It’s early December. You know you need help. Your treatment team has recommended a higher level of care, or perhaps you’ve finally acknowledged that your eating disorder has progressed beyond what you can manage on your own. And then you look at the calendar, and the holidays are here. December brings a cascade of celebrations: Christmas, Hanukkah, school breaks, and family gatherings. The thought of entering treatment now feels impossible.
This internal debate plays out in treatment offices and family conversations across the country every year. The pull is powerful: one side desperately wants connection, tradition, and normalcy during this special time of year. The other side knows that waiting might make everything worse. The tension is real, and the struggle is valid. Research from the National Alliance on Mental Illness found that 64% of individuals living with a mental illness reported their conditions worsened around the holidays. The season that promises joy and connection often delivers the opposite for those struggling with their mental health. A 2023 survey by the American Psychological Association revealed that 89% of U.S. adults feel stressed during the holiday season, with 41% reporting higher stress levels compared to other times of the year. For someone battling an ED, these statistics take on urgent, personal meaning.
Common Questions About Holiday Treatment Decisions
If you’re facing the possibility of starting treatment over the holidays, you’re likely grappling with several interconnected concerns. Below are the questions most frequently asked during this decision-making process, along with honest answers grounded in both clinical reality and compassion for how difficult this choice is.
What makes the holiday season particularly challenging?
The holidays are genuinely difficult for eating disorders, and pretending otherwise helps no one. Family gatherings usually center around food, as do many cultural holiday traditions around the world. Relatives might make comments about appearance, and eating habits and routines get disrupted. On the flip side, isolation and loneliness can negatively impact a considerable number of people during the holiday season, especially when they are lacking in broader support systems. These numbers are particularly high among the LGBTQ+ community, Gen Z, and single adults. For someone with an eating disorder, these can be triggers that can destabilize weeks or months of progress, or accelerate a decline that’s already underway. To compound the issue, regular sessions with outpatient providers may be off-schedule or reduced as your treatment team navigates their own holiday plans and commitments.
Beyond these immediate challenges, the holidays also create a false sense that after will somehow be easier. In fact, January brings its own stressors, with returns to work and school bringing about demands that have been on pause during the holiday season. For most of us, life remains busy and full of obligations all through the year.
What are the risks of delaying treatment?
“Just until after the holidays.” It’s a phrase treatment providers hear constantly during this time of year. The logic seems reasonable on the surface; wait a few weeks, get through the celebrations, and then start in January when things quiet down. Behind this delay often lives a fantasy of one last “normal” holiday. One final celebration before everything changes. The eating disorder whispers that you can hold it together for just a little longer, that you deserve this time with your family, that treatment can wait.
But there’s often fear operating simultaneously, which is the fear of getting worse. The fear that this delay will cost you more than you can afford to lose. And if you are too caught up in the fantasy to acknowledge the fear, quite often your loved ones are mired in it. These competing fears create paralysis—or conflict—and can be dangerous.
The holidays create a false sense that “after” will somehow be easier. The reality is that January brings its own stressors, with returns to work and school bringing about demands that have been on pause during the holiday season. For most of us, life is busy and full of obligations all through the year. Mental health diagnoses like eating disorders don’t become easier just because the calendar flipped. They get harder, more acute, and more complex with the passage of time.
The research on delaying treatment is sobering. One study found that the average length of delay between onset of eating disorder symptoms and treatment-seeking was 5.28 years. What starts as “just a few weeks” easily becomes months, then years. Research also shows that children and adolescents have higher recovery rates for eating disorders than adults, and as the illness progresses, neurobiological and psychosocial factors develop that make people more resistant to treatment. In essence, the longer treatment is delayed, the more time an individual’s brain adapts to the distorted behavioral patterns of the illness. The ED becomes more entrenched, and the path back becomes harder. Every week of delay matters, especially for young people.
What are some signs that I need residential treatment?
What we need to face, with compassion and while validating the difficulty of the decision, is that if treatment is medically necessary, delaying is dangerous. The question becomes how to determine what level of care is appropriate and necessary for your specific situation. Clinical appropriateness depends on your medical status, level of distress, and ability to function, regardless of preference or timing.
‘Ai Pono offers free phone assessments that include a review of medical records and a clinical recommendation for appropriate level of care. This professional evaluation helps determine whether residential treatment is necessary or if a lower level of care might be appropriate to start.
Residential treatment becomes necessary when:
- Medical complications require monitoring beyond what outpatient care can provide
- Co-occurring mental health symptoms (depression, anxiety, suicidality) are severe
- Previous attempts at lower levels of care have not been successful
- Your eating disorder is significantly interfering with your ability to function
- Completing meals without extreme distress or compensatory behaviors becomes difficult or impossible.
- Your eating disorder is significantly interfering with your ability to function in important areas of life (school, work, relationships)
For adolescents and young adults, especially, early intervention matters enormously. The highest recovery rates occur in this age group, but only when treatment is accessed promptly. Waiting doesn’t serve young people; it robs them of their best chance at full recovery.
What if my loved ones ask me to delay treatment?
Sometimes the pressure to wait doesn’t come from the person struggling. Loved ones, particularly parents, may resist the timing because they want their family member home for the holidays, because they’re hopeful symptoms will improve on their own, or because the disruption feels too significant to manage during an already stressful season. This creates a different kind of conflict where the individual recognizes they need help, but family dynamics complicate the path forward.
If you find yourself needing to advocate for treatment when others want you to wait, consider these approaches:
- Be direct about the severity of your symptoms rather than minimizing to protect others from worry. “I’m struggling more than you realize” creates clarity that “I’m managing” does not.
- Emphasize what delaying actually costs rather than arguing about inconvenience. “My symptoms are getting worse, not better, and waiting makes recovery harder” grounds the conversation in medical reality.
- Involve your treatment team in family discussions so that clinical recommendations come from professionals, not just from you. This removes some of the emotional burden and provides external validation of what’s needed.
- Acknowledge that the timing is difficult for everyone while maintaining that medical necessity doesn’t pause for convenience. Both things can be true simultaneously.
Will I be able to see my family during treatment?
This concern is valid and worth examining honestly. Treatment programs incorporate family work and typically offer visiting opportunities, though the specifics vary by program and individual treatment needs. At ‘Ai Pono, on-site visits are typically approved after the first week or two of treatment, with weekend visiting hours being standard and additional frequency and flexibility built in for holidays. Day passes for up to 5 hours are also considered for those who have been with us over thirty days, provided there are no safety concerns. Our clients are also able to stay in touch regularly with family and friends via phone or video chat, with additional personal electronics time offered during the holidays
The more important question might be: Will you truly be present with your family if your eating disorder is severe? Can you engage meaningfully when you’re consumed by anxiety about meals, obsessing over calories, or physically weakened? Many people discover that the fantasy of being “home for the holidays” doesn’t match the reality of being trapped in an eating disorder during the holidays. At ‘Ai Pono, we find that while many individuals express reservations about coming during the November/December months, most find upon arrival that the safety and support of our environment is just what they needed, as opposed to juggling the stress, triggers, and expectations that would have been realistically attached to staying home for the holidays. It is common for our clients to choose—and even prefer—to remain in care through the holidays.
Can I do eating disorder treatment from home?
For those in Hawaii, ‘Ai Pono offers virtual intensive outpatient programming throughout the state that can provide structure and support during the holidays while allowing individuals to remain in their home environment. This can serve as an appropriate level of care for some, or as a bridge to more intensive treatment if needed.
If you’re medically stable enough to try a lower level of care, and the emotional disruption of being away from family during the holidays would be significantly destabilizing, this may be an option worth exploring with your treatment team. Virtual IOP provides multiple weekly sessions, including individual therapy, group support, and nutrition counseling while maintaining connection to home, work, or school.
The agreement you need with yourself and your team is this: if the lower level of care isn’t working, you will step up. Not in a few weeks. Not after the holidays. When it becomes clear that you need more intensive support, you’ll accept it. This requires brutal honesty about your symptoms, your behaviors, and your safety.
How do I honestly assess what I need right now?
Be truthful with yourself and your treatment team about where you actually are:
- Am I medically stable? (This requires professional assessment, not your own judgment)
- Am I safe from self-harm and suicidal thoughts?
- Have I been honest about the severity of my symptoms, or am I minimizing?
- Is my resistance to higher-level care coming from genuine clinical factors, or from my eating disorder’s fear of change?
- If I’m considering a lower level of care, am I truly committed to stepping up if needed, or am I using it to avoid intensive treatment?
- What does my treatment team actually recommend, not what I wish they would recommend?
- If I wait, am I confident I can maintain my current level of functioning, or is decline likely?
Your safety and your recovery are not less important because the holidays are approaching. The treatment you need doesn’t become optional because the timing feels wrong. If you or someone you love is facing this decision, reach out to ‘Ai Pono. Our team can help you assess what level of care is truly needed and develop a plan that prioritizes health and safety while acknowledging the complexity of this time of year.
For more information about ‘Ai Pono’s programs, including our virtual IOP services available throughout Hawaii, visit aipono.com or call (808) 470-5924.
