On Boxing Day, 2019, Francesca found herself in the worst possible environment: an over-the-top festive gathering with an equally over-the-top amount of festive food. It was the usual fare: roast potatoes, turkey crown, pigs in blankets. Plus all the leftover chocolate and confectionary that hadn’t been consumed the day before.

“A family friend made a casual comment like, ‘Well, time to hit the gym in the new year!’ and it completely threw me,” the 37-year-old recalls. Everyone else laughed it off, but for Francesca, who has suffered with anorexia and exercise addiction since the age of 19, it triggered a spiral of guilt and self-doubt. “That comment made me consciously restrict my eating. The next morning, I went for a run.”

Christmas is synonymous with plenty of things: tinsel, presents, drinks with the word “mulled” in the title. But it’s also synonymous with eating. The whole circus starts as early as 1 November, when we wave goodbye to Halloween ad campaigns and say hello to Christmas ones. These inevitably depict variations on the same theme: families gathered around the dinner table, sparring over who gets to eat the last potato; children sneaking downstairs after midnight to scoff an extra mince pie; friends trying and failing to bake a chocolate yule log for a drinks party.

Whichever way you spin it, this time of year is intrinsically linked to consuming excessive amounts of food, perpetuating a binging mentality predicated on extremes. Everywhere you look, from the high street to billboards, the narrative goes something like this: “Oh go on, it’s Christmas! It’s time to indulge! You can start the diet in January!”

The idea is that now is the season to throw caution to the wind and eat as much as possible with the intention of depriving yourself come New Year’s Day. It’s not the healthiest messaging for any of us – whatever happened to moderation? – but it’s particularly dangerous for those struggling with eating disorders, for whom the festive build-up is a constant source of anxiety and dread.

“Subconsciously, this time of year really affects me,” says Lauren, 27, who struggled with disordered eating between the ages of 13 to 25. “In the past, when I was in the prime of my eating disorder and severely bulimic, Christmas was a nightmare. It often revolves around alcohol and food, with so many events like work parties or nights out with friends, most of which centre on eating and drinking. I’m definitely a people pleaser, so I find it hard to say no, which makes these situations even more challenging.”

Thankfully, things have been much better for Lauren since she received treatment at The Dawn Wellness Centre and Rehab in Thailand. But Christmas still poses its challenges. “Recently, I followed a strict carnivore diet and boxed every morning for 30 days straight, staying completely in control,” she says. “Now that it’s over, I’ve found it harder to cope. I recently went down to London to visit the Christmas markets, and I have nights out or meals planned with friends. I love doing these things, but they can still be difficult and often trigger internal battles. I find myself struggling and fighting in my head more every day.”

The noise of indulging versus restricting is one that’s particularly difficult to shake during the Christmas period. “It’s also a time when routines go out the window, which is unsettling when you rely on them to manage an eating disorder,” adds Francesca. “For many of us, it’s less about the food itself and more about the constant mental gymnastics that go with it.”

In the UK, roughly 1.25 million people have an eating disorder, according to leading charity Beat. Research suggests that around 46 per cent of anorexia patients fully recover, 33 per cent are improving and 20 per cent remain chronically ill. Similar research regarding bulimia suggests that 45 per cent make a full recovery while 27 per cent improve considerably and 23 per cent suffer chronically.

Beyond the obvious food-centric triggers that come with Christmas, there are other difficulties, particularly if you’re underweight, meaning you feel the cold more harshly. “When I was at my worst, there were winters, including Christmas, when I wouldn’t leave the house for months because it just wasn’t worth it,” says Lauren. “My whole body would shake constantly. I remember one winter when my mum and dad had to install extra heaters and fires in my room because I couldn’t stay warm.”

Then there’s all that extra family time; roughly seven in 10 Britons spend Christmas with their immediate relatives, according to YouGov. “Christmas can bring up all the difficult inter-personal and family dynamics that are often at the root of eating disorders,” says Rebecca Sparkes, a UKCP-registered psychotherapist specialising in eating disorders and addiction. “Most sufferers will have grown up in families where emotional needs were not expressed. Eating disorders will flourish in families where emotional expression isn’t modelled or encouraged.”

Disordered eating can also be exacerbated by inevitable comparisons with the “perfect” families we often see presented in Christmas films and TV shows. “The emphasis on spending time with close family and the expectation that it will be a ‘happy’ time is extremely challenging,” adds Sparkes.

But not having family around presents its own challenges. For most people, work quietens down at this time of year; if you don’t have loved ones to spend time with, it can mean spending long stretches of time alone. “Loneliness is a major trigger for people struggling with eating disorders,” says Helen Wells, psychotherapist and clinical director at The Dawn. “While Christmas is seen as a time of togetherness, many individuals feel a profound sense of loneliness, either because they believe no one understands their struggles or due to strained family relationships.”

It doesn’t help that people without eating disorders often aren’t equipped to support those struggling with them. “My immediate family are fantastic,” says. “They know what helps and what doesn’t – like keeping to regular mealtimes instead of having a massive 4pm lunch that throws everything off. They also steer clear of any comments about dieting or body image, which is a huge relief.” Extended family or friends aren’t always as clued up though. “They’ll say things like, ‘You’re looking healthy!’, or even joking about how much food someone’s eating. Those comments, even if they seem harmless, can be really triggering.”

Anorexia and bulimia are complex illnesses that many misunderstand despite their best intentions, fostering a culture of shame that makes it harder for sufferers to be upfront with those closest to them about what they’re going through. “A few years ago, I was caught going to the toilet straight after a Christmas meal, and the guilt and shame I felt were horrendous,” recalls Lauren. “It’s a horrible feeling, knowing my whole family is there, enjoying a nice Christmas meal that my mum spent hours cooking, while I was consumed with guilt for the rest of the day.”

When it comes to navigating all this, it’s hard to know where to start. But the best thing you can do is prepare in advance. “Schedule social arrangements and ideally plan food choices in advance,” suggests Dr Lorna Richards, a consultant psychiatrist based at Priory Hospital Woking. “Arrange to sit next to someone who can be relied upon to support you during the more overwhelming meals. Talk openly and honestly with close loved ones so that you can all work together to make Christmas a happy time.”

Taking the attention away from food as much as you can is also crucial. “This might be making Christmas decorations, going to a concert or carol service, or taking a walk somewhere special to you,” suggests Emma Jamieson, helpline manager at Beat. “You could also agree on a sign to discreetly show when you need support and encouragement from a loved one, like drinking from a particular mug.”

As for routine, try to find it where you can; this includes having downtime on your own or with someone close, advises Dr Richards. “Remember that everyone finds some aspects of this time of year difficult so be a bit easy on yourself if you can. Despite some of the pitfalls, it is very likely that you will be able to enjoy some of your time over Christmas and the New Year.”

If you’re struggling to find support among those closest to you, it can help to reach out to others in a similar position. This is what has worked for Lauren since she started her recovery process two years ago. “Any coping mechanisms I use these days come from my days at The Dawn because I was connecting with people who truly understood me,” she says. “Even now, if I’m struggling, I can still reach out to them. With Christmas coming up, I’ve been finding it harder and have leaned on them for support. They’ve been an incredible help.”

For anyone struggling with the issues raised in this article, eating disorder charity Beat’s helpline is available 365 days a year on 0808 801 0677. NCFED offers information, resources and counselling for those suffering from eating disorders, as well as their support networks. Visit eating-disorders.org.uk or call 0845 838 2040