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Brothers and Sisters: How They Can Help You Recover

Reprinted from Eating Disorders Today
By Walter Vandereycken, MD, PhD, and Ellie Van Vreckem, MA
Winter 2002 Volume 1, Number 1
©2002 Gürze Books

They may be irritating and impossible at times, but your brothers and sisters may actually help speed your recovery from an eating disorder.

Over the many years that we have worked with families of anorexia nervosa and bulimia nervosa patients, we have learned how helpful brothers and sisters can be and the importance of their relationships with the patient and parents. Whenever possible, we try to involve siblings in therapy, regardless of their age or the fact that they are no longer living at home. All of the siblings are invited to participate, even those who other family members say are "certainly not coming" or "not important." Most brothers and sisters react enthusiastically when asked to participate.

"Younger siblings may feel unfairly excluded if not informed about, or involved in, treatment; and not telling younger children might give the impression that they are part of the problem." —Bulimia: A Guide for Family & Friends by Sherman & Thompson

Why should brothers and sisters be included in treatment?
Siblings help clarify family interactions. First, siblings can help therapists understand and clarify past and present family interactions. They often have surprising and refreshing ideas about how the family functions. In this way, they can act as "consultants" to therapists, especially when issues between family members remain unresolved.

Siblings may act as "nurturers." Brothers and sisters often lean upon each other for support, particularly in families that have poor parenting. One surprise is that real and genuine help is often provided by those siblings from whom one would expect the least help—for example, the "silent" sister who is having problems herself.

We try to understand each sibling's position within the family and ask for everyone's second opinions. If for some practical reason they can't come to the treatment sessions in person, we interview them on the phone or ask them to write us a letter. We explain our treatment principles and goals in separate sessions. Usually siblings understand the significance of the eating disorder and its social effects very well. By understanding what is going on in treatment, siblings can also act as "co-therapists" at home, getting the family involved in discussions or more freely expressing their opinions about daily life.

Siblings can act as role models. Finally, siblings who have independent lives while keeping a positive contact with the parents can act as "models" to help patients make the often-difficult transition from child to independent adult.

Setting boundaries
Siblings can be a tremendous force for good, but can also be part of the problem. For example, a sibling, usually an older brother or sister, can be over-involved or may try to act like a parent. Or there may be sibling rivalry or incest. Each of these problem areas is handled individually, with special sessions.

Although we have only touched on a few aspects of including siblings in treatment, our conclusion is clear: we can learn a lot from brothers and sisters. They help us deepen our understanding of eating disorders and enlarge the scope and potential of treatment.

The Authors
Walter Vandereycken, MD, PhD, is Professor of Psychiatry at the Catholic University of Leuven, Belgium.
Ellie Van Vreckem, MA, is Clinical Psychologist and Psychotherapist at the Eating Disorders Unit of the University Center St. Joseph in Kortenberg, Belgium.

Sisters with Anorexia Nervosa

Question:
Two of our three daughters have symptoms of anorexia nervosa. Is this common, and, if so, why don't all sisters develop it?

Answer:
The fact is, sisters of girls with anorexia nervosa (AN) do have an increased risk of developing this disorder because it does run in families. The good news is that only a few sisters of girls with AN also develop it. Eating disorders do appear to run in families, but we still don't know why some sisters are affected while others are not. A recent study of 45 pairs of sisters gives us a few clues. In that study, those with AN differed from their healthy sisters in several ways. First, they were more perfectionistic and/or more likely to comply with their parents' wishes. Next, they had feeding problems when they were infants. Daughters who developed AN also reported that their parents had higher expectations of them, and that they were highly competitive with their sisters. They thought their sister was their parents' favorite and that she was more attractive than they were. The sisters with AN were also more likely to report sexual abuse. There were no marked genetic differences among the sisters (Psychological Medicine, volume 31, page 317, 2001).

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Additional Resources:
Predicting the Onset of Anorexia Nervosa and Bulimia Nervosa
Preschool Lesson Plan
Pregnancy and Eating Disorders
Prematurity, Birth Trauma Linked to Risk of Anorexia Nervosa
Psychosocial Treatment of Binge Eating Disorder: An Update