Eating disorders are a family disorder; everyone in the family is impacted. Regardless of how the eating disorder presents, family members are often worried, angry, and find themselves in various situations that prompt intense emotional reactions from the sufferer. Typically, when clients enter treatment, they involve their parents and significant others, but siblings are often left out of the equation. I am often surprised to hear from my outpatient clients that their siblings have never been involved in their family therapy. When I was working at an eating disorder treatment center, we worked hard to get siblings to join our family group and sessions, but we often were met with hesitation.  

The excuses are vast as to why siblings are not able to or uninterested in attending treatment. There is often a mixture of reasons: they’re too young, they have their own mental health issues, there is discord between the siblings, the client doesn’t want them involved, the sibling doesn’t want to be involved, etc. The problem is, those excuses may be hindering the sibling and client from truly processing the experience and the effect on the family system. Siblings are often left feeling powerless, helpless, and invalidated throughout their sibling’s eating disorder. As a result, the conflict between siblings may potentially exacerbate eating disorder symptoms.

 In many families, the eating disorder takes over relationships by halting communication, placing unrealistic expectations on family members, and increasing the likelihood of ongoing family discord. Research suggests that siblings who endorsed a balanced caregiving role towards the sufferer felt more satisfied with their role in the family dynamic. Avoiding siblings in treatment can perpetuate sibling discord and overall ruptures in the family dynamic.

This topic is near and dear to my heart. When I was 17, I was undergoing eating disorder treatment; my brother, 10, and my sister, 14, where highly aware of my eating disorder. Although I never talked to them about it directly, eating disorders hold families hostage. Each time my parents had to leave them to take me to an appointment, each time my parents had tearful, hushed conversations about my care, each time I ruined a family dinner or vacation with my outbursts over a meal, I took a tiny piece of their childhoods with me. Sufferers are often not aware that this is happening, and when they are, it often adds to their guilt and shame about the illness. I was not myself. I was surviving a deadly illness, and I had no idea how my behaviors could affect my family. And, although it’s been 14 years since I embarked on my recovery journey, my siblings still resent me for taking away a portion of their childhood. Despite the drastic effect, my illness had on my entire family, and my siblings were never involved in my treatment.

 Despite them never being involved therapeutically, they were probably my strongest allies in recovery. Both of them, never having struggled with disordered eating, served as role models for me as to what healthy relationships with food could look like. They both ate when they were hungry, stopped when they were full, and never thought about it again. Of course, I doubted if that was possible for me, but I was intrigued by their carefree attitude towards food, and although it was hard to admit it, I wanted that life. How powerful it could have been to have them involved in my treatment! Having my siblings in family therapy may have allowed me to communicate how they inspired me and consequently help them feel empowered in the process, and maybe chip away at some of their fear!

As with most things in life, balance is vital. In no way am I, implying that it is a sibling’s job to save someone with an eating disorder. Instead, I am requesting that we get rid of the elephant in the room. Siblings know far more than parents, and sufferers realize that. By involving them in care and helping them process their own experience related to the eating disorder, we can perhaps prevent a lifetime of resentment and decades of secrecy!

My younger brother and sister at my graduate school graduation back in 2012