What would Thanksgiving be without platefuls of turkey and pumpkin pie? Christmas without rich eggnog and sugary cookies? Or New Year's Eve without a night-long flow of champagne and munchies?
Food is an inextricable part of holidays -- the joyous indulgences and the giddy overdoing of the season -- but for those with anorexia, bulimia and other eating disorders, this time of year puts them face-to-face with their worst enemy.
"Mealtimes were horrible anyway, so you can imagine what Thanksgiving and Christmas dinners were like," said one woman whose two daughters, now in their 20s, had eating disorders during their teen years. "The one with bulimia would eat everything in sight, which you at first would think was a delight, because food is supposed to be a gift of love. And the one with anorexia, she had to go through these rituals . . . the carrots had to be cut just so, the napkin had to be placed just right."
Holidays can be problematic for bulimics (who binge then purge) and anorexics (who starve to sometimes fatally low weights) -- with food seemingly everywhere during this time of year, what with family gatherings and office parties, big feasts and endless nibbling.
"Holidays are socially accepted binge periods," said Dr. Harry Brandt, director of Mercy Medical Center's Eating Disorders Program. "It's a set-up for the battlefield of food."
"Food is in excess, and the foods that are in excess are the ones that are densely caloric," said David Roth, Ph.D, director of the Weight Management and Eating Disorders Institute at Sheppard and Enoch Pratt Hospital. "The kind of people who eat in response to the sight and smell of food can get on a roll -- once they start, they can't stop."
Beyond the sheer ubiquity of food during this time of year, holidays can exacerbate unresolved problems -- such as depression, stress and family conflicts -- that trigger either over- or under-eating among eating-disorder sufferers, health professionals said.
?3 "Eating disorders are not really about eating,"
said Libby Champney, a social worker who leads a support group for relatives of people with eating disorders. "They're about dealing with emotional conflicts through food."
Because many eating disorders start early -- the typical sufferer is a teen-age girl or young woman -- they're often rooted in family problems, doctors and other health workers said. Sometimes, an eating disorder is a reaction to childhood abuse, physical, emotional or sexual. The disorder can also stem from any number of other family situations: A chaotic household can lead one of its members to seek control through food, for example. Or, a parent's use of food as a reward or a sign of affection for a child can lead to a lifelong dependence on food as a substitute for unfilled needs.
"Whatever problems exist in families can get exhibited in the eating disorder," said Dr. Charles Murkofsky, director of the eating disorders program at Gracie Square Hospital in New York. "The food issues become the battleground for problems that are more far-reaching."
Which is why many eating disorder sufferers can dread rather than anticipate family get-togethers for Thanksgiving or Christmas.
"Holidays were about the worst," said a 28-year-old Baltimore woman who has largely recovered from a 10-year bout of bulimia. "I would rather they didn't happen. Inevitably, if I would overeat, I wouldn't react like everyone else -- that it was just one meal. It would start a punishing cycle. I would have to fix it."
For the woman, who asked that her name not be used, "fixing" things meant purging. She has been hospitalized four different times in the past, but has recovered through a combination of therapy, anti-depressants and attending support groups.
Holidays were particularly stressful for her large family, she believes, what with different brothers and sisters coming home from college.
"My mother would be stressed, and she would lose it over holidays. She would yell and scream and throw things and throw people out," the woman recalled. "It was like growing up in a war zone."
She developed a perfectionist streak -- common in people with eating disorders, professionals say -- and an obsessive need to be thin.
Holidays can set up a perfectionist for failure, said Linda Ciatola, a social worker and health educator who specializes in eating disorders and is affiliated with Mercy Medical Center. She and other professionals said many people with eating disorders feel pressure to shop and cook and tend to everyone's needs except their own this time of year.
"We're led to believe we're supposed to have Norman Rockwell holidays, and if we don't live up to that, we've failed," she said.
The flip side of holiday celebrations is the underlying melancholy that can pervade, especially for those already depressed, doctors said.