Anorexia nervosa in the family: a sibling's perspective

Abstract

There is very little research which explores the experience of living with adolescent anorexia nervosa (AN) from the perspective of a sister or brother. This is despite the fact that siblings are often encouraged to participate in the treatment of their sister or brother's AN through involvement in family therapy.Twenty semi-structured qualitative interviews were conducted with siblings of young people currently receiving treatment for AN. Interviews were designed to find out more about the experience of living with a sibling's AN, and what helped these participants to cope. Where siblings had been involved in treatment, views on the positive and negative aspects of this experience were also collected.Qualitative thematic analysis was used to analyse the data, and five primary themes were identified which showed congruence amongst participants. These themes were: 'feelings about AN'; 'the sibling relationship'; 'avoidance'; "emotional supports' and 'involvement in treatment'.The findings from this study give voice to some of the hopes, concerns and coping mechanisms used by sisters and brothers when confronted with the impact of AN in the family. Further empirical research to evaluate some of the key factors that help siblings cope with this often stressful situation could lead to the development of intervention strategies for siblings of patients with AN.Findings from this study suggest that siblings could benefit from more detailed guidelines regarding their role in family therapy.Friends and family have encouraged and supported me throughout this busy time. Special thanks go to my husband Jonathan, and my sons Matt, Richard and Sam, who motivated me, helped me out, and reminded me to keep a balance in my life. I am also grateful for the friendship, advice and support of fellow DCP students, and from my friends Vanessa Brown and Heather Jackson.

Psychosocial Well‐being of Siblings of Adolescents with Anorexia Nervosa

“…In summary, previous research has shown that siblings of children with chronic illness and mental health difficulties have a range of both positive and negative experiences. Some similar findings exist with regard to the siblings of individuals with AN, but research is scarce and largely qualitative (Areemit et al, ; Bachner‐Melman, ; Dimitropoulos et al, ; Garley & Johnson, ; Honey et al, ; Honey & Halse, ; Withers et al, ). There is no quantitative research with siblings of adolescents involved in family therapy for AN, despite FBT becoming one of the most widely used and empirically validated treatments for medically stable adolescents with AN (Lock, ).…”

“…The findings could suggest that siblings' difficulties with peers increased as treatment progressed, perhaps due to the illness or treatment contributing to social withdrawal from peers. It has been previously noted that siblings of adolescents with AN rely on family for emotional support, as stigma and ignorance of AN makes it difficult to speak to others about the disorder (Withers et al, ). Despite this finding, there were no significant differences in mean scores on peer problems between participants at diagnosis and following treatment.…”

“…In the only available quantitative study, 16 out of 20 participating siblings reported poorer quality of life related to the onset of their sibling's eating disorder (Areemit, Katzman, Pinhas, & Kaufman, ). Conversely, other qualitative studies have noted that, in addition to difficulties, siblings often report positive experiences such as developing a greater understanding of mental illness and closer sibling relationships (Dimitropoulos, Klopfer, Lazar, & Schacter, ; Withers et al, ).…”

“…The potential deleterious side‐effects of FBT for sibling well‐being are particularly important given that relatives of individuals with AN are already at higher risk for psychopathology (Lilenfeld et al, ). Qualitative research suggests that families are concerned about the impact of AN and FBT on siblings (Withers et al, ); however, there has been no quantitative study of sibling well‐being within an FBT programme. Of importance, there is evidence that family functioning actually improves during FBT (Ciao, Accurso, Fitzsimmons‐Craft, Lock, & Le Grange, ).…”

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

“…Overall, studies indicated that having a sibling with an ED affected non-ED siblings' inter-personal relations and social life. While in some studies siblings reported turning to their friends for help and comfort (25,31,42), others found siblings avoided disclosing their feelings and experiences outside the family (39). This secrecy sometimes stemmed from parents' wish to conceal the diagnosed sibling's status (32), or alternatively from the non-ED sibling's own sense of embarrassment and shame, or from fear of stigma and of being perceived as weak (32,39,42).…”