When an eating disorder takes hold of a person, every member of the family is impacted in some way.
The family dynamics prior to the onset of an eating disorders, create a unique dynamic for families dealing with one. The family dynamics prior to the onset of the eating disorder may shape the individual responses among family members yet the overall response remains remarkably similar from family to family. The mental and physical health of each individual, and the family environment as a whole, impacts the family such that a “reorganization” of family life ensues, and each members’ life tends to become focused around the eating disorder treatment. Yet family remains the most important resource for recovery of an eating disorder. Siblings are not immune to the impact of the eating disorder and may have a variety of responses to the illness of their sibling.
The fact that eating disorders can cause serious and even life-threatening physical changes in the individual causes the anxiety of family members to focus on doing whatever they can to reduce the potential for disaster – the loss of their loved one. Unfortunately this may actually play a role in maintaining the problem. Negative ways of coping become more prominent, including taking control, anger and blaming, avoidance, denial or substance use. Time and attention from parents that would normally be available for a wider range of family activities is nonexistent. There may be concerns among siblings for the health of their parents as well.
In general, family members may all feel as though they’ve lost control over their lives to their siblings eating disorder. Meal times become challenging for siblings as family meals become intense and filled with conflict. This may cause healthy siblings to avoid family meals altogether, preferring instead to eat elsewhere. A new routine is established often with family members feeling like they’re constantly at risk of causing a meltdown with the struggling sibling, should they say something that triggers him or her. Unfortunately, this may lead to tolerance of the eating disorder behaviors, simply to avoid such occurrences. Resentment surrounding these illness-related changes to family life is common and in itself may lead to guilty feelings among siblings, particularly if they feel that they may have contributed to the eating disorder by something they said or did. In turn they may compensate by taking on more responsibility for caring for the individual although this in turn may lead to more behavioral issues of their own becoming oppositional or even outright defiant. They may have feelings of rejection by their siblings’ behavior toward them and they may begin to separate more and more from the sibling. Occasionally a previously well sibling will develop an eating disorder.
Given the lengthy treatment duration of an eating disorder, the impact on siblings is extended during a critical period of time in their own growth and development physically and emotionally. They are facing the challenges of school, peers and developing their own individual identity. Their development can represent a reality check on the cost of the eating disorder to the ill sibling and may become part of a motivation to resist the eating disorder. Depending on their own stage of development, a younger sibling may be less aware of the effects of the eating disorder and may not wish to see their older sibling as ill. They may attempt to care for their ill sister or brother by assisting them with everyday tasks or by providing companionship and emotional support. These siblings may express concerns and opinions but are confidants and even confront their sisters and brothers. At times, they may bring the illness to the attention of their parents.
The pre-illness factors that contribute to sibling responses to the eating disorder and ill sibling include age, gender, personalities of siblings, length of time the illness has been present, whether or not the sibling lives at home and the relationship of the siblings prior to the illness. Siblings may indeed be similarly at risk for some of the same behaviors as the individual with the illness. The intense stress on families and the strain on sibling relationships is often unavoidable. It is important to consider siblings as an integral part of all treatment methods including family and individual therapy. Ultimately the healthy sibling may become a model for healthier behaviors.