Jeri hasn't looked forward to the holidays for a while now.
For her and others like her who suffer from eating disorders, "visions of sugarplums" and the smell of grandma's pumpkin pie are not necessarily welcome.In fact, they touch off serious panic.
The holidays have been frightening the Orem mother for 20 years, since the age of 14 when she was battling anorexia through binges of compulsive overeating and into her more recent bulimia.
Now for the first time, the 33-year-old mother of twins thinks she can face the holidays with a little more enthusiasm, thanks to strength gained from years of therapy.
"I always made it a bad experience," Jeri said. "My whole thoughts turned toward, `When am I going to be able to throw up?' I could anticipate for months, I had such a fear of food.
"I hope I can do this. I don't want the holidays to be automatic downers because they go on for weeks."
Jeri isn't alone in her fears. Patients with eating disorders around the nation dread the holiday season with its family get-togethers and its focus on traditions of eating.
Randy Hardman, one of the doctors at the regional Center for Change treatment center in Orem, collected thoughts from some of the female patients who are currently undergoing treatment for severe anorexia and bulimia.
"This is the time of year that sort of amplifies the anxieties for these women. The emotional intensity and the food is a double whammy for them," he said. "Most family members think it is about food and weight, but it is about self-rejection."
"Christmas is the hardest time with my bulimia," said a patient. "So much food, so much love and so much joy, but I could not feel the love or joy, so I indulged in the food as a replacement."
"Holidays are pure hell when you have an eating disorder," said one woman. "Social pressures are hard. I feel like everyone is watching."
One patient described it like this: "I always hated it when the holiday season would roll around. It meant that I would have to face my two worst enemies - food and people - and a lot of them."
"When I'm hurting inside and struggling with what `normal'food portions even are, I need the help, emotional understanding and support of family and other people. Handle with care, but please handle. Accept me the way I am. Let me back in the family," said one.
"My life with an eating disorder during the holidays is a living hell, full of constant hiding and fear," another said. "It seems like the food police are out on patrol."
Anorexics dislike having anyone watch them eat anyway, Hardman said. Added on to the guilt they already feel about any kind of food indulgence, the emotional weight becomes too great.
"I have had patients describe that they would rather jump off a cliff without a parachute than to have somebody watch them eat food."
Yet many women with eating disorders are waiting for their families to notice their pain.
Bulimic patients believe they destroy the family's sense of well-being once they head for the bathroom. "It is hard to see everyone so happy before I made the trek to the bathroom," described a patient. "I felt unworthy to be happy."
Family members and friends are in a difficult position. Most want to help but are uncertain of how much to try and what to do.
Patients don't want to be fussed over, but they don't want to be ignored, either.
Those with eating disorders usually already have intimacy problems with the people in their lives, Hardman said.
"It is extremely terrifying for women with eating disorders to be emotionally intimate with other people. It feels too vulnerable and unsafe, so they revert to their eating disorder."
To be immersed in the family context brings up all the issues, fears, conflicts and worries that feed the eating disorder that causes everyone so much pain, he said.
Hardman suggests people start off the holidays with candor. They should discuss what will help and what will not.
It's a good idea to break down the festivities into small groups that are not as overwhelming and to take the focus off food.
However, Hardman said family members should not feel responsible and guilty for the eating disorder and attempt to micromanage the situation for the one suffering.
"Relax and put the emphasis on personal things and not on the food disorder," Hardman said.
Offer support. Express love and acceptance.
He said those suffering absolutely need to seek professional help and the sooner the better. Those with a shorter history of the disorder are helped more quickly. Those who don't get help have a high mortality rate.
Jeri says she has great sympathy for the spouses and family members of an eating disorder patient.
"It's been hard on my husband," she said. "He's been really helpful and supportive, but it's just really hard. He tells me he loves me, but I haven't felt deserving of that love. Then I think he expects me to just do this, and what if I can't?"