Holidays and Family Gatherings

We feel festive during the holiday season, and consider the holidays as an encore to relaxation. With that being said, when coping with an eating disorder, holidays can mean facing stress and challenges around food. To eating disorder victims, food is perceived as an enemy. Therefore, its availability and abundance are a solid ground for battle. Moreover, tendency toward problematic behaviors such as food restriction, fasting, uncontrolled eating, binging, purging, or use of laxatives is common.

Remember that regardless of the stage your child is in their journey for recovery, social events can be triggering.

In my experience, here are a few useful tips that made my life easier:

  • Plan, plan, plan and then plan more. The more your child knows and accepts, the more likely it is that family gathering will be successful. Schedule for your child a session with their therapist prior to the family gathering to aid with coping strategies to alleviate some of the stress. Let them know what food will be served, and what they can eat and how much.  If needed, bring your own dish and place it in front of your child, and plan who would sit next to them at the table. Establish a space that can be used in the event anxiety needs to be handled and so forth. Even select clothing ahead of time.
  • Let the attendees know ahead of time that you are coping with your child’s eating disorder, and therefore topics such as dieting, eating habits, and exercising are prohibited. Do not engage in discussions around how your child eats, or how they look. Acceptance and compassion towards the sufferer are most welcome.
  • Feel OK to say NO. You will be invited to multiple events and activities. It is important that you find the right balance between the events you attend, and these you decline, in order to guarantee your child’s mental health and fulfillment. Consult with your child about the extent of activities, and find the sweet spot that is OK for both of you.
  • Always keep in mind that your child did not choose to be ill, and you are there to support them in enjoying the holiday season.
  • Remember that victims of an eating disorder may feel uncomfortable eating with a large amount of people. In the case that your child does not eat the sufficient amount during an event, make sure you plan a meal the moment you get home. Skipping ANY meal is never an option.
  • Always keep in mind that your child did not choose to be ill, and that you are there to support them. This includes weekdays, weekends and the holiday season

Animal Aid in Healing

Each person is unique. A treatment plan that is right for a certain individual, might be the wrong one for a different individual. It has been scientifically proven, however, that animals can aid in treatment, and have a positive impact on most people emotionally and physically.

Animals are comforting, non-judgmental, and provide unconditional love. Specifically around dogs and horses, people report:

  • Feeling safe and protected
  • Alleviating stress, anxiety, depression, and obsessive thoughts
  • Boosting self-esteem, awareness, and empowerment
  • Easing social interactions and awareness
  • Developing flexibility in thinking and beliefs, patience, and empathy
  • Easing the need of control

It will not be the right solution for everyone struggling with an eating disorder, but for those that it is, let the magic start!

For more in depth information about this, contact me.

Resources

  • Bradley T. Klontz et al(2007). The effectiveness of equine-assisted experiential therapy: Results of an open clinical trial. Society and Animals, 15, 257-267.
  • Sandra B. Barker(1999). Therapeutic Aspects of the Human-Companion Animal Interaction. Psychiatric Times, 16.
  • Veronica Lac et al (2013) Equine-Assisted Psychotherapy as a Creative Relational Approach to Treating Clients With Eating Disorder
  • Ana Myriam Lavín-Pérez Effects of Dog-Assisted Therapy in Adolescents with Eating Disorders: A Study Protocol for a Pilot Controlled Trial

Stages to Recovery

Be patient. It is going to be a long and winding road, but don’t give up! Recovery is possible!

Knowing the stages will help you understand where your child was, where they are at, and what they have yet to go. It is possible that your child will find a stage in recovery where they feel comfortable, and will stay there. It is up to your child to decide how far they go.

I strongly believe that, in order to be calmer, happier, enjoy peace of mind, and get back the control on their life, your child has to reach stage 5. It is not going to be easy, but it is doable!

5 Stages of Eating Disorder Recovery

  1. Pre-contemplation
    • The individual is in denial about their illness, and refuses to admit that they are sick.
    • People around this individual may notice signs of an eating disorder, the person might ignore or refuse to acknowledge these concerns.
  2. Contemplation
    • Individual is aware that they have a problem.
    • The person with the eating disorder might fear change, but may start to be open to the idea of recovery.
    • In this stage, the individual will likely alternate between wanting to change, and staying in their eating disorder habits.
  3. Preparation
    • The individual decides that they want to recover.
    • This person is not sure how to change their eating disorder habits.
    • It is recommended to get professional help to form a recovery plan.
  4. Action
    • The person with an eating disorder starts to take steps to recover.
    • It is common in this stage to move a couple steps forward, and then take a couple steps back.
  5. Maintenance
    • The individual has been in the action stage for at least six months.
    • They have taken steps to improve their eating habits.
    • Relapses and slip-ups are common in this stage.

References

Impact of Sport

Did you know that athletes are nearly three times more likely to have an eating disorder than the average person? Personalities of athletes are a major factor in the development of eating disorders. These characteristics are often seen in those with Anorexia Nervosa. They include:

  • high self-expectations
  • determination
  • perfectionism
  • competitiveness
  • preoccupation with weight and dieting

Sports with a high risk of encouraging eating disorders include sports where weight class requirements are strict, and provide the athlete a competitive advantage. These sports emphasize appearance and/or weight requirements (e.g. wrestling, bodybuilding, and martial arts). Other sports at high risk for eating disorders are those that are judged, such as ballet, figure skating, and gymnastics. Sports where the focus is on the individual rather than on an entire team, like track and field, are also of a higher risk. If a coach only focuses on performance, rather than the athlete’s health, the coach may also be a key contributor to the development of an eating disorder.

Since exercising is considered healthy, and is associated with appearance, under certain circumstances, regular exercise may mask or worsen an eating disorder. This may even lead to resistance to treatment. It is, therefore, important for parents to understand the reason behind their child’s activities and exercise.

Does the child “have to” exercise, or do they “want to” exercise. Beware that poor nutrition may lead to exercise addiction, and that exercise is often used to “purge” calories, thereby being dangerous for the child’s health.

Tips for parents:

  • Understand the motivation for being active
  • Do not offer sport activity as a reward for eating
  • Beware of relative energy deficiency in sport (eating less relative to the energy expenditure)
  • Restrict competitive sports during recovery
  • Do not use exercise to manage anxiety or depression
  • Avoid exercise during poor nutrition and/or during weight recovery as it can risk the health of the heart, internal organs, and bones

References

Take an Action

You may expect seeing all or a part of these signs and symptoms. Usually, your intuition as a parent is correct; trust yourself, as you know your child the most. The earlier you act, the better. Act now.

  • Does your child fast and skip meals?
  • Has your daughter missed two periods along with losing weight?
  • Have you noticed binge eating? Are large amounts of food missing?
  • Have you found laxatives or diet pills?
  • Does your child excessively exercise?
  • Has your child refused to eat non dietary foods?
  • Have you noticed an extreme control over calorie intake and the meal portion itself?
  • Does your child prefer eating on their own? Do they refuse to eat with the family?
  • Has your child been possessively reading diet books? Looking for healthy, low calorie recipes? Demonstrating dietary behavior?
  • Have you noticed a strong will to eat only healthy food? Restriction of certain food groups?
  • Has your child visited eating disorder websites?
  • Does your child suddenly decide to become vegetarian? Vegan?
  • Have you noticed that your child keeps going to the bathroom, or frequently showers immediately after eating?
  • Have you observed an unusual number of stomach flu episodes? What about frequent bouts of stomach pain?
  • Has your child shared a fear of looking fat?
  • Have you noticed a distorted perception of body, shape, or image?
  • Did you notice your child get upset when someone comments on their appearance?
  • Does your child have difficulty sleeping?
  • Have you observed growth of soft and fine hair all over child’s body?
  • Have you noticed any signs of self-harm?
  • Have you noticed any signs of depression or suicidal ideations?

References:

  • Bodell, L., Forney, K. J., Keel, P., Gutierrez, P., & Joiner, T. E. (2014). Consequences of making weight: A review of eating disorder symptoms and diagnoses in the United States military. Clinical Psychology: Science and Practice, 21(4), 398–409. https://doi.org/10.1111/cpsp.12082
  • Help Your Teenager Beat an Eating Disorder, Second Edition By James Lock, Daniel Le Grange · 2015
  • Christian, C., Perko, V. L., Vanzhula, I. A., Tregarthen, J. P., Forbush, K. T., & Levinson, C. A. (2020). Eating disorder core symptoms and symptom pathways across developmental stages: A network analysis. Journal of Abnormal Psychology, 129(2), 177–190. https://doi.org/10.1037/abn0000477
  • Gonzalez A. Kohn M.R. Clarke S.D. Eating disorders in adolescents. Aust Fam Physician. 2007; 36: 614-619 https://pubmed.ncbi.nlm.nih.gov/17676184/
  • Solenberger S.E. Exercise and eating disorders: a 3-year inpatient hospital record analysis. Eat Behav. 2001; 2: 151-168 DOI: 10.1016/s1471-0153(01)00026-5
  • Tanofsky-Kraff M. Binge eating among children and adolescents.in: Jelalian E. Steele R.G. Handbook of Childhood and Adolescent Obesity. Springer Science, New York20
  • Laura M. Thornto et al. Anorexia Nervosa, Major Depression, and Suicide Attempts: Shared Genetic Factors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996767/
  • Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method Second Edition By by Anna Crane, Gráinne Smith, and Janet Treasure