How Siblings can Support their Brother or Sister with an Eating Disorder
Most childhood eating disorders will affect not only the child suffering but the whole family system.
This includes everyone from parents, grandparents, aunts and uncles, family friends to immediate siblings, both living in the home and not. When it comes to getting siblings involved in treatment, it can get complicated and seem unnatural to parents at first. Think about it- did you bring your child’s brother or sister to their last therapy appointment? Would you require them to attend their siblings parent-teacher conference? Unless it was for childcare reasons, I’m going to guess, probably not.
We don’t tend to involve siblings when a serious mental or physical health concern is going on. That could be for protection, because of their age. There can be the thought, “oh they are too young to understand”. It could be because it’s difficult logistically, “how can I expect my 10 year old to skip baseball to come to these appointments?” It can be because the eating disorder has caused tension or stress in the sibling relationship already, “how can I ask her sister to come talk about our sick daughter for another hour when she already feels like her sisters eating disorder is taking over her life?”
Trust me, these are all VALID points that I understand and empathize with.
As families, we have only become busier and life more chaotic within the last 25 years. With an eating disorder in the picture that likely means more appointments, more therapy sessions, more obligations and more shuffling from place to place. It is not easy to figure out how your family will be there to cover meals, let alone weekly therapy sessions with the entire family.
Yet- it is what I am going to recommend you try to do.
FBT or family-based treatment, recommends that all family members living in the household be present for appointments.
These are typically one hour a week. With technology, many of these appointments can be virtual which can be a huge help when trying to get everyone together. One parent could even join from the office, and a sibling from their car after school. Technology has given us the gift of time and convenience. Logistically, it is not easy to get the family together for an hour a week, but let me tell you why your sick child needs it.
If you have been dealing with the eating disorder for a while, you will concur that it has impacted everyone living in your home.
Whether that be because meals look different now- maybe you have all started eating “healthier” to accommodate your sick child- with good intentions at first! But now that means that “pizza Friday’s” are no longer and your other children are missing that. Maybe you can no longer go out for ice cream on a summer evening the way you used to before the eating disorder. Maybe you haven’t bought the fun foods you used to buy for your kids and the house is full of things your sick child MIGHT be ok with eating.
On top of food and meal changes at home, I can imagine there is more stress than ever before. This is likely palpable to everyone and even more prominent during meal times. Tension, stress, yelling, name calling, refusing to eat what you cooked, leaving the table, throwing things- these are all common things I’ve heard from parents of children with eating disorders. And all of these parents tell me they would have never accepted these behaviors from their child before the eating disorder showed up. It can be such a difficult road to navigate when your child does not seem like your child anymore. Siblings see these escalations and feel the tension.
They can tell their parents are stressed and something is going on with their sibling, but they may not understand why.
If the eating disorder is not talked about openly and honestly in an age appropriate way with siblings, it can leave them to fill in the blanks with their imagination. They may worry that their sibling will never get better.
They may long for the sibling they used to know while being so frustrated with the way their sibling acts now. They may be scared for their siblings life, while also being frustrated that because of their sibling they can’t do things they used to do together anymore. They may be struggling with their own emotions, but know their parents are already stressed and not want to bring anything to them.
Siblings of children with eating disorders can go through a range of complicated and contradictory emotions. Family therapy is just the place to process them. It allows them dedicated time and space to share their emotions with the family. It gives them an opportunity to be heard and validated. The therapist can also provide age appropriate materials and education about eating disorders, which can help siblings understand more and in turn, be more understanding with their siblings outbursts and struggles.
So what does it look like for siblings to be involved outside of coming to therapy sessions?
Younger children love to be involved and feel helpful. They can support their sick sibling by doing something nice for them- drawing a picture or doing a chore for that sibling. They may invite them to play a game after dinner to keep the sick sibling occupied and help with racing thoughts.
Older siblings can be a system of support when a child feels like their parents are against them. Siblings can align with their sick brother or sister and listen to them when they feel parents are being unfair. It is important your child with an eating disorder has an outlet and someone to talk to. Often times, siblings understand what is going on the most and can be a great resource. They can also offer to keep them distracted when eating disorder thoughts are loud by watching a movie or going on an errand.
It’s important that siblings are heard during therapy and have a chance to let their I’ll sibling know how the ED IS affecting them. Though this is hard to hear, it can be a connection point and can sometimes be motivating for the sick sibling to want to make things better for the family.
Another important thing to remember is that it is not recommended for siblings to be in charge of meals or monitoring during meals.
We want to keep the sibling relationship strong and as an ally for the sick child. Siblings may feel torn if they are tasked with watching for behaviors (throwing food away, exercising, purging). They want to tell on the eating disorder, but they also don’t want their sibling to be mad at them. Be sure to have an open family conversation about everyone’s roles in treating the eating disorder. Parents and caregivers (grandparents or other adults) are in charge of meals and battling eating disorder behavior; siblings are for emotional support and fun distraction during hard times. The exception to this would be if there is an adult sibling living outside the home.