A holiday like Thanksgiving that is centered on food, family and more food can be a precarious time for people struggling with eating disorders or disordered eating.
Alex Mutti, 27, of New York City, said she always loved Thanksgiving until her early teens, when she began to suffer from an eating disorder and the holiday became "really terrifying."
She said making it through Thanksgiving became even more difficult even as she went through recovery.
"In my experience, a lot of eating disorder recovery was around eating mindfully and creating routine around my eating," Mutti told "Good Morning America." "And Thanksgiving throws all that out the window. Not many people are eating mindfully on Thanksgiving."
"Losing that kind of routine that became safe for me was always really anxiety-provoking," she said. "And being around the extended family and friends was difficult, even if they didn’t say anything."
Lauren Larkin, now a mental health counselor in private practice in New York City, said she recalls many Thanksgivings she "white-knuckled" her way through the worst stages of her eating disorder, prior to recovery.
"Thanksgiving is really the holiday where you talk about food and talk about regretting the food you ate," she said. "I would push myself to show up and act like everyone else and be like everyone else, even when maybe I couldn’t, and then I would have really intense anxiety afterwards."
This holiday is approaching as the United States has seen a mental health crisis during the coronavirus pandemic, of which eating disorders are a major part.
The number of people who were hospitalized for eating disorders doubled in the U.S. during the pandemic, according to research published recently in JAMA Network.
And even for people who may more casually struggle with disordered eating, this Thanksgiving holiday may be more fraught with discussions on weight and looks as family members see each other for the first time in months due to the pandemic.
"I think about the stereotypical great-aunt who is stuck in the diet culture and who is going to make comments about your weight," said Larkin. "Thanksgiving is probably the most triggering holiday for anyone who has struggled."
As Thanksgiving Day nears, here are five tips from experts to help cope with diet and negative food talk.
1. Set boundaries.
If you are at a holiday meal with supportive family members or friends, Christy Harrison, a registered dietitian and author of the book "Anti-Diet" recommends setting boundaries ahead of time, like asking loved ones to not comment on your body or what you're eating, and to do the same for others too.
If difficult conversation does emerge at the dinner table, Harrison suggests appealing to people on an emotional level.
"They probably care about you, they're people you're spending the holidays with, so talk on a human level about why diet talk hurts you or what you have found to be helpful in your own relationship with food," she said. "And keep it focused on yourself, like, 'for me,' and, 'in my experience.'"
"And if you're not quite as close, you can say something a little less personal, like, 'I've found that talking about this kind of stuff just makes the meal less fun for me," she said.
2. Remember it is one meal, one day.
"Remember that it’s just one day, it's just another day of eating and you can have those foods anytime you want," said Larkin. "Try to minimize the importance and the exact rules around food and remember, you can have it anytime. You can have more. "You can have less. It’s just one day out of 365 days of the year."
Speaking of her own recovery, Larkin, who got treatment at The Renfrew Center, added, "Those are the kinds of conversations I had to have with myself and with my individual therapist leading up those these events until it became true for me."
Larkin and other experts also recommend staying in a routine with meals both before and after a Thanksgiving lunch or dinner, again reinforcing that it is just one meal among many.
3. Start new traditions.
Larkin said that during certain parts of her eating disorder and her recovery, she chose to travel over the Thanksgiving holiday instead of joining family.
"I had to put my needs in front of my family's need of wanting to see me and had to say, 'Even though you want to see me, this holiday is too triggering and I'm not going to participate in the way that I normally would,'" she said. "That's okay."
In other cases, a healthy new tradition may be going to a Thanksgiving dinner hosted by friends instead of family, or organizing activities before and after a Thanksgiving meal that don't involve sitting and talking about food, according to Larkin.
4. Have an ally by your side.
Chelsea M. Kronengold, a spokesperson for the National Eating Disorders Association, said it is important to have a support system on hand around a stressful holiday like Thanksgiving.
"If you have a therapist or a nutritionist, talk to them about your concerns prior to the holiday so you can work together on helpful coping strategies," she said. "And in addition to professional support, if you have a friend or a family member who's either in the room with you or available for you to text if the meal is challenging or the family dynamics are challenging, that can be extremely helpful."
5. Practice self-compassion.
"It’s okay to acknowledge that Thanksgiving and other food and family-focused holidays won’t be easy," said Kronengold. "If you end up restricting or bingeing, remember that tomorrow is a new day."
"When you perpetuate that cycle of shame and guilt, it's only going to be counterproductive to your mental health and your recovery journey," she said.
If you or a loved one is struggling with food and body image concerns this Thanksgiving, the National Eating Disorder Association (NEDA) Helpline is available via click-to-chat on Thanksgiving Day from 12 pm - 8 pm ET. For 24/7 crisis support, text "NEDA" to 741-741.