Understanding and Helping the Siblings of Eating Disorder Patients
By Sarah K. Ravin, Ph.D.
Eating disorders affect the entire family, but siblings are often overlooked in our conversations about family-based care. An eating disorder can impact the patient’s siblings from various angles:
* Through their parents. Siblings often receive less attention when parents are consumed with caring for the ill child. Parents often feel worried, stressed, and irritable, and these emotions spill over into their relationships with their other children.
* By impacting family life. Family meals with an eating disordered person can be tense or explosive, so siblings may dread family meals or avoid them altogether. Family trips may be cancelled or ruined. The financial burden of ED treatment impacts siblings as well.
* Through their social environment. Parents may not be available to drive siblings to their activities when they are spending long hours preparing and supervising meals and driving the ill sibling to appointments. Siblings may feel embarrassed to invite friends over when their ill brother is acting particularly bizarre. Siblings may have to deal with gossip from neighbors. They may feel conflicted about telling their friends about their family’s situation, and they have to deal with the stigma of mental illness at a very young age.
* Through the change in eating habits. Parents are encouraged to serve their anorexic children high-calorie foods to restore their weight. Sometimes siblings over-indulge in these foods and gain unneeded weight.
* Through their genes. Biological siblings of eating disorder patients are 10 times more likely to develop an eating disorder compared to the general population. Additionally, siblings of eating disorder patients may inherit genes that predispose them to other psychiatric illnesses
Brothers and sisters may experience a variety of emotions while their sibling is ill. They may worry that he will get sicker or die. They may grieve for the loss of their sibling’s true personality, and they may miss her terribly if she is away from home for treatment. They may worry about their own risk for developing an eating disorder. They may feel angry at their sibling for making mealtimes miserable, or jealous because of all of the attention he is getting. Siblings may react by withdrawing, having difficulty at school, or acting out. Very young siblings may manifest their distress through physical symptoms.
It may not be possible for parents to shield siblings completely from the impact of the eating disorder. However, there are some steps that parents can take to minimize the damage and help siblings cope:
* Immediately upon diagnosis, provide siblings with age-appropriate information on their sibling’s diagnosis, symptoms, and treatment. Explain that the disorder is biologically-based and that the child did not chose to have it. I have a sibling reading list, as well as a list of Q & A for siblings of AN patients.* Be frank with siblings about the seriousness of the eating disorder. Honesty helps siblings understand why it is so important that the family intervenes immediately and aggressively, and why other activities have to take a back seat for now.
* Be honest with siblings about the reality of dealing with the eating disorder. Acknowledge that, for a period of time, family life will change and you may not be able to spend as much time with them.
* Bring siblings to some Family-Based Treatment (FBT) sessions so that the therapist can explain the illness to them, answer their questions, and help them learn to support their ill sister or brother.* Make a point of scheduling one-on-one time with each sibling and talking with them about their lives apart from the eating disorder.
* Talk with siblings about their feelings and reactions to the eating disorder. Let them know that it is totally normal and understandable to feel worried, angry, jealous, resentful, or sad in this situation.
* Ensure that siblings remain in a support role, rather than taking on a parent’s role. Siblings can help their ill sister by providing her with distraction before, during, and after meals, by being good listeners and providing empathy, and by engaging her in normal sibling activities. Siblings can help by taking over kitchen chores that the eating disordered person is not well enough to do. Do not involve siblings in the actual process of re-feeding or supervising meals, as this can put them in a delicate position of being torn between “loyalty” to their ill brother and the responsibility of reporting ED behaviors to their parents.
An eating disorder can also impact siblings in a positive way. For example, they may grow closer to their ill brother and value him more after almost losing him. They may feel needed and important in the treatment process. Siblings may become more aware of EDs and other psychiatric illnesses in their friends and try to intervene whenever they see concerning behaviors. They may have improved body image after witnessing the disturbing body image distress of their ill sibling. Often, siblings benefit from having more frequent family meals and structured eating habits. They may grow and mature from the experience, developing more autonomy when parents’ focus is elsewhere. Finally, siblings benefit from strengthened parental unity. If a sibling develops an eating disorder or another illness in the future, their parents tend to intervene immediately and are much more equipped to deal with it.
Dr Sarah Ravin’s website is in my blog roll.
