Christmas celebrations in the UK often centre on food, drink and family gatherings, but campaigners warn that the party season can place additional strain on those living with eating disorders.
"It's tricky even years down the line to watch the happiness and festivities at Christmas," says Katie Scott, 21, who is in recovery from an eating disorder.
"I have always loved [the time of year] - I love the food, I love being with my family. But now it's difficult because of the eating disorder."
She adds: "No matter how hard I try or want it to be carefree or eating-disorder free I know that it can't be - it's bittersweet."
Her comments come as new guidance is published to help those living with eating disorders over the festive season.
Katie first became unwell at the age of 14, restricting her food intake and falling into depression. She was initially diagnosed with eating disorder not otherwise specified (EDNOS), and later with anorexia aged 16.
She describes her first diagnosis as the beginning of a "long and ongoing struggle" with eating and her weight, mood and self-harm, straining her relationships with her family and friends.
"It left me feeling desperate and isolated," she says. "It was a life-threatening situation."
Katie dropped out of school for periods of time, undergoing inpatient treatment. She was finally discharged from hospital aged 18, joining the year below her at school to finish her education before going to university.
"I had to rebuild my life from rock bottom," she says.
Katie explains that she has found Christmas "an especially difficult time" both while unwell and in recovery, often feeling unable to get fully involved with the festivities.
"The celebrations are obviously very focused around food," she says. "I love food, but I'm scared of it so I have this contradiction - the fear factor.
"I've found Christmas quite hard to deal with in the past because I wanted to look forward to it, but all of the elements that I love [about it] became stressful and scary."
She adds: "I think anorexia might be an extreme version of losing the magic of Christmas. It's still a lovely time of year but it's not quite the same.
"I kid myself each year that it will be but it's never as easy as it was before. It can be disappointing."
The charity Beat estimates 1.25 million people in the UK have an eating disorder, with anorexia known to have the highest mortality rate of any mental illness.
Offering support at Christmas
The NHS and eating disorder charity Beat have published new guidance on how to support people with eating disorders and their families at Christmas.
The advice aims to help friends and family of those of any age with such an illness navigate the festive period - while continuing to manage a condition.
Some of the suggested techniques, based on experience from clinicians, patients and parents, include:
- Serving food as a buffet rather than as sit-down meals
- Minimising the social expectations of people with eating disorders over the festive season
- Treating meals on and around Christmas Day as routinely as possible
- Planning well ahead and thinking about how food features in the day
- Once dinner is over, shifting the focus on to other activities such as playing games
- Making loved ones aware to avoid questions about weight or appetite
For Katie, planning the structure of the day is key, including what she will do if she is feeling stressed - whether that is stepping outside or going for a walk.
She also advises finding someone to confide in. "Try and have one person who is at least aware that you might struggle," she says.
Beat has also published advice on how to spot the signs of an eating disorder on its website.
Katie says the Christmas period can also be a hard time for her mother, who, she notices, is focused on keeping her safe and feeling OK amid the celebrations.
"She's had a few very difficult Christmases with me," Katie says. "It's almost worse for mum because she has to deal with me and can't anticipate how I'm going to react."
Dr Prathiba Chitsabesan, NHS associate clinical director for children and young people's mental health, says supporting families to manage eating disorders at home is "crucial".
She adds that the "added pressure of New Year's resolutions and the bombardment of weight loss messaging" so close to Christmas can prove challenging for those living with an eating disorder.
"Hopefully these tips will really make a difference," she says.
Caroline Price, Beat's director of services, has warned that the pressure to eat large amounts at Christmas "can be triggering" for people with binge-eating disorder and bulimia, as well as causing anxiety for people with anorexia.
She says: "People with eating disorders often try to hide their illness and at Christmas when eating is a social occasion - often with people who they do not see frequently - they may feel ashamed and want to isolate themselves from others.
"At the same time, Christmas can be a source of distress for families who are caring for someone with an eating disorder.
"All these pressures can be made more difficult as the normal support networks are often not available at Christmas, as friends may be away, and regular social activities close for the holidays."
Anyone worried about their own or someone else's health is urged to contact Beat's helplines, which are open year-round and every day from 16:00 to 20:00 GMT from 24 December to 1 January.
Those in need of support can get in contact via phone, email, anonymous one-to-one webchat or social media messaging.
- Beat's adult helpline can be reached on 0808 801 0677, or there is a dedicated Youthline for under-18s on 0808 801 0711. The online support groups and one-to-one webchat can be accessed here.