Religious holidays can be a time to connect with family, feel the strength of community, build new memories, celebrate with others, and deepen spiritual beliefs. However, many religious events can also be a trying time for individuals struggling with eating disorders, as they might feature more restrictive food rules, fasting practices, or be highly centered around preparing food and eating it in front of others. In this post, we discuss how these challenges may show up for your clients and how you can support them.
Which Holidays Are We Talking About?
Before we dive into the specifics of how certain religious practices may affect your client, let’s first learn more about what they’re practicing and why. Lent, which began on the 22nd of February and will be observed until April 6th, is a 40-day season of prayer, fasting, and charity commemorating the 40 days Jesus spent fasting in the desert before beginning his public ministry. Many Christians use Lent as a time to be penitent and honor Jesus’ suffering, which they feel can bring them closer to Him and strengthen their relationship with God.
Ramadan is a holy month in Islam, began on the evening of March 22nd, where Muslims around the world will practice fasting from food, drinks (including water), and sexual activity from sunrise to sunset. It is believed that during Ramadan Allah revealed the Qur’ān to Prophet Muhammad, and it is often viewed as a time of self-restraint, cleansing, and reflection.
Passover, the week-long holiday celebrating the story of the Israelite’s escape from slavery and departure from ancient Egypt, begins at sundown on April 5th. Observant Jewish people typically abstain from leavened foods (such as bread), retell the exodus tale, and gather with family and friends for the Passover Seder, a ritual feast.
All three of these holidays share the common tradition of abstaining as a means of reflection and remembrance, which can be a trigger for those suffering from an eating disorder.
Possible Triggers and Behaviors:
Here are just a few of the ways this season may present difficulties for your client.
- Practices such as fasting or denial of indulgences, though intended to honor Jesus’ suffering, can closely resemble the restriction, rules and rigidity that drive and maintain eating disorder cycles. This may cause a client to suppress difficult but meaningful emotions, rather than directing their focus to Jesus’ sacrifice. The sacrifices that may start as a religious practice could possibly shift in service of the eating disorder and/or fuel an eating disorder cycle.
- Clients may experience disconnection from their spiritual intentions and positive reinforcement for fasting or avoiding certain foods when others applaud the “discipline” needed for their “sacrifice”.
- Self-recrimination may result when a person in recovery becomes aware that their spiritual practice has become co-opted by their eating disorder and can ignite or exacerbate a spiral of shame that ultimately worsens their illness.
- Ramadan’s practice of fasting can contribute to bingeing. One may restrict food all day and then engage in binge eating upon breaking the fast due to feeling extreme amounts of hunger or feeling as though they have permission to binge because they were “good all day” by fasting, reiterating the idea that food should be earned.
- Breaking the fast can cause both emotional and physical discomfort, such as stomach pain, diarrhea, nausea, and bloating. This discomfort can bring on guilt or shame for some people. Some folks may purge as a way to cope with the physical and emotional distress caused by eating.
- For those who are struggling with restriction and chronic dieting, fasting can perpetuate the restrictive mindset and its associated behaviors. Some people may continue to restrict past sunset. This can place the individual at increased medical risk and impact functioning, mood, and anxiety levels.
- Clients may be praised for weight loss during Ramadan. This can place a lot of pressure on the individual who is fasting to continue the restrictive behaviors beyond the fasting hours and beyond Ramadan. For folks in larger bodies, there can be increased pressure from the self, family, or friends to use Ramadan as a way to kick off a diet and lose weight. This mentality can trigger disordered eating or even a relapse for someone in eating disorder recovery.
- Foods with leavening agents, called “chametz”, are not allowed for the entire holiday of Passover. This can present multiple challenges for anyone who is used to a routine of eating grains and legumes or may be trying to incorporate those foods into their meal plan as part of their exposure work in eating disorder treatment. The interpretation and pursuit of these rules is influenced by each Jewish individual’s family, Diasporic community, and level of observance. For those who strictly observe, one is not supposed to own any leavened foods, and should stringently clean their homes to get rid of any leavened products. This can apply to dishes and cookware in addition to the food itself and can present multiple challenges for those with OCD and anxiety.
- The Passover Seder is a long ritual that can present multiple difficulties, including but not limited to, managing the timing of eating, feeling too hungry or too full, consuming the minimum required amounts of matzoh, drinking the 4 cups of wine, spending too much time with family, navigating difficult family relationships, or experiencing feelings of loneliness for those who don’t celebrate with family or friends.
- For those preparing Passover, there can be a lot of stress in the cooking, cleaning and preparations. For those that go away to Passover programs, there is often stress associated with the significant emphasis and expectations around appearance, clothing, and dress.
How Practitioners Can Help
Here are a few ways you can support patients in their eating disorder recovery in a religiously-sensitive manner.
- Ask patients about religious and cultural norms, practices and ideals they grew up with, and their current relationship with these traditions.
- Suggest and explore challenge foods that are religiously, culturally, and familiarly relevant.
- During holidays, explore options and alternatives, such as taking a fast from a non-food related item, such as social media, or ask if clients would be open to adding in something, like volunteering, reading, rest, or prayer.
- Include a Rabbi, Imam, Priest, or other religious leader as an important part of an individual’s recovery team, to assist with observances and coordination of care. These religious leaders may be able to offer spiritual guidance or formally excuse your client from participating in certain religious practices, especially if those practices would likely compromise your client’s health or jeopardize their eating disorder recovery.
- Explore how patients may feel deviating from these traditional religious and familial practices to follow their meal plan, abstain from fasting, and/or eat traditionally forbidden foods. It’s important to acknowledge the shame, guilt, or discomfort they may feel. Your client may also benefit from including family members in these discussions, especially in collectivist cultures. These holidays may offer a time for reflection, building emotional tolerance skills, and using faith as a motivation for recovery.
How Renfrew Can Support Your Clients
As a non-denominational treatment facility, Renfrew provides a safe and healing community for patients from all faiths and backgrounds along the continuum of religious observance. Because many individuals find strength and healing in their place of worship, we offer optional faith-based programs, such as Christian programming and Jewish programming, for those who are interested in moving toward a return to health within the context of their beliefs.
In this sacred season, it feels especially important to engage with your client through a lens of cultural humility. Incorporating religion, spirituality, and culture into your work can lead to a more comprehensive understanding of their identities, customs, and attitudes around food and body. Perhaps this time presents a unique opportunity to take a step toward greater understanding and appreciation of cultures and traditions shared by your clients that may be different than your own.