Sibling Relationships in Adolescent Eating Disorder Treatment

This study explored the quality of sibling relationships amongst a sample of adolescent patients receiving treatment for an eating disorder. Despite the importance of siblings in adolescents' lives and the utilization of family-based treatment (FBT) as the gold standard treatment, sibling relationships are often overlooked. When sibling relationships have been investigated in the literature, the story has been one-sided, with patient perspectives being omitted. We sought to understand, through the eyes of the patient, the overall quality of the sibling relationship on four factors: warmth/closeness, relative status/power, conflict, and rivalry, and ways in which the onset of the eating disorder changed the relationship regarding these four factors. Of particular interest was discovering specific behaviors, interactions, and aspects of the sibling relationship that patients felt contributed, either negatively or positively, to their eating disorder and recovery efforts. We also hoped to provide patients the opportunity to share ideas or suggestions that could better support their recovery efforts. Methods: Semi-structured individual interviews (N = 14) were completed with adolescent patients. Data were analyzed using a hybrid inductive and deductive approach and thematic content analysis. Results: After the onset of the eating disorder, participants expressed decreased warmth and closeness, increased conflict, and increased competition for family resources. Siblings were often one of the first in patients' lives to suspect the eating disorder. Helpful aspects included greater understanding of their siblings' condition and increased ability to relate to their siblings' struggles, sibling motivation, and involvement in treatment. Comparison, competition, and invalidating or triggering comments were unhelpful. Patients suggested implementation of sibling education and increased involvement in treatment. A common thread throughout this study is the patients' desire to be fully seen, heard, and understood, which they identify to be a critical aspect of achieving recovery. Conclusions: Findings illustrate the importance of sibling relationships among adolescents receiving treatment for an eating disorder. We demonstrate that siblings can be important resources in prevention and early identification efforts. We echo the voices of our patients and advocate for increased sibling education and sibling involvement in treatment, in hopes that our efforts can better support these patients and their families in their journey to recovery.