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The holiday season can bring with it a mix of emotions for everyone in the family. It’s common to feel excitement, anxiety, joy, depression, and apprehension at the weeks ahead. But for adolescents with bulimia nervosa or any other common eating disorder diagnosis, the holidays can be especially difficult to navigate. Then, when you add in school commitments and academic programs, family commitments, and memories that may or not be happy ones—sticking to a recovery plan can also become very difficult. But that shouldn’t keep teens and their loved ones from going into the winter season without hope. If families and adolescents with an eating disorder diagnosis keep the lines of communication open and work hard to follow their bulimia treatment steps, the holidays can be a joyful time overall. Keep reading to learn more about bulimia nervosa recovery during the holiday season and the benefits of ongoing eating disorder counseling through Clementine treatment centers.

How Can Adolescents and Their Families Work Together to Navigate Eating Disorder Recovery During the Holidays?

What Are the Main Obstacles?

For many people, holiday gatherings are all about coming together to share food and give gifts. But for those with an eating disorder diagnosis, the very idea of a gathering centered around a large meal can still be quite intimidating. This is especially true if other friends and family members are aware that teens recently completed an anorexia nervosa or bulimia nervosa treatment program. Teens may feel pressure to make it look as if they no longer have any issues surrounding food and mealtimes, or simply have so much anxiety leading up to the gathering that they make themselves feel ill. The holidays can easily present numerous challenges and obstacles for teens in eating disorder recovery and their families as well.

So, how can parents and their children best avoid getting too wrapped up in what’s expected of them and simply enjoy spending time with loved ones? It helps to do refresh their memory on the different causes of bulimia nervosa and other common eating disorders and remember the coping mechanisms that each person was taught in therapy.

What Are the Causes of Bulimia Nervosa and Other Common Eating Disorders?

While there is no exact cause of bulimia nervosa and other common eating disorders like anorexia nervosa and binge eating disorder, researchers and medical professionals believe that the combination of several factors can result in the development of an eating disorder. Most commonly, it is believed that those who develop eating disorders are exposed to some combination of genetic, environmental, cultural, and psychological factors. For teens, this can mean that they cause of their disordered eating habits are a result of:

  • A High-Stress Academic or Home Life
  • Particularly Stressful Life Changes
  • Negative Body Image
  • A History of Trauma or Abuse
  • Low Self-Esteem
  • Demand to Achieve “Ideal” Body Type for Sports or Other Activities
  • A Genetic Predisposition to Developing the Condition (one or more parents may have had a previous eating disorder diagnosis)
  • Co-Occurring Disorders like Depression, Obsessive-Compulsive Disorder, Drug or Alcohol Abuse, and Panic Disorder
  • Environmental or Situational Stressors (like Holiday Commitments)

Bulimia Nervosa Warning Signs and Symptoms

If some time has passed since adolescents have completed a bulimia recovery program, it may also be helpful for parents and other family members to review common warning signs of the condition. These include:

  • Dramatic fluctuations in body weight and/or body shape
  • Chronic dehydration
  • Recurring gastrointestinal issues like acid reflux
  • Missed periods or complete lack of menstruation in adolescent girls
  • Oral health issues like lacerations in the throat or mouth from self-induced vomiting
  • Hiding or hoarding food and empty wrappers found in the trash
  • Using the restroom often during meals and directly after mealtime
  • Carrying the smell of vomit

Common Signs of Binge Eating Disorder

  • Eating meals in secrecy
  • The disappearance of large amounts of food
  • Inability to control portion sizes
  • Eating large amounts of food in a very short period
  • Eating even when not feeling hungry
  • Making excuses to not eat at family meals

Common Warning Signs of Anorexia Nervosa

  • Cooking meals for others without eating
  • Only eating certain food groups
  • Eating foods in a specific order
  • Avoiding family gatherings or activities that center around food
  • Skipping meals frequently
  • Drastically shifting body weight and overall body shape
  • Missed periods or complete lack of menstruation in adolescent girls

During the holidays, it is also very common for these eating disorder signs and symptoms to create strains between teens and their families. This is particularly common if the individual is working to hide their abnormal eating behaviors or avoiding regular interactions with friends and family. This is why it’s so important for parents to keep the lines of communication open during the holiday season and even though the rest of their lives is plenty busy, to keep a watchful eye on their child during this stressful time of the year.

The Many Benefits of a Great Support Team

When the holiday blues start to take over and teens feel like they want to turn to past eating disorder behaviors to cope, having access to a strong support team can be lifesaving. Whether they feel comfortable speaking directly to their parents, their teachers, other adult family members or their friends, it’s essential that their community works hard to let them know that they always have someone to talk to. At Clementine, we understand the value in a great support system and are always happy to help parents create a dialogue with their children and keep those lines of communication wide open. Unsure of which questions to ask if a bulimia nervosa flair-up seems to be happening? Our experienced and knowledgeable team of care experts are here to help guide parents through the conversation and ensure that everyone is on the same page.

Structuring a Holiday Game Plan

In addition to regular communication with teens, it can be extremely helpful to work together as a family to come up with a holiday game plan. If adolescents have a structured holiday plan in front of them there are less likely to feel overwhelmed at the weeks ahead and can plan accordingly for larger events. It can be very helpful to know in advance where the family will be going for each gathering, what foods will be available, and at what time meals are expected to be served. Will the gathering include gift-giving, games, or anything else that has to do with food? If so, be sure to outline this well in advance.

It’s no secret that each holiday event the family attends is sure to include large quantities of tempting and even anxiety-provoking foods that can make it difficult for teens to stick to their new coping mechanisms. However, a structured holiday plan is consistent with many recovery-based behaviors and is ideal for helping teens to stay confident and in control during these otherwise risky events.

Holiday Meal Plans

It is normal to feel a bit of anxiety surrounding the sheer quantities of food available to be consumed during the holiday season, whether you deal with disordered eating tendencies or not. For those who have been diagnosed with bulimia nervosa or binge eating disorder, the temptation to overindulge can be great during the holidays. And for those with an anorexia nervosa diagnosis, it can be common to simply want to avoid family gatherings altogether in an attempt to avoid overindulging on rich and calorie-dense foods.

To circumnavigate these feelings and help teens to have a better chance of enjoying holiday events, accurately timing the holiday meal is very important. For example, if the family typically enjoys dinner together at 7:30 pm each night, they should do the same for holiday gatherings as well. If teens are used to eating lunch at a specific time, then enjoy a light snack before dinner, they should also stick to this routine. When these eating schedules are thrown off track, adolescents are much more likely to revert to previous disordered eating behaviors.

Expressing Gratitude

With so much to do and so many people to see during the holidays, it can be easy to lose sight of what the season should be all about. Everyone knows that the holidays are often very stressful but for those recovering from an eating disorder diagnosis, the risk of relapse goes up during the holiday season. One way to combat the feelings of stress and anxiety during this time is to work together as a family to set aside a few moments each day for expressing gratitude. This can be done individually or as a group but can be very helpful in bringing teens back to a centered place each day when they can reflect on the ups and downs of the past year. Meditation, journaling or letter writing can all be helpful tools during this time of reflection and gratitude as well.

Holiday Do’s and Don’ts for Adolescents in Recovery

Please Do:

  • Create and follow a structured eating plan.
  • Always check the menu for each event well in advance.
  • Determine when and where meals will take place during holiday events.
  • Identify and lean on a supportive person to help during stressful moments.
  • Avoid negative self-talk or the pressure to look a certain way for holiday functions. Instead, adopt a “come as you are” mentality to make each gathering feel more stress-free.
  • Communicate feelings to parents or other trusted loved ones
  • Develop new family traditions that don’t revolve around food like caroling, charity toy drives, game nights, and other activities.
  • Cook healthy meals together as a family to help avoid the want to binge on “forbidden” or rich holiday treats.
  • Always have an exit strategy in place and kindly excuse the family from events if things become too overwhelming.

Please Don’t:

  • Think that it’s possible to “wing it” at holiday parties.
  • Keep feelings bottled up as to not “inconvenience” others.
  • Avoid discussing fears and be too afraid to ask for help.
  • Offer to cook or bake dishes for a party if the idea of being in the kitchen or being responsible for providing food for others is too much.
  • Go into each event with an all or nothing mindset. If there is s slip at a gathering, that doesn’t mean the day is ruined or that each new event on the calendar will be the same.
  • Drink alcohol. Alcohol consumption can lower inhibitions and make it much more difficult to stick to a structured holiday plan.
  • Offer to host if the responsibilities involved will be too stressful.

Eating Disorder Counseling for Adolescents at Clementine

At Clementine, we have years of combined experience working directly with adolescents and their families as they navigate eating disorder recovery. Our friendly and compassionate team is here to provide the tools necessary for teens to replace their disordered eating habits with new coping skills. With the help of our residential and day treatment programs, adolescents can enjoy long-term eating disorder recovery. 

Interested in learning more about our adolescent bulimia nervosa treatment programs? Please give us a call at 1.858.900.2221 or contact our admissions specialists today for more information or to schedule a tour.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.