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Supporting Siblings: Insights and Strategies

By Judith Banker MA, LLP, FAED and Judy Krasna, F.E.A.S.T. Executive Director

While there is a recent wave of research investigating the type and extent of impact on siblings of people with eating disorders (some of which are listed at the end of this post), there are few findings available that provide strategies and/or interventions to address the impact. In looking to the literature addressing the impact on fellow siblings living with a sister or brother with severe mental illness we find this article offers three basic strategies:

  1. Gain insight and knowledge
  2. Join peer support groups
  3. Identify a silver lining

The unfortunate reality is that there are very few peer support groups for siblings of people with eating disorders. While there are silver linings, siblings may have difficulty identifying them or feel guilty about seeing the positive in a situation where their sister/brother is ill.

F.E.A.S.T. Executive Director Judy Krasna and F.E.A.S.T. Advisor Judith Banker led a webinar discussion about insights and strategies that can help siblings (and parents) of people with eating disorders. Here are some excerpts:

  • We know that siblings are impacted by eating disorders to varying degrees based on age, relationship with the person affected by the eating disorder, personality, family dynamics, and other factors. Many times, these siblings are caught between their ill sister/brother and their parents. For example, they may witness their sibling exhibiting behaviors which they know are harmful, such as throwing away food, binge eating, vomiting, excessive exercise, etc. and they are torn by the dilemma of whether to keep their sibling safe and report this behavior to their parents or to preserve their sibling relationship and keep their sibling’s behavior a secret. If you discover that one of your children has hidden their sibling’s dangerous behaviors from you, try to understand that they are trying to mediate multiple alliances and keep their relationship with their affected sibling intact. Sometimes parents inadvertently rely on siblings to be their ally without realizing that this puts siblings in an untenable position. 
  • Siblings should be siblings; they should not be policing food, exercise, or other behaviors and they should not be involved in feeding/meals and reporting what their affected sibling did/did not eat. 
  • Siblings see the distress that their sister’s/brother’s eating disorder is causing to their parents, and may be reluctant to create any further burden by “unloading” their own struggles and challenges. This can lead to siblings suppressing their own needs and keeping their feelings bottled up inside, resulting in their own mental health becoming compromised. Siblings can also burn out from trying to help their sister/brother, especially if their usually loving sibling is pushing them away. They may experience feelings of guilt, responsibility, anger, anxiety, depression, and other negative emotions. They may also seek to separate themselves more from the family strain by spending time with friends, extended family, or in outside activities. 
  • Siblings of all ages can be impacted, including young siblings. It is important to educate siblings about their sister’s/brother’s eating disorder in an age-appropriate manner, emphasizing that eating disorders are an illness like any other illness and not a choice or a cry for attention. Don’t assume that just because a sibling is very young, he/she doesn’t sense or realize that something is wrong. 
  • Siblings get hurt. They can lose their brother/sister to the eating disorder; they feel like they take a back seat to the illness, which gets top billing, and it causes an abundance of pain and anger. Siblings can understand that their sister/brother has a brain-based disorder that is beyond their control and still be hurt by it. While the instinct may be to “protect” the child with the eating disorder and to defend them against their siblings’ anger, this makes the siblings feel very invalidated. Parents can validate the siblings’ feelings without maligning the child affected by the eating disorder. As parents, we have to support all of our children. This is extremely difficult at times, but the simple recognition and acknowledgement that the other children are impacted and need validation can shift the family dynamic in a subtle but positive and meaningful way. 
  • If family/friends want to help, they can be tasked with being a support for siblings (invite them over for an activity, take them out for dinner, a movie, etc.). In addition, if siblings want to help, they can figure out a way to contribute to the family/affected sibling, taking on a manageable specific task or role, which will strengthen their sense of agency and give them a concrete way to contribute that they can sustain over a long period of time. This can mitigate their own feelings of helplessness, guilt, and overwhelm while providing enduring and solid scaffolding for the family system. However, siblings should always feel like they have an “out” and that they are not obligated to maintain these contributions if it becomes too difficult or burdensome. They should be informed about putting their own oxygen mask on first and about the priority of their own self-care and mental wellness. 
  • It is natural for parents to want to protect the privacy of their child affected by an eating disorder but shrouding the family in secrecy and privacy can cause siblings to feel stigma and shame, which leaves them feeling unable to share their feelings or talk about their situation with people who can help support them. Parents need to find the balance between privacy and support. Disclosing what your family is going through to those in a position to help siblings (e.g., teachers, extended family and friends) will get them the support and attention that can help them get through the distress and havoc that an eating disorder creates in the family. 
  • Feeding a child with an eating disorder that has resulted in malnourishment needs to be the priority, even when it lowers the quality of life of the whole family. Try to find ways to make mealtimes more tolerable for siblings by, for example, enlisting friends and family to invite them for meals outside of the house whenever possible or allowing siblings to eat separately. 
  • Siblings are scared. They need constant assurances that things are going to be okay. They may benefit from therapy and a space of their own to talk about their feelings. Sometimes when offered therapy, siblings refuse, saying that it’s not necessary, they are fine. Keep offering therapy. Make sure siblings know that the door to therapy is always open if/when they decide that they want to try it. 
  • It can be immensely difficult for parents to divide their attention between a child affected by an eating disorder and other children in the family.  It’s natural for parents to focus all of their attention and energies on a child at the beginning of treatment, or during any acute or severe phase of an illness. What makes the situation more challenging for parents of people with eating disorders, is that eating disorders are open ended, with no definitive recovery time. This places parents in a position where they are forced to pivot and find ways to help siblings keep on living while also focusing intensively on the recovery of the child who is ill. This is unspeakably hard and requires parents to be superhuman as they are pulled in multiple directions simultaneously. One strategy that can help ensure siblings get regular attention is for the parent/s to dedicate time each day for a specific activity/ritual with each child to maintain a sense of consistency and stability. 
  • As we know that eating disorders run in families, it’s important to keep an eye on siblings and watch for concerning behaviors that may indicate the development of an eating disorder. While the prospect of having more than one child in treatment for an eating disorder can be overwhelming, early recognition and intervention are paramount and can stem illness severity and length of treatment. 

In closing, though sibling relationships often suffer as a consequence of an eating disorder, these relationships can be repaired, and even strengthened, going forward. Families are resilient; they can weather the worst of storms and come out whole. As parents, we can’t mend the sibling relationships damaged by our child’s eating disorder, but we can facilitate the healing process by joining our kids together for family activities, vacations, outings, etc. that promote family unity. Slowly but surely, when given adequate time and opportunity, these sibling relationships can regenerate themselves and bloom once again.

For further resources:

Siblings of Individuals With Eating Disorders: A Review of the Literature 

Inpatients with Severe Anorexia Nervosa and Their Siblings: Non-shared Experiences and Family Functioning 

“Putting your own oxygen mask on first”: a qualitative study of siblings of adults with anorexia or bulimia 

When Your Sibling Has An Eating Disorder 

Anorexia Nervosa and the Family: Effect on Younger Sisters to Anorexia Patients 

Psychological Distress Among Sisters of Young Females With Eating Disorders: The Role of Negative Sibling Relationships and Sense of Coherence 

Non-psychopathology Related Outcomes Among Siblings of Individuals with Mental Illness: A Systematic Review 

 

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1 Comment

  1. Joanne L Humphries

    This is all very useful and relevant. We would have hugely benefitted from this angle ten years ago. My two girls, siblings of an older sister with anorexia and, as it turns out, autism, have been to hell and back trying to manage the strain of such an illness in their beloved older sister. We had psychological help along the way which, as adults, my husband and I were able to make use of but they lost the will to attend therapy sessions as, in their words, it didn’t change anything.
    The support we needed was much greater than we got, as this illness is so much bigger than anyone can possibly imagine who hasn’t lived through it. Most therapists haven’t.

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