Experiences of Eating Difficulties in Siblings of People with Anorexia Nervosa: A Reflexive Thematic Analysis

Background: Siblings of people with Anorexia Nervosa (AN) have been found to experience strong emotions, changing family roles and poorer wellbeing as a consequence of witnessing the illness. These factors, combined with genetic influences, may put siblings at an increased risk of developing eating disorder psychopathology. 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. Methods: 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. Analysis 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. Changing family roles following their sibling’s illness could have influenced the development of eating difficulties, and limited participants’ ability to access support for their own difficulties. Systemic beliefs regarding the value of thinness were prevalent and influential. Possible 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. Conclusions: 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.