“They don’t really get heard”: A qualitative study of sibling involvement across two forms of family-based treatment for adolescent anorexia nervosa

Abstract

Little is known about the involvement of siblings in family-based treatment (FBT) for anorexia nervosa (AN). To explore the experience of families, adolescents who had completed FBT, their siblings, and parents were interviewed. Siblings reported that involvement in FBT enhanced their understanding of anorexia and that they supported their family in various ways. While siblings often wished they had attended more sessions, there was no consensus among parents and patients regarding sibling attendance and many were concerned about potential negative impacts on siblings. Clinicians should discuss sibling roles and expectations early in FBT and work actively with families to address concerns.

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

“…The reviewed studies indicated that the changes in family relationships and everyday life brought about a change in non-ED siblings' perceived roles in the family as well. As reported in several qualitative studies, non-ED siblings commonly assumed responsibility over their siblings' health and well-being, especially when they were the older siblings (25,32,43,46). Non-ED siblings described a dual and at times conflicting role, in which they were both supporters of the diagnosed siblings and the caring parents' collaborators (25,31,32).…”

“…Guilt was also a prominent emotion among non-ED siblings. Some felt responsible for the onset of the ED due to their past remarks or actions, some blamed themselves for not helping their siblings as much as they could, and for some the split loyalty, to their patents on one hand and to their siblings on the other, evoked a persistent sense of guilt (25,31,32,43,46). Moreover, in-depth interviews with non-ED siblings revealed a sense of grief and sacrifice, as well as a feeling they lost their family, their normal childhood, their good relationship with their sibling, and their individual identity (32,42,43).…”

“…First, most studies found non-ED siblings' relationships with diagnosed siblings significantly changed due to the disorder (43,46,47). While some studies reported that non-ED siblings experienced stronger and closer relationships with their siblings (25,28,43,46,47), others described their relationships weakened, or increased in strain and tension (25,28,32,46). Generally, non-ED siblings described an ambivalence towards their relationships with their siblings, which included both close and affectionate interactions, and conflictual and distancing communication (43).…”

“…Qualitative studies found various factors straining this relationship. The most prevalent of those was difficulty in understanding diagnosed siblings' feelings, thoughts, and behaviors (25,32,47), and at times viewing those as a manipulative and preconceived way of seeking attention (25,32,46). In several studies, non-ED siblings reported feeling neglected and underprivileged in comparison to their siblings, and expressed frustration over their experience of differential parental treatment (31,43).…”

“…Non-ED siblings described a dual and at times conflicting role, in which they were both supporters of the diagnosed siblings and the caring parents' collaborators (25,31,32). They tried to balance protecting their siblings, collaborating with them, and keeping their secrets, with gathering information regarding their eating habits for their parents' surveillance and care (25,32,43,46), at times in response to parents' direct requests (25,31). Non-ED siblings reported serving as mediators between the diagnosed sibling and the parents, either when they felt close to both sides or when they felt their parents were ineffective in their coping with the disorder (31,43).…”