Experiences of eating difficulties in siblings of people with anorexia nervosa: a reflexive thematic analysis
Tóm tắt
Siblings of people with anorexia nervosa (AN) have been found to experience strong emotions, changing family roles and poorer wellbeing as a consequence of experiencing the effects of the illness on their sibling and family system. These factors, combined with genetic influences, may put siblings at an increased risk of developing eating disorder psychopathology in addition to other mental health issues. This research aims to explore the experiences of siblings of people with AN who have had eating difficulties themselves and investigate issues that may be important to the development and prevention of eating difficulties in this population. This qualitative study used a reflexive thematic analysis approach. Ten adults who had witnessed a sibling with AN and experienced eating difficulties themselves participated in semi-structured interviews. Participants’ own eating difficulties were affected by the specific experience of witnessing a sibling with AN through mealtimes becoming emotionally charged, an increased focus on body size and diet, and comparisons with their sibling. Difficult experiences, such as marital discord amongst parents were common, as was a difficulty in managing emotions. The onset of AN within the family caused participants to take on caring responsibilities for their sibling and to hide their own difficulties for fear of adding additional burden to their parents. This reduced their perceived ability to access support and for some increased a desire to restrict as a coping mechanism for the stress they were experiencing. Systemic beliefs regarding the value of thinness were prevalent and influential. Protective factors, such as not wanting to become as unwell as a sibling with AN and an understanding of the negative consequences of AN, aided recovery. Eating difficulties in siblings of people with AN may be influenced by competition for slimness, increased focus on diet and body size, and a need to manage difficult emotions. The disruption to social connections and a difficulty finding emotional support that may be experienced by people when a sibling develops AN may further influence susceptibility to eating difficulties. Further research is needed into the best ways to support siblings of people with AN.
This research investigates the experiences of people who have had a sibling with anorexia and had some eating difficulties themselves. Participants described difficult emotions after their sibling developed anorexia and many took on responsibility for helping their sibling. This was a stressful experience which some people managed by restricting their own eating. There was an increased focus on food and body size in the home, and this could also influence participants’ diet. Getting help could be difficult as participants did not want to burden their family with their own difficulties. This research concludes that when treating people with anorexia, the impact on siblings should be considered, and support should be offered to siblings to help them to manage the difficulties that this illness presents.
Tài liệu tham khảo
Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18:31–47.
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry. 2011;68:724.
Eisler I, Simic M, Blessitt E, Dodge L. Maudsley service manual for child and adolescent eating disorders. In: South London and Maudsley NHS Foundation Trust Kingʼs Health Partners. Maudsley-Service-Manual-for-Child-and-Adolescent-Eating-Disorders-July-2016.pdf (2016).
Anastasiadou D, Medina-Pradas C, Sepulveda AR, Treasure J. A systematic review of family caregiving in eating disorders. Eat Behav. 2014;15:464–77.
Zabala MJ, Macdonald P, Treasure J. Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eur Eat Disord Rev. 2009;17:338–49.
Coomber K, King RM. The role of sisters in body image dissatisfaction and disordered eating. Sex Roles. 2008;59:81–93.
van Langenberg T, Sawyer SM, le Grange D, Hughes EK. Psychosocial well-being of siblings of adolescents with anorexia nervosa. Eur Eat Disord Rev. 2016;24:438–45.
Maon I, Horesh D, Gvion Y. Siblings of individuals with eating disorders: a review of the literature. Front Psych. 2020;11:604.
Strober M. Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. Am J Psychiatry. 2000;157:393–401.
Steinhausen H-C, Jakobsen H, Helenius D, Munk-Jørgensen P, Strober M. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations. Int J Eat Disord. 2015;48:1–8.
Benninghoven D, Tetsch N, Jantschek G. Patients with eating disorders and their siblings: an investigation of body image perceptions. Eur Child Adolesc Psychiatry. 2008;17:118–26.
Wunderlich U, Gerlinghoff M, Backmund H. Eating disturbances in siblings of patients with eating disorders. Eat Weight Disord Stud Anorex Bulim Obes. 2004;9:258–63.
Amianto F, Abbate-Daga G, Morando S, Sobrero C, Fassino S. Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology? Psychiatry Res. 2011;187:401–8.
Callio C, Gustafsson S. Living with a sibling who suffers from an eating disorder: a pilot interview study. J Multidiscip Healthc. 2016;9:615–22.
Areemit RS, Katzman DK, Pinhas L, Kaufman ME. The experience of siblings of adolescents with eating disorders. J Adolesc Health. 2010;46:569–76.
Jungbauer J, Heibach J, Urban K. Experiences, burdens, and support needs in siblings of girls and women with anorexia nervosa: results from a qualitative interview study. Clin Soc Work J. 2016;44:78–86.
Maloney MJ, Shepard-Spiro P. Eating attitudes and behaviors of anorexia nervosa patients and their sisters. Gen Hosp Psychiatry. 1983;5:285–8.
Dimitropoulos G, Freeman VE, Bellai K, Olmsted M. Inpatients with severe anorexia nervosa and their siblings: non-shared experiences and family functioning. Eur Eat Disord Rev. 2013;21:284–93.
Thornton LM, Mazzeo SE, Bulik CM. The heritability of eating disorders: methods and current findings. Curr Top Behav Neurosci. 2011;6:141.
Hübel C, Marzi SJ, Breen G, Bulik CM. Epigenetics in eating disorders: a systematic review. Mol Psychiatry. 2019;24:901–15.
Minuchin S, Rosman BL, Baker L. Psychosomatic families: anorexia nervosa in context. Soc Serv Rev. 1979;53:147–51.
Eisler I. The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. J Fam Ther. 2005;27:104–31.
Zarychta K, Kulis E, Gan Y, Chan CKY, Horodyska K, Luszczynska A. Why are you eating, mom? Maternal emotional, restrained, and external eating explaining children’s eating styles. Appetite. 2019;141:104335.
Arroyo A, Segrin C, Andersen KK. Intergenerational transmission of disordered eating: direct and indirect maternal communication among grandmothers, mothers, and daughters. Body Image. 2017;20:107–15.
Bauer KW, Bucchianeri MM, Neumark-Sztainer D. Mother-reported parental weight talk and adolescent girls’ emotional health, weight control attempts, and disordered eating behaviors. J Eat Disord. 2013;1:45.
Blake CE, Bisogni CA, Sobal J, Jastran M, Devine CM. How adults construct evening meals. Scripts Food Choice Appet. 2008;51:654–62.
Izydorczyk B, Sitnik-Warchulska K. Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages. Front Psychol. 2018;9:429.
Yehuda R, Halligan SL, Bierer LM. Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring. J Psychiatr Res. 2001;35:261–70.
Harold GT, Rice F, Hay DF, Boivin J, van den Bree M, Thapar A. Familial transmission of depression and antisocial behavior symptoms: disentangling the contribution of inherited and environmental factors and testing the mediating role of parenting. Psychol Med. 2011;41:1175–85.
Tower RB, Kasl SV. Depressive symptoms across older spouses: longitudinal influences. Psychol Aging. 1996;11:683–97.
Park RJ, Senior R, Stein A. The offspring of mothers with eating disorders. Eur Child Adolesc Psychiatry. 2003;12:1–1.
Rusell GFM, Treasure J, Eisler I. Mothers with anorexia nervosa who underfeed their children: their recognition and management. Psychol Med. 1998;28:93–108.
Allison S, Warin M, Bastiampillai T. Anorexia nervosa and social contagion: clinical implications. Aust N Z J Psychiatry. 2014;48:116–20.
Vandereycken W. Can eating disorders become ‘contagious’ in group therapy and specialized inpatient care? Eur Eat Disord Rev. 2011;19:289–95.
Costa-Font J, Jofre-Bonet M. Anorexia, body image and peer effects: evidence from a sample of European women. Economica. 2013;80:44–64.
Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1:13.
Schmidt U, Treasure J. Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol. 2006;45:343–66.
Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive interpersonal model for anorexia nervosa revisited: the perpetuating factors that contribute to the development of the severe and enduring illness. J Clin Med. 2020;9:630.
Schmidt U, Tiller J, Blanchard M, Andrews B, Treasure J. Is there a specific trauma precipitating anorexia nervosa? Psychol Med. 1997;27:523–30.
Roberts ME, Tchanturia K, Treasure JL. Is attention to detail a similarly strong candidate endophenotype for anorexia nervosa and bulimia nervosa? World J Biol Psychiatry. 2013;14:452–63.
Tenconi E, Santonastaso P, Degortes D, Bosello R, Titton F, Mapelli D, Favaro A. Set-shifting abilities, central coherence, and handedness in anorexia nervosa patients, their unaffected siblings and healthy controls: exploring putative endophenotypes. World J Biol Psychiatry. 2010;11:813–23.
Kanakam N, Raoult C, Collier D, Treasure J. Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: a preliminary investigation in twins. World J Biol Psychiatry. 2013;14:464–75.
Holliday J, Tchanturia K, Landau S, Collier D, Treasure J. Is impaired set-shifting an endophenotype of anorexia nervosa? Am J Psychiatry. 2005;162:2269–75.
Corfield F. Attachment, affect and social processing in eating disorders. King’s College London; 2014. https://kclpure.kcl.ac.uk/portal/files/45170797/2014_Corfield_Freya_1030299.
Halvorsen I, Rø Ø, Heyerdahl S. Nine-year follow-up of girls with anorexia nervosa and their siblings: Retrospective perceptions of parental bonding and the influence of illness on their everyday life. Eur Eat Disord Rev. 2013;21:20–7.
Cook-Darzens S, Doyen C, Falissard B, Mouren M-C. Self-perceived family functioning in 40 French families of anorexic adolescents: implications for therapy. Eur Eat Disord Rev. 2005;13:223–36.
Dimitropoulos G, Klopfer K, Lazar L, Schacter R. Caring for a sibling with anorexia nervosa: a qualitative study. Eur Eat Disord Rev. 2009;17:350–65.
Garley D, Johnson B. Siblings and eating disorders: a phenomenological perspective. J Psychiatr Ment Health Nurs. 1994;1:157–64.
Karlstad J, Moe CF, Wattum M, Adelsten Stokland R, Brinchmann BS. “Putting your own oxygen mask on first”: a qualitative study of siblings of adults with anorexia or bulimia. J Eat Disord. 2021;9:83.
Arcelus J, Haslam M, Farrow C, Meyer C. The role of interpersonal functioning in the maintenance of eating psychopathology: a systematic review and testable model. Clin Psychol Rev. 2013;33:156–67.
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Qual Quant. 2021;56:1–22.
Tobin GA, Rmn R, Rnt R, Begley CM, Rm R, Ffnrcsi R, Tobin G. Methodological rigour within a qualitative framework. J Adv Nurs. 2004;48:388–96.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis. Int J Qual Methods. 2017;16:1–13.
Tsiantas G, King RM. Similarities in body image in sisters: the role of sociocultural internalization and social comparison. Eat Disord. 2001;9:141–58.
Fjermestad KW, Rø AE, Espeland KE, Halvorsen MS, Halvorsen IM. “Do I exist in this world, really, or is it just her?” Youths’ perspectives of living with a sibling with anorexia nervosa. Eat Disord. 2020;28:80–95.
Kupeli N, Norton S, Chilcot J, Campbell IC, Schmidt UH, Troop NA. Affect systems, changes in body mass index, disordered eating and stress: an 18-month longitudinal study in women. Health Psychol Behav Med. 2017;5:214–28.
Costarelli V, Patsai A. Academic examination stress increases disordered eating symptomatology in female university students. Eat Weight Disord Stud Anorex Bulim Obes. 2012;17:164–9.
Ball K, Lee C. Relationships between psychological stress, coping and disordered eating: A review. Psychol Health. 2000;14:1007–35.
Birt L, Scott S, Cavers D, Campbell C, Walter F. Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qual Health Res. 2016;26:1802–11.
Scutt E, Langdon-Daly J, Smithson J. Patient perspectives of the positive and negative aspects of inpatient treatment for anorexia nervosa: a systematic review. 2022.
Breen LJ, Darlaston-Jones D. Moving beyond the enduring dominance of positivism in psychological research: implications for psychology in Australia. Aust Psychol. 2010;45:67–76.
Persico A, Grandclerc S, Giraud C, Moro MR, Blanchet C. “We thought we were alone”: the subjective experience of the siblings of anorexic adolescent patients. Front Psych. 2021;12:664517.