Experiences of eating difficulties in siblings of people with anorexia nervosa: a reflexive thematic analysis

Abstract

Background Siblings of people with anorexia nervosa (AN) have been found to experience strong emotions, changing family roles and poorer wellbeing as a consequence of experiencing the effects of the illness on their sibling and family system. These factors, combined with genetic influences, may put siblings at an increased risk of developing eating disorder psychopathology in addition to other mental health issues. This research aims to explore the experiences of siblings of people with AN who have had eating difficulties themselves and investigate issues that may be important to the development and prevention of eating difficulties in this population. Methods This qualitative study used a reflexive thematic analysis approach. Ten adults who had witnessed a sibling with AN and experienced eating difficulties themselves participated in semi-structured interviews. Analysis Participants’ own eating difficulties were affected by the specific experience of witnessing a sibling with AN through mealtimes becoming emotionally charged, an increased focus on body size and diet, and comparisons with their sibling. Difficult experiences, such as marital discord amongst parents were common, as was a difficulty in managing emotions. The onset of AN within the family caused participants to take on caring responsibilities for their sibling and to hide their own difficulties for fear of adding additional burden to their parents. This reduced their perceived ability to access support and for some increased a desire to restrict as a coping mechanism for the stress they were experiencing. Systemic beliefs regarding the value of thinness were prevalent and influential. Protective factors, such as not wanting to become as unwell as a sibling with AN and an understanding of the negative consequences of AN, aided recovery. Conclusions Eating difficulties in siblings of people with AN may be influenced by competition for slimness, increased focus on diet and body size, and a need to manage difficult emotions. The disruption to social connections and a difficulty finding emotional support that may be experienced by people when a sibling develops AN may further influence susceptibility to eating difficulties. Further research is needed into the best ways to support siblings of people with AN.

The experiences of having a sibling with an eating disorder: A systematic review of the literature

“…The presence of an ED within a family changes the way all members view food (Fjermestad et al., 2019), and impacts siblings' food choices (Areemit et al., 2010; Scutt et al., 2022), and eating behaviours (Areemit et al., 2010; Garley & Johnson, 1994). There is a greater emphasis on food (Fjermestad et al., 2019) and siblings are more aware of their food and diet choices which extends to how this would affect their SED (Quish, 2010).…”

“…Female siblings experienced feelings of being watched and judged by their SED (Hutchison et al., 2022). Some siblings reported being made to eat to set a good example for their SED to the extent of overeating (Scutt et al., 2022), and developing disordered eating behaviours themselves (Quish, 2010). Others reported mirroring their SEDs' behaviours to maintain a close connection (Quish, 2010).…”

“…In some families, siblings considered themselves as the only source of support for their SED (Dimitropoulos et al., 2009; Scutt et al., 2022) because their parents minimised or denied the ED (Dimitropoulos et al., 2009). Concerns about what they perceived as neglect (Quish, 2010) led them to serve as a protector for their SED (Dimitropoulos et al., 2009).…”

“…Many siblings report that their lives are plagued with worry and concern about the life‐threatening weight loss and the risk of suicide (Jungbauer et al., 2016). They describe themselves as witnessing a gradual death with their SED slowly wasting away in front of them (Quish, 2010; Scutt et al., 2022) and experiencing a profound sense of loss.…”

“…They report a closer relationship with their parents (Areemit et al., 2010; Grunwald, 2014), particularly following their SED's recovery (Grunwald, 2014). Similarly, siblings report a closer sibling relationship with their SED (Callio & Gustafsson, 2016; Havard, 2019; Latzer et al., 2002; Moses, 2013; Scutt et al., 2022) which is also more supportive (Scutt et al., 2022). They spend more time together, take better care of each other (Callio & Gustafsson, 2016), and experience an increase in communication and joviality with their SED as a result of the ED (Havard, 2019).…”