When an adolescent is struggling with an eating disorder like anorexia, it can affect the whole family. Often times, there are siblings within the family system that are impacted by their brother or sister (biological or not) who they see struggling. In some families, the eating disorder may be discussed openly, and in others it may not. When clients enter treatment, what is evident is that there is a change in structure and routine for the entire family.

We have conducted sibling support groups in our intensive outpatient programs in order to provide a space for siblings to have a voice – to ask questions and voice concerns they have regarding eating disorders, and more specifically, their experience with their brother or sister. Through these groups, it is evident that siblings have a lot to ask, say and often contribute:

Siblings can find a sense of connection to other siblings – Groups allow siblings to feel like they are not alone and that other kids have a brother or sister struggling with an eating disorder too. Often they have the same questions and in a group setting they feel safe asking them.

The eating disorder clinic isn’t necessarily a scary place – Visiting the treatment location has been helpful for siblings. They are given the opportunity to have meals with other families going through similar experiences in an environment that often feels supportive and helpful. Without a “picture” of where their sibling is receiving treatment, they often don’t know what to expect. It can be helpful, and relieving, to see the location and where their parents and sibling are three nights a week, when they are not home.

Siblings have questions – Social and environmental factors (i.e. media, peers) influence and shape our perceptions and knowledge about eating disorders. Siblings often learn information about eating disorders which can include myths and misconceptions that are not always true. When able to discuss what they know about eating disorders they are provided with the opportunity to learn more information and contradict any misconceptions.

Siblings are concerned – Many siblings ask questions like: “will my sister/brother ever recover?” “How long will this take?” “Will they ever be like they were before all this?” It can be helpful to create an environment where they can share these concerns as they come up.

Siblings wonder what they can do to help – Many siblings want to help and don’t know how. What, if anything, can they do?

According to researchers, Herrin & Matsumoto, “Siblings, according to the Maudsley Approach, should not take on the responsibility of re-feeding because their role in the process of recovery is to act as a cheerleader and to provide sympathy for the anorexic child.” It is important that siblings know that they are not in charge of their sister or brother’s eating. Many siblings will find it relieving to know that parents are in charge of this and they are not. Therefore, siblings can be a neutral presence at the table and a safe place for their sister or brother to confide in.

Siblings can be allies. Siblings can bring a sense of humor and relief to the family. Siblings often are more open to supporting their brother/sister when they realize that they don’t have to play a role in refeeding. In this sense, the only thing that siblings need to be, is what they already are. Often, it is essential for adolescents to see that while everyone can be supportive, not everyone is associated with the treatment process and specific treatment interventions.

The sibling bond can serve as a relationship. The eating disorder can tend to cause adolescents to isolate. The sibling relationship can serve as a relationship, appropriate to developmental age, for the adolescent, outside of their relationship with parents. This can assist in decreasing isolation and in working toward the ultimate goal – returning to adolescent development. When so much of the client’s time is taken up with meals and snacks, supervised by parents, the sibling can provide a relationship within the home, outside of meals and eating.

Siblings can participate in family meetings & family therapy sessions. Too often, family therapy occurs with the patient and their parents and, at times, with only one parent present. Just as the involvement of either parents, or all primary caretakers, is considered essential to successful outcomes in Family-Based Treatment (FBT), so are all immediate family members considered essential to the process of true family therapy. While it may not be possible or practical for all members to attend each scheduled meeting, major shifts to the dynamics of a family can occur when members who are not consistently present do attend and are able to contribute something that may have been left out previously. The introduction of siblings to family therapy can be an opportunity for new perspectives, a review of progress and challenges within treatment to that point, and a turning point for patients who may have been wondering why “family therapy” has only included part of the family. At times, patients are waiting for something that has already been said to be said by someone else, and siblings who are aware of the hard work and concerns expressed by their parents, are waiting for an opportunity to express their own opinions and concerns. As mentioned above, the presence of siblings can also help to add humor and lighten the mood, or to draw attention to relational patterns that were not evident to the clinician previously.

While we let them know what can be helpful, it is also okay to let them know what might not be helpful. It is okay to let siblings know why what they are doing or saying (i.e., “just eat”) may not be supportive. Without any guidance, siblings may think that what they are doing is helping their brother/sister. They don’t know if we don’t tell them, and it can be most effective to do so in a non-judgmental manner.


About the authors:

Caitlin Shannon, LCSW received her MSW at Salem State University and currently works as a clinician in the adolescent Partial Hospitalization and Intensive Outpatient Programs at Walden Behavioral Care’s Peabody Clinic. Caitlin has worked at Walden since December 2008. During this time, she previously worked as a clinician in Walden’s admissions department and as a mental health counselor on both the residential and inpatient units.

Michael Chiumiento, MA has been working within Walden’s adolescent continuum since 2010. He is a doctoral candidate at Massachusetts School of Professional Psychology/William James College and is currently researching the role of group therapy for parents in successful outcomes of FBT. He has assisted in the development of additional group therapy components for parents, and the dissemination of Dialectical Behavioral Therapy and FBT interventions to adolescent and family within Walden’s Inpatient, Partial Hospitalization, and Intensive Outpatient Programs.