviours. If you decide you want to have this conversation, emphasise that you care, and that you understand that this will be about your loved ones’ emotional wellbeing and safety. For example:

o   “If you want to take a time-out just after eating, I understand. You might feel very anxious and overwhelmed, and I want to support you. I also want you to be safe. If you want a time-out, I think it’s important that we make sure you have someone who you feel safe with that can be there with you to support you while your emotions might be really high. Can we decide about how we might do that?”

§  Suggestions:

·         You, a sibling, other point-person, or animal companion accompany them on a time out

·         Phone call with you, a sibling, a close friend, a hotline

 Nominating a ‘Point Person’

It can be helpful to discuss with your loved one if they would like to nominate a ‘point person’ to ask if they can have some time-out with, if they start to feel overwhelmed, triggered, or upset. There could be a number of ways to discuss how to communicate with this person that they would like to take some time-out with them, such as: texting them a symbol or a word, signalling to them (a wave, a gesture etc). Your loved one may prefer to talk to a friend online or over the phone, or talk to an online support group. If your loved one does not feel comfortable with this idea, does not feel they need it, or it’s not possible, it’s still helpful to discuss your options. They may prefer to take their own time-outs without another person’s support.

 Expectation of Hugging (If you are in an area where COVID-19 restrictions are no longer applying, or your visitors are not complying)

Hugging can occur a lot more during the holiday season, and can be a socially expected greeting or farewell. Hugging, however, can be overwhelming or triggering for a person with an eating disorder, particularly if they identify as transgender or gender diverse, or they are neurodivergent (i.e. autistic, ADHD). This is because hugging someone can make a person with an eating disorder more aware of their body, which can lead to feelings of dissociation, self-alienation, body confusion, or negative feelings about their body. It can also feel very intrusive and upsetting. If the person is trans or gender diverse, it can lead to or heighten feelings of gender dysphoria. If the person is neurodivergent, it can lead to increased sensory overload on days that may already be full of a lot of stimulus, particularly if there is a lot of social pressure for eye contact and conversation. Sometimes with hugging, a person can also make comments about the body of someone with an eating disorder, particularly if they know the person has an eating disorder, or is healing and recovering from their eating disorder. This can be doubly triggering.

It can be helpful to discuss with your loved one how they might like to approach the expectation of hugging. People with eating disorders may feel heightened pressure in social situations, and may feel bad or guilty if they don’t express a common social expression of affection. People with eating disorders are very vulnerable to putting their emotional needs below the expectations or needs of other people. So it’s very important to emphasise to your loved one that their emotional safety and comfort is absolutely vital and that you want to support them with this.

·         You may like to open the discussion with your loved one that sometimes you can feel expected to hug someone when you don’t really want to, and that it can get overwhelming, especially when there’s a lot of people. You might like to say that there are options, and that you can help. This might look like:

o   “When our visitors arrive, you or I could say: ‘let’s just wave or blow a kiss. Air hug! Air high-five!’ (This might be particularly pertinent with COVID-19 considerations).

o   If the visitors do not wish to honour this, stay firm and say: ‘We lovingly insist.’ Then step back, go ahead with the wave/blowing a kiss/air hug/air five.

 Giving/Receiving Gifts

Giving and receiving gifts can be an anxious experience for many people. For people with eating disorders, this can feel extremely anxious, due to the combined experience of anxiety of the person’s/their own response to the gift and the audience perception, social anxiety, and body-related anxiety (body surveillance, gender dysphoria, negative body image). It can be helpful to discuss with your loved one how they might like to approach gift-giving during the holidays. They might feel that this is something that they can manage, or they may feel that they would like to do it a bit differently. Here are some possible suggestions:

·         Receiving gifts

o   They (or you) could thank visitors for the gifts and say they will open them a little bit later. Then they can choose to open them on their own without an audience and choose to thank the gift-giver at a later time.

o   If the gift-giving is happening in a group (e.g. over video calls, sitting in a circle), presents for your loved one could be put aside, and they could choose to take a time-out at this moment (e.g. stating they will open them later, walking/playing with a pet, making a call to a support line, chatting to a friend).  

o   If the gift-giving is happening in a group (e.g. sitting in a circle), opening presents one at a time in a turn can be less overwhelming than all at once, with all of the focus on the one person. Your loved one could also choose to thank the gift-giver and say they will open the gift later.

·         Giving gifts

o   Your loved one may feel anxious about giving gifts in person. They may prefer that someone else give gifts on their behalf. It can be helpful to suggest this and ask if this is something they would prefer.

o   Your loved one may feel anxious about watching someone receive a gift from them. They may prefer not to be present. It can be helpful to ask if they would feel anxious about watching someone open a gift from them. Some possible options if they do, is that after the gift is given to the person, they or you can make the request: “please open it later”.

Conversation Response Practice and Support

It can be helpful to discuss with your loved one that conversations with others during the holidays may be difficult, and to practice some responses. This can include whether they would like you to step in, and what your responses might be.

·         Diet-talk, weight-related, food-related or eating disorder-related comments or questions

o   A person may make an unhelpful comment or question that centres diet-talk, is food-moralising, body-shaming, or refers directly to your loved ones’ eating disorder or body. It can be helpful to discuss or roleplay some responses to this, including if your loved one would like you to step in. Some possible responses to these kind of comments your loved one or you could make can be:

 · “I don’t agree with diet culture, it’s harmful for everyone. I like doing things that make me feel good. Lately I’ve been really getting into… (reading/game/special interest/hobby etc)”

· “I don’t agree with body-shaming, it’s harmful for everyone. I like doing things that make me feel good. Lately I’ve been really getting into… (reading/game/special interest/hobby etc)”

· “We only have one life. I want it to be special and beautiful, not filled with guilt and shame because of diet culture. This year really reminded me of that. Lately I’ve been really grateful for…”

· “All bodies are beautiful, and we should be grateful for them and honour them. I love honouring myself by doing things that make me feel good. It makes me happy that we’re all here together. I’m so grateful.” 

o   (Comment about loved one’s weight or eating disorder)

· Possible responses by loved one:

·         “I don’t want to talk about that.” (leaving or changing subject)

·         “I’m working really hard on my wellbeing, and I’m proud of that. Lately I’ve been doing lots of things that make me feel good. I’ve been getting really into… (reading/game/special interest/hobby etc). What do you like to do?”

·         “Eating disorders aren’t about weight, shape or size. They’re so much more about emotions. I’m working hard on my emotional wellbeing, and doing things that make me feel good. What kinds of things do you like to do to make yourself feel good?”

· Possible responses by you:

·         “I don’t think we need to talk about that.” (Asking loved one if they’d like to go outside/ go somewhere else) (changing the subject)

·         “We’re supporting ____ in how hard they’re working on improving their emotional wellbeing, and we’re really proud of that. We’re so happy that we’re all here to celebrate the holidays together. It’s such a special time, especially after this year, when it’s been so hard.”              

·         “Eating disorders aren’t about weight, shape or size. They’re so much more about emotions. We’re supporting ____ in how hard they’re working on improving their emotional wellbeing, and we’re really proud of that. What do you want to do more of this coming year?”

·         Racism, LGBTQ+ discrimination, abelism, classism, offensive comments or questions (including climate denial, COVID-19 denial, anti-vaxxing comments, anti-feminist ideology etc)  

o   Some possible responses to offensive comments that can be made:

· “I don’t agree with that, and I think this discussion should be over.”

· “I find that offensive and harmful, and I think this discussion is over.”

 · “I believe in human rights, and I don’t agree with any of that. I think this discussion is over.”

· “That ideology isn’t welcome in my household. This conversation is over.”

· “I don’t agree with that at all, and I’m leaving this conversation. It’s harmful.”

· (Inviting your loved one to leave the conversation): “I don’t agree with that at all. I’m leaving this conversation. It’s harmful. (Loved one’s name) let’s go talk about something else.”

· (Inviting your loved one to leave the conversation): “I believe in human rights, and I don’t agree with any of that. (Loved one’s name) let’s go talk about something else.”

·         What they’ve been doing lately

o   A person with an eating disorder may feel anxious or triggered when met with questions about what they’ve been doing lately. For some people, this can lead to feelings of comparison to others, shame or hopelessness about their eating disorder, guilt, shame, or self-judgement about self-expectations or feeling that others expect them to be doing or achieving certain things. Some possible responses may be:

 · “I’m concentrating on doing things that make me happy. I really love (reading/craft/gaming/puzzles/music/nature/pets/spending time with people online or in person etc)”

·         Their future

o   Similarly, a person with an eating disorder may feel anxious or triggered when met with questions about what they are doing with their life. This can lead to feelings of comparison to others, shame or hopelessness about their eating disorder and the impact it’s had on their life (losses and grief), guilt, shame, or self-judgement about self-expectations or feeling that others expect them to be doing or achieving certain things. Some possible responses may be:

·  “I hope in the future I’m happy and doing things I love. Some things I really like doing/am interested in are (area of interest/special interest/ reading/craft/gaming/puzzles/music/nature/pets/spending time with people online or in person etc)” 

·         A person they feel uncomfortable talking to

o   It can be helpful to discuss with your loved one about how to respond to a situation if there’s someone they don’t feel comfortable talking to. Ask them if there’s anyone they feel uncomfortable talking to, and if they’d like to tell you about it. There may also be a situation where they’re talking to someone and then feel uncomfortable and wish to leave the conversation. Discuss some possibilities in these situations:

 · Excusing themselves and leaving

 · If they don’t feel comfortable excusing themselves and leaving, and they have told you there is a person they don’t wish to speak to, maybe you or another person could interrupt and say you wish to borrow them for a moment/ask them something, and take them away from the situation

· If the conversation becomes uncomfortable, some possibilities might be:

·         Saying that they just remembered something, excusing themselves and leaving

·         Saying that they’d rather talk not talk about that, excusing themselves and leaving

·         Saying they just remembered they had something to ask you or their point-person, excusing themselves, and leaving. They can then come up to you or their point person, and indicate if they need support

Pressure at the Dinner Table

·         Who they want to sit beside

o   If you are eating in the company of others, it can be helpful to discuss beforehand with your loved one if they would like to sit at the table, and if so, who they would like to sit beside

·         Food they would like to have at the table

o   If you are eating at your home, it can be helpful to discuss with your loved one some foods that they would like to have at the table, and if there are any foods they would rather not have at the table, or if there are some foods they would prefer not to be placed near them at the table

·         If you are not at your home        

o   It can be helpful to discuss your loved one bringing food they feel comfortable eating with them as a back-up. You may also wish to discuss with them if they would like you to say anything with them in support if they choose to eat the food they have brought such as:             

§  “____ is going to eat something they’ve brought”.

o   If they are bringing food with them and choose to eat this, it may also be helpful to discuss where they’d like to eat it (e.g. with others, or by themselves, or in the company of a pet).

o   If going to a restaurant/café etc. it can be helpful to discuss looking at menus beforehand, as deciding on what they’d like to order can bring down a sense of anxiety. It can also be helpful to discuss if they’d like to order the same thing as you to feel supported in their choice.

§  If you are going to a restaurant/café, and your loved one is ordering from a menu, it can also be helpful to discuss with them beforehand if they would like to bring some food as ‘back-up’ in case once they get there they feel anxious or overwhelmed. 

·         If your loved one feels uncomfortable eating in front of others or a particular person, including on video calls, it can be helpful to discuss if they’d rather eat in a different place, or with a nominated person or in the company of a pet.

·         Your loved one may like to have some of their own music, podcast, e-book etc. with them while eating, or have one ear phone in. This can help with self-soothing, distraction, or to reduce anxiety or take the power out of any potential triggering conversation.

Increasing Sensory Safety

The holidays can be a source of a lot of sensory stimulus, which can be a bit overwhelming for a lot of people, particularly for those with eating disorders who may already have a lot of heightened anxiety. This is especially true for those who are neurodivergent. It can be helpful to discuss with your loved one if there is something that would help, or if there is something they are sensitive too.

Considerations:

·         Music

o   Turning music volume low

o   Taking a break from Xmas songs

o   Your loved one choosing some of their own music, or having their phone or own music device

·         Xmas crackers or sparklers

o   Are these startling or upsetting? Would your loved one prefer not to be around?

·         Lights

o   Does your loved one get overwhelmed by too many lights or need a break from them? Could you organise a dark space for them to take a break in?

·         Headphones

o   Would your loved one like to bring noise-cancelling headphones with them?

·         Sensory box

o   Would your loved one like to bring a sensory-soothing box or object/s with them or have this close by?

·         Room/space retreat or point person

o   Would your loved one like to discuss a room or space that they can go to when feeling overwhelmed, or a point person or animal companion they can be with?

Conversation that Focuses on the COVID-19 Pandemic

The COVID-19 Pandemic has been a source of immense stress, anxiety and grief. People with eating disorders commonly experience very high levels of anxiety and depression. During the pandemic, people with eating disorders have been extremely vulnerable to the combined impact of the pandemic itself, fear and grief about others and the state of the world, social isolation, anxiety and depression, food and resource availability, their eating disorder, health issues and medical barriers, poverty, social determinant factors and marginalisations. Conversation focusing on the COVID-19 pandemic can therefore increase stress impacts for people with eating disorders who are already facing heightened vulnerability.

It can be helpful for you to try to change conversations about the pandemic when they arrive, including limiting too much news coverage. Some responses to COVID-19 centered conversation may be:

· “Let’s take a break from pandemic talk for today, and concentrate on being together”

· “I’m so happy that we’re here together. Let’s not waste it talking about the pandemic”

· “I’m so grateful that we can share this time and be together. Let’s not spend it talking about COVID”

Conversation that Mentions the COVID-19 Pandemic and Weight/Exercise/Coping

Unfortunately, diet culture and weight stigma is so deeply ingrained, during times of immense stress and fear, people often return to socio-cultural messages and teaching that they find familiar and give them a sense of control, particularly ones that may enforce a sense of a goal when they feel helpless.

During the holidays, someone may make comments specifically related to the COVID-19 pandemic that centers around weight, exercise, or body-related changes.

It can be helpful to discuss with your loved one how they might like to respond to this, including if  they would like you to step in. Some responses might be something like:

 · “Our bodies have incredible ways of helping us to survive in times of stress. I’m so grateful of all the ways our bodies can change to help get through. I’m so glad (person) is still here with us.”

 · “It’s so sad that diet culture means that people feel they have to cope in a certain way during a global pandemic and unbelievable tragedy. I’m so grateful for all the different ways our bodies change to help us cope. I’m so thankful we’re still here together, and can celebrate with food and laughter.”

· “We all cope differently in times of incredible stress. No one ever needs to explain or apologise for that.”

· “Our bodies do everything they can to help us survive. I’m so glad (person) is still here with us.”

· “Our bodies change so much throughout our lives. Of course they’re going to change in a global pandemic! Think of the stress. I’m so grateful for what our bodies do to help us survive.”

Conclusion

The important thing to remember is to support the emotional wellbeing of yourself and your loved one during the holidays. Eating disorder healing and recovery is a long-term self and body healing relationship of connection to the self, others, the world, and experiences. It takes immense courage, and it’s hard work. The most important thing here is that you are showing your loved one that you are supporting them, you want to listen and hear them, and that you are standing with them in solidarity, and prioritising their wellbeing through the holidays.

In love, solidarity, and acceptance,

Rosie