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Elwyn R, Williams M, Smith E, Smith S. Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes. J Eat Disord 2024; 12:127. [PMID: 39223672 PMCID: PMC11367789 DOI: 10.1186/s40337-024-01078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Research into the risk of anorexia nervosa (AN) has examined twin pairs to further the understanding of the contributions of genetics, trait inheritance, and environmental factors to eating disorder (ED) development. Investigations of twin experiences of EDs have been biologically-based and have not considered the qualitative, phenomenological aspects of twin experiences. A gap in the literature exists regarding understanding of discordant twins with EDs. This research was developed in response, with the aim to deepen understanding of AN in discordant twins and to create novel ideas for further research and testing. The case studies presented in this article provide lived experience insights of two identical discordant twin pairs: one twin pair discordant for longstanding AN and one twin pair discordant for 'atypical' AN (the twin with AN has recovered). The perspectives and experiences of each co-twin (one with AN and one without) explore a number of factors that may have contributed to twin discordance in these cases, and how each twin has responded to the impact of AN in their lives. Through use of first-person accounts in case study presentation, this article centres social justice values of lived experience leadership and involvement in research. This article aims to extend current knowledge and understanding of EDs in discordant twins, particularly regarding risk for ED development, ED duration, diagnosis and treatment, and recovery processes.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and Psychiatry, Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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2
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Heneghan A, Manitsa I, Livanou M, Treasure J. The experiences of having a sibling with an eating disorder: A systematic review of the literature. EUROPEAN EATING DISORDERS REVIEW 2024; 32:382-403. [PMID: 37983651 DOI: 10.1002/erv.3051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Research on carers in the context of eating disorders (EDs) has predominantly focused on parents and offspring, overlooking the adverse effects EDs have on the lives of siblings. This study aims to shift the paradigm by reviewing the literature in this area. To the authors' knowledge, this is the first review of the literature that broadly captured the lived experiences of siblings without being limited by specific search terms such as coping strategies and levels of psychopathology. METHOD Six databases (ERIC, MEDLINE, PsycInfo, Pubmed, Scopus, and Web of Science) were searched using predetermined search strings. Quantitative, qualitative, and mixed methods studies were included as long as they were focused on siblings' experiences of having a brother or sister with an ED. No publication date restrictions were applied, and thorough quality assessments were initially carried out before a qualitative analysis of the data was conducted. RESULTS Twenty-one studies were eligible for inclusion, thematic synthesis yielded six core themes, and 17 subthemes related to the inter- and intrapersonal impacts of the ED on siblings' lives. These themes and sub-themes include fragmentation in family relationships, parentification, and competition and jealousy. CONCLUSION It is of utmost importance to gain a better understanding of siblings' experiences and needs in relation to EDs. The findings are discussed in relation to the existing literature and theoretical and clinical implications, for example, tailored approaches accounting for siblings' experiences.
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Affiliation(s)
- Anya Heneghan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ifigeneia Manitsa
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Maria Livanou
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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3
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Jayasinghe A, Wrobel A, Filia K, Byrne LK, Melvin G, Murrihy S, Moller C, Berk L, Berk M, Cotton S. Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis. Psychol Med 2023; 53:6945-6964. [PMID: 37489510 PMCID: PMC10951414 DOI: 10.1017/s0033291723001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI. METHODS Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings' experience were eligible. The literature search was conducted up until 20th October 2022. RESULTS Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99-18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09-27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (β = -16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings' illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings' distress and/or burden. Siblings' experience of wellbeing and caregiving were closely related. CONCLUSION This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.
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Affiliation(s)
- Anuradhi Jayasinghe
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Anna Wrobel
- Orygen, Parkville, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kate Filia
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Linda K. Byrne
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Geelong, Victoria, Australia
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Sean Murrihy
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Carl Moller
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- Orygen, Parkville, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sue Cotton
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Karlstad J, Moe CF, Adelsten Stokland R, Brinchmann BS. "Balancing within a closed family system": a grounded theory study of how family life is affected by having a family member with an eating disorder. J Eat Disord 2022; 10:147. [PMID: 36217195 PMCID: PMC9551600 DOI: 10.1186/s40337-022-00669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This qualitative study explores how having an adult daughter or sister with anorexia nervosa or bulimia nervosa affects the family's daily life. Previous research has focused on the family's role in the development of an eating disorder, while more recently the focus has been on the illness's impact on the family. Caring for an individual with an eating disorder can involve distress, guilt, extra burdens, and unmet needs. By interviewing the family members of adults with eating disorders this study aims to gain insights into how the family members experience the impact of the eating disorder over time. METHODS A constructivist grounded theory approach was comprised to gather and analyse data to develop a theory on how families experience life with an adult daughter or sister with an eating disorder. Semi-structured individual interviews were conducted with 21 parents and siblings from across Norway. RESULTS The participants reported a lack of professional help and the families had to handle the challenges related to the illness themselves, hence being left to themselves as a family was identified as the participants' main concern. To manage this concern the families had to balance a pattern of care within the closed family system, and this comprises the core category of the study. Families balanced a pattern of care by shifting roles, adapting meal routines, and maintaining openness within the family. CONCLUSIONS The findings implicate that families need clarification of roles and responsibilities in relation to the health services in caring for the individual with an eating disorder. More research on taking a family perspective concerning adults with eating disorders is needed.
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Affiliation(s)
- Jannike Karlstad
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Cathrine F Moe
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Berit S Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
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5
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Hutchison S, House J, McDermott B, Simic M, Baudinet J, Eisler I. Silent witnesses: the experience of having a sibling with anorexia nervosa. J Eat Disord 2022; 10:134. [PMID: 36068560 PMCID: PMC9450355 DOI: 10.1186/s40337-022-00655-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study explored the experience of having a sibling with anorexia nervosa and the sibling perspectives on service provision. METHOD Four focus groups were conducted with 14 siblings (8 female, 6 male, age 11-19 years) of adolescents with anorexia nervosa or related restrictive eating disorders. Group discussions were transcribed and analysed using thematic analysis. RESULTS Four themes and eight sub-themes were generated. These illustrated siblings feel greatly affected by the way the family needs to change to support someone with anorexia nervosa. Feelings of ambivalence and acceptance were also evident. They described silencing their own emotions and needs so as not to trouble others, and distancing themselves from their families in order to cope. Some female (but no male) siblings identified an impact on their own perceptions of eating and body image. Siblings generally felt that services had not attended to their needs, and that they had not been appropriately included in treatment. CONCLUSIONS Data from this study suggest the sibling experience needs to be more carefully considered and included in treatment. This may include a more explicit invitation to sessions and a more active discussion about their own needs and useful involvement in treatment sessions. Findings point to ways siblings may be better supported, such as peer support groups.
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Affiliation(s)
- Suzanne Hutchison
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jennifer House
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Beth McDermott
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. .,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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6
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Scutt E, Langdon-Daly J, Smithson J. Experiences of eating difficulties in siblings of people with anorexia nervosa: a reflexive thematic analysis. J Eat Disord 2022; 10:123. [PMID: 35987655 PMCID: PMC9392277 DOI: 10.1186/s40337-022-00646-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/31/2022] [Indexed: 12/03/2022] Open
Abstract
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 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. 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. 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. 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.
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7
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Coleman M, Jones EJ, Hoiles KJ, McEvoy PM. The association between carer self-compassion, expressed emotion, quality of life, and paediatric eating disorder symptoms. Eat Behav 2022; 45:101628. [PMID: 35490441 DOI: 10.1016/j.eatbeh.2022.101628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to investigate carer variables on paediatric eating disorders. We examined whether carer self-compassion, the tendency to treat oneself with kindness during distress and disappointments, was associated with lower carer expressed emotion, and, in turn, whether lower carer expressed emotion would be associated with both higher carer quality of life and lower eating disorder symptoms in young people. Further, we examined whether higher carer quality of life was associated with lower adolescent eating disorder symptoms. METHOD Data were extracted from the Helping out Paediatric Eating Disorders (HOPE) project database. Participants included children and adolescents diagnosed with a DSM5 eating disorder and their primary carer (N of dyads = 359). Primary carers completed the Self-Compassion Scale-Short Form (SCS-SF), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF), and the Family Questionnaire-Expressed Emotion (FQ-EE). Children and adolescents completed an adapted version of the Eating Disorder Examination (EDE). RESULTS As hypothesised, structural equation modelling (SEM) revealed a direct relationship between higher carer self-compassion and lower expressed emotion, and between lower expressed emotion and both higher carer quality of life and lower eating disorder symptoms. However, contrary to our hypothesis, carer quality of life was not significantly associated with paediatric eating disorder symptoms. Expressed emotion carried significant indirect effects between carer self-compassion and (a) paediatric eating disorder symptoms and (b) carer quality of life. DISCUSSION The results highlight the importance of further research to determine whether targeting carer self-compassion is helpful in the treatment of eating disorders in young people.
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Affiliation(s)
| | - Emily J Jones
- Eating Disorders Program, Child and Adolescent Mental Health Service, Perth, Australia.
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Mental Health Service, Perth, Australia
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
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Batchelor R, Cribben H, Macdonald P, Treasure J, Cini E, Nicholls D, Kan C. The experiential perspectives of siblings and partners caring for a loved one with an eating disorder in the UK. BJPsych Open 2022; 8:e76. [PMID: 35322783 PMCID: PMC9059625 DOI: 10.1192/bjo.2022.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Caring for a loved one with an eating disorder typically comes with a multitude of challenges, yet siblings and partners are often overlooked. It is important to understand if current clinical guidance for supporting carers are effective and being utilised for these groups, to help meet their needs. AIMS To identify the experiential perspectives of siblings and partners of a loved one with an eating disorder compared with guidance for improving the adequacy of support provided to carers published by Beat and Academy for Eating Disorders. METHOD Three online focus groups were held for ten siblings and five partners from across the UK (12 females and three males). Carers had experience of caring for a loved one with anorexia nervosa (13 carers) or bulimia nervosa (two carers), across a range of therapeutic settings. Focus group transcriptions were analysed with thematic analysis. RESULTS Four key themes were identified: (a) role-specific needs, (b) challenges encountered by siblings and partners, (c) generic needs and helpful strategies or approaches, and (d) accounts of service provision and family support. CONCLUSIONS Overall, the majority of experiences reported by siblings and partners did not meet the published guidance. Consequently, clinical practice recommendations were identified for services, alongside the charity sector, to take a proactive approach in detecting difficulties, providing skills training and emotional/practical support, adapting/tailoring peer support groups and supporting online facilitation. Our findings part-informed the design of our national online survey on loved ones' experiences of care in eating disorders.
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Affiliation(s)
- Rachel Batchelor
- Department of Psychology, Royal Holloway, University of London, UK
| | - Hannah Cribben
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Erica Cini
- East London Eating Disorder Service for Children and Young People, East London NHS Foundation Trust, UK; and Nutrition Science Group, Division of Medicine, University College London, UK
| | | | - Carol Kan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Rynkiewicz A, Dembiński Ł, Koletzko B, Michaud PA, Hadjipanayis A, Grossman Z, Korslund K, King BH, Treasure J, Peregud-Pogorzelski J, Del Torso S, Valiulis A, Mazur A. Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations. Front Pediatr 2022; 10:806399. [PMID: 35558369 PMCID: PMC9086960 DOI: 10.3389/fped.2022.806399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.
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Affiliation(s)
- Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland.,Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdańsk, Poland
| | - Łukasz Dembiński
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Berthold Koletzko
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Pierre-André Michaud
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Zachi Grossman
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | | | - Bryan H King
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Janet Treasure
- Eating Disorder Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland.,Polish Society of Paediatrics, Warsaw, Poland
| | - Stefano Del Torso
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,ChildCare WorldWide-CCWWItalia OdV, Padova, Italy
| | - Arunas Valiulis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Medical Faculty, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Artur Mazur
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland
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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. [PMID: 34238375 PMCID: PMC8264474 DOI: 10.1186/s40337-021-00440-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In families where one of the siblings has an eating disorder (ED), research indicates that the siblings without eating disorders (EDs) experience insufficient care and negative changes in family life. The illness then takes up a great deal of space within the family. Support from the siblings without EDs is considered to be important for the recovery of the sibling with ED. A key issue is how to involve siblings without EDs in treatment and establish what kind of support they themselves need. A majority of the research on EDs and family has focused on children and adolescents with EDs. The aim of this study is to expand knowledge about the experiences and coping strategies of sisters and brothers of adult women with anorexia nervosa or bulimia nervosa. METHODS This qualitative study used a constructivist grounded theory approach. Individual semi-structured interviews were conducted with 10 sisters and brothers (aged 20-31 years). They were recruited from eating disorders and general psychiatrics units and from user organisations for patients with eating disorders within Norway. An iterative process of data collection, coding and analysis was employed in order to generate a theory about these participants' experiences and strategies. RESULTS The core category is "put your own oxygen mask on first". It indicates that the siblings realize that they need to take care of themselves first, in order to be able to stay involved with their sister with the ED. The three subcategories; "taking a new role", "distancing" and "adapted care" describe how the siblings handle their situation as the relatives of adult sisters with an ED. The siblings without ED became more responsible and independent and assumed a caregiving role. They downplayed their own needs to reduce their parents' burden. This new role became difficult to fulfil and the siblings experienced that over time they needed more distance. Eventually, they developed a more manageable way of caring for their sister. CONCLUSIONS The findings suggest that the ED challenged the boundaries within the family. The siblings without ED assumed a caregiver role, gradually leading to exhaustion and the need to distance from the sister with the ED, to take care of themselves.
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Affiliation(s)
- Jannike Karlstad
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Cathrine F Moe
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
| | - Mari Wattum
- KUN Centre for Equality and Diversity, Nordfold, Norway
| | | | - Berit S Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
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11
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Lockertsen V, Holm LAW, Nilsen L, Rø Ø, Burger LM, Røssberg JI. The transition process between child and adolescent mental services and adult mental health services for patients with anorexia nervosa: a qualitative study of the parents' experiences. J Eat Disord 2021; 9:45. [PMID: 33849646 PMCID: PMC8045171 DOI: 10.1186/s40337-021-00404-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with Anorexia Nervosa (AN) often experience the transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) as challenging. This period tends to have a negative influence on the continuity of care for the adolescents and represents a demanding and difficult period for the parents. To our knowledge, no previous study has explored the parents' experience with the transition from CAMHS to AMHS. Therefore, this qualitative study examines how parents experience the transition process from CAMHS to AMHS. METHODS In collaboration with a service user with carer experience, qualitative interviews were conducted with 10 parents who had experienced the transition from CAMHS to AMHS, some from outpatient care and others from both in- and outpatient mental care units in Norway. All had some experience with specialized eating disorder units. The interviews were analyzed with a Systematic Text Condensation (STC) approach. Service users' perspectives were involved in all steps of the research process. RESULTS Six categories represent the parents' experiences of the transition: (1) the discharge when the child turns 18 years old is sudden; (2) the lack of continuity is often followed by deterioration and relapses in the patient; (3) the lack of involvement and information causes distress; (4) knowledge - an important factor for developing a trusting relationship between parents` and clinicians`; (5) parents have overwhelming multifaceted responsibilities; and (6) parents need professional support. CONCLUSION Improving the transition by including parents and adolescents and preparing them for the transition period could ease parental caregiving distress and improve adolescents' compliance with treatment. Clinicians should increase their focus on the important role of parents in the transition process. The system should implement routines and guidelines to offer caregivers support and guidance during the transition process.
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Affiliation(s)
- Veronica Lockertsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway.
| | | | - Liv Nilsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway
| | - Øyvind Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
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12
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Marinaci T, Carpinelli L, Savarese G. What does anorexia nervosa mean? Qualitative study of the representation of the eating disorder, the role of the family and treatment by maternal caregivers. BJPsych Open 2021; 7:e75. [PMID: 33814024 PMCID: PMC8086394 DOI: 10.1192/bjo.2021.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a serious health problem worldwide. The literature widely recognises the roles of the family and caregivers in modulating the onset, development, maintenance and treatment of this disorder. However, few studies have addressed the problem from the perspective of maternal caregivers. AIMS This study aims to fill this gap by exploring how the meaning given to the term 'eating disorder' influences how mothers communicate with each other about a family member's health problems, how they present symptoms and how this problem is managed. METHOD A narrative research project was conducted to capture the mothers' experiences of living with a daughter diagnosed with anorexia nervosa. In particular, four semi-structured interviews were conducted to explore the ways in which they made sense of the disorder, their roles in treatment and their daughters' treatment experiences. RESULTS The results show that the ways in which mothers characterise the disease guide their method of tackling it and the relationship they have with their daughter, as well as how they see their role in the care and treatment process. CONCLUSIONS Anorexia is experienced as something that is uncontainable, and a dimension of its accommodation characterises the relationship between mothers and daughters receiving treatment for the disorder. Treatment is accompanied by a delegating dimension, and the clinical implications are discussed in this study.
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Affiliation(s)
- Tiziana Marinaci
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Salerno, Italy
| | - Luna Carpinelli
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Salerno, Italy
| | - Giulia Savarese
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Salerno, Italy
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13
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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 Psychiatry 2021; 12:664517. [PMID: 34079486 PMCID: PMC8166282 DOI: 10.3389/fpsyt.2021.664517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: The siblings of patients suffering from Anorexia Nervosa (AN) are potentially affected by a disturbed emotional experience that often remains undetected. In order to bring them a psychological support, the Maison de Solenn proposed a support group program for these siblings. The current research explores their mental representations of AN and their emotional experience in the support group named "sibling group." Method: This exploratory study is based on a phenomenological and inductive qualitative method. Four girls and three boys aged between 6 and 19 participating in the "sibling group" were included in a one-time focus group session using a semi-structured interview guide. The thematic data analysis was performed by applying the methods of interpretative phenomenological analysis. Results: Themes that emerged from the interview fall into four categories: AN explained by siblings; the individual emotional experience of siblings; the family experience of siblings and the experience inside the "sibling group." Discussion: According to our participants, the "sibling group" thus functions as a good compromise between keeping an active role in the anorexic patient's care and taking a step back to avoid being eaten up by the illness. Sibling-group participants retrieved a sense of belonging, which is normally one of the functions of being a sibling. It is important to note that the "sibling group" is part of the comprehensive (or global) family-based approach included in an institutional multidisciplinary integrative care framework.
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Affiliation(s)
| | - Salome Grandclerc
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France.,CESP, Fac. de médecine - Univ. Paris Sud, Fac. de médecine - UVSQ, INSERM ≪ DevPsy ≫, Université Paris Saclay, Villejuif, France
| | | | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France.,CESP, Fac. de médecine - Univ. Paris Sud, Fac. de médecine - UVSQ, INSERM ≪ DevPsy ≫, Université Paris Saclay, Villejuif, France.,Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Corinne Blanchet
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France.,CESP, Fac. de médecine - Univ. Paris Sud, Fac. de médecine - UVSQ, INSERM ≪ DevPsy ≫, Université Paris Saclay, Villejuif, France.,Université de Paris, PCPP, Boulogne-Billancourt, France
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14
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Maon I, Horesh D, Gvion Y. Siblings of Individuals With Eating Disorders: A Review of the Literature. Front Psychiatry 2020; 11:604. [PMID: 32695030 PMCID: PMC7338552 DOI: 10.3389/fpsyt.2020.00604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/10/2020] [Indexed: 01/04/2023] Open
Abstract
Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.
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Affiliation(s)
- Iris Maon
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
- Department of Psychiatry, New York University School of Medicine, New York City, NY, United States
| | - Yari Gvion
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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15
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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:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
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16
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A Comparison of Personality, Life Events, Comorbidity, and Health in Monozygotic Twins Discordant for Anorexia Nervosa. Twin Res Hum Genet 2017; 20:310-318. [PMID: 28535840 DOI: 10.1017/thg.2017.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Genetic and environmental factors contribute to the etiology of anorexia nervosa (AN). The co-twin control design is one of the most powerful methods available to evaluate environmental factors that could contribute to differences between monozygotic (MZ) twins who are discordant for AN. Using available data from a unique and rare sample of 22 Swedish female MZ pairs discordant for AN, we compared personality, life events, comorbidity, and health factors. Twins with AN had significantly higher perfectionism scores than unaffected co-twins and reported younger ages at first diet than unaffected co-twins who had dieted. Consistent with previous literature, more twins with AN reported gastrointestinal problems than unaffected co-twins. Although not significant due to low statistical power, more unaffected co-twins reported experiencing emotional neglect than twins with AN. Early dieting may be a harbinger of the development of AN or an early symptom. Higher perfectionism may represent a risk factor, sequela, or both. Sibling perception of neglect is noteworthy given the impact of an ill child with AN on family function and wellbeing. The health and wellbeing of siblings should be addressed clinically when one child in the family suffers from AN.
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17
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Callio C, Gustafsson SA. Living with a sibling who suffers from an eating disorder: a pilot interview study. J Multidiscip Healthc 2016; 9:615-622. [PMID: 27877051 PMCID: PMC5108610 DOI: 10.2147/jmdh.s115934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Having a sibling who suffers from an eating disorder (ED) has a profound effect on healthy siblings' own health, quality of life and family relationships, yet siblings have been an excluded group within health care, and there is a lack of knowledge regarding healthy siblings' needs and wishes for information and support. Thus, the aim of this study was to examine adolescents' experiences of living with a sibling who suffers from an ED. METHOD In this small-scale pilot study, three boys and two girls aged 15-20 years were interviewed, and the interviews were analyzed by qualitative content analysis. RESULTS This study confirms prior knowledge of adolescents' experiences of living with a sibling who is suffering from an ED. The adolescents were concerned about their siblings and lacked information about their siblings' illness and treatment progress. The girls described that their everyday life had been heavily influenced by their sisters' illness, while the boys described that their everyday life with friends and activities were not affected to such a great extent. One new result that emerged as something positive was that some informants described that although the ED was a source of conflict in the family, it had led to greater awareness of the importance of gaining sufficient energy and had contributed to better meal situations in the family. CONCLUSION Having a sibling with an ED had a profound and negative effect on family relationships, and was often a source of conflict, especially around mealtime. However, it appeared that if parents were able to organize family meals and create an open and supportive climate, the negative effects for the family could be reduced. The health care professionals need to acknowledge the siblings' need for information and support, and support parents in their important role of caring for well siblings.
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Affiliation(s)
- Carina Callio
- Faculty of Medicine and Health, University Health Care Research Center, Region Örebro County, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- Faculty of Medicine and Health, University Health Care Research Center, Region Örebro County, Örebro University, Örebro, Sweden
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18
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van Langenberg T, Sawyer SM, Le Grange D, Hughes EK. Psychosocial Well-being of Siblings of Adolescents with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 24:438-445. [PMID: 27501269 DOI: 10.1002/erv.2469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed. METHOD Eighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment. RESULTS Mothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT. CONCLUSIONS Siblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Australia.,The Royal Children's Hospital Centre for Adolescent Health, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Daniel Le Grange
- Department of Paediatrics, The University of Melbourne, Australia.,Department of Psychiatry, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth K Hughes
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Australia. .,The Royal Children's Hospital Centre for Adolescent Health, Parkville, VIC, Australia. .,Murdoch Childrens Research Institute, Parkville, VIC, Australia.
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19
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Abstract
The aim of this study is to evaluate the recent literature on carers/parenting interventions for people with eating disorders. Interesting and important new findings are highlighted as well as the implications that this may have for treatment. We have reviewed and critically analysed the recent literature. Close others often play an important role in recognising the early signs of eating disorders and accessing and implementing treatment. Their role in helping with recovery is to give support and hold a united front themselves and with the professional team to avoid those common interpersonal reactions that adversely impact on outcome such as accommodating to the illness and reacting with high expressed emotion (overprotection and hostility). Managing this role is difficult, and coping resources are often strained. Carers ask for and are now getting expert training in skills to manage this role. There is an overlap between carer/parenting interventions and family therapies. The interface with close others is critical both for early recognition and access and implementation of treatment. Interventions which equip families and close others with the skills to manage eating disorder behaviours are showing potential at improving outcomes.
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20
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Engman-Bredvik S, Carballeira Suarez N, Levi R, Nilsson K. Multi-family therapy in anorexia nervosa--A qualitative study of parental experiences. Eat Disord 2016; 24:186-97. [PMID: 25879257 DOI: 10.1080/10640266.2015.1034053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.
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Affiliation(s)
- Sofie Engman-Bredvik
- a Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden
| | - Nivia Carballeira Suarez
- a Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden
| | - Richard Levi
- b Rehabilitation Medicine, Department of Community Medicine and Rehabilitation , Umeå University , Umeå , Sweden
| | - Karin Nilsson
- a Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden
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21
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Fox JR, Dean M, Whittlesea A. The Experience of Caring For or Living with an Individual with an Eating Disorder: A Meta-Synthesis of Qualitative Studies. Clin Psychol Psychother 2015; 24:103-125. [PMID: 26472481 DOI: 10.1002/cpp.1984] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/11/2022]
Abstract
Eating disorders (ED) has the highest mortality rate of psychiatric disorders and a high incidence of comorbidity. Because of the average age of onset, care typically befalls family members. However, despite the severity of the disorder and the burden placed on the family, research into the caregiving experience is still developing. Studies have shown caregivers of individuals with ED to experience high levels of distress, burden and expressed emotion. Recent theoretical models have underscored the importance of caregivers' responses as a maintenance factor for the ED, and family therapy has proved efficacious. However, the literature pertaining to the experience of family members living with or caring for an individual with an ED has not been systematically reviewed. This review aimed to synthesize qualitative studies relating to the caring experience and its impact, thereby gaining an understanding from the perspective of the individuals themselves. Relevant search terms were utilized to systematically search key databases. Twenty studies, with a total sample of 239 participants, met the inclusion criteria. Nine core themes emerged from the synthesis, forming the basis of an explanatory theory. The ED was found to have a pervasive impact upon family members, mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation. The majority of studies identified unmet carer needs. The implications of the findings are discussed with reference to existing theoretical models and in terms of clinical practice. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES Carers experience a significant amount of guilt and distress once they have found out about their loved one's eating disorder. Across the studies, there were many themes of unmet need for carers. Siblings have often been overlooked by both clinicians and researchers. Interventions for people with eating disorders should also acknowledge carers and close family members.
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Affiliation(s)
- John Re Fox
- Department of Psychology, Royal Holloway, University of London, Surrey, UK.,Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK
| | - Madeleine Dean
- Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK
| | - Anna Whittlesea
- School of Psychological Sciences, University of Manchester, Manchester, UK
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22
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Fiorillo A, Sampogna G, Del Vecchio V, Luciano M, Monteleone AM, Di Maso V, Garcia CS, Barbuto E, Monteleone P, Maj M. Development and validation of the Family Coping Questionnaire for Eating Disorders. Int J Eat Disord 2015; 48:298-304. [PMID: 25359185 DOI: 10.1002/eat.22367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop and validate a new instrument, the Family Coping Questionnaire for Eating Disorders (FCQ-ED), specifically designed to assess the coping strategies of relatives of patients with eating disorders (EDs). METHOD The study was articulated in the following seven stages: (1) in-depth analysis of scientific literature; (2) focus groups with expert researchers and clinicians in the fields of EDs and family assessment; (3) development of a pre-final version of the questionnaire; (4) recruitment of relatives and patients with EDs; (5) data collection; (6) statistical analysis; (7) finalization of the questionnaire. RESULTS The final version of the questionnaire consists of 32 items, grouped in five subscales ("avoidance," "coercion," "collusion," "information," and "positive communication with the patient"), with a Cronbach's alpha ranging between 0.820 and 0.625. All Items with a Cohen's Kappa > 0.60 were included in the final version of the questionnaire. Factor analysis led to the identifications of two factors, the problem-oriented and the emotion-focused coping strategies. DISCUSSION The final version of the questionnaire shows good psychometric properties, and it requires a short time to be completed. The five subscales correspond to those adopted by relatives of patients with schizophrenia, confirming that relatives of patients with EDs need to be supported and informed on how to cope with patient's disturbing behaviours. This questionnaire may be particularly useful for the development of psychoeducational packages for relatives of patients with EDs and the evaluation of the impact of family functioning on the course of the disease.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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23
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Eating disorders: predictors of change in the quality of life of caregivers. Psychiatry Res 2014; 215:718-26. [PMID: 24418049 DOI: 10.1016/j.psychres.2013.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 01/31/2023]
Abstract
Eating disorders (EDs) have a strong impact on the quality of life (QoL) of caregivers. This study explores the longitudinal changes in the QoL of ED caregivers at 1 (T1; n=109) and 2 years (T2; n=32) follow-up, and identifies predictors of improvement at 1-year follow-up. ED outpatients also completed a battery of tests at T1 (n=69) and T2 (n=11). Multivariate hierarchical linear mixed models were used, in which the caregivers' 1-year changes in QoL, anxiety and depression scores were analysed as the dependent variables. Predictor variables were the caregivers' perception of burden, perception of the severity of the patient's ED, kinship data, and the ED person's scores on QoL, anxiety depression and ED symptoms. Higher scores in mental health and low perception of burden at baseline predicted improved caregiver QoL at 1-year follow-up. The caregivers' QoL improved if the perception of burden decreased over time and if depression of the patient improved. The results suggest that interventions directed to reduce the caregivers' perception of burden and to improve the mental health of the ED patients would lead to improved caregiver QoL. The high attrition rate at T2 made prediction analyses unviable.
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24
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Sanders A, Szymanski K, Fiori K. The family roles of siblings of people diagnosed with a mental disorder: heroes and lost children. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 49:257-62. [PMID: 24990636 DOI: 10.1002/ijop.12020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 07/05/2013] [Indexed: 11/06/2022]
Abstract
In order to cope with the diagnosis of mental illness in a family member, siblings may be forced to adjust their roles in the family. Taking into account the crucial role that some siblings play in caregiving for the mentally ill especially when the parents are no longer available, it is imperative to develop awareness of their unique needs and address them. Thirty-three adult siblings of people diagnosed with a mental disorder completed the Role Behaviour Inventory (RBI) and a general questionnaire including open-ended questions regarding the roles they played in their families of origin. Findings from the inventory and general questionnaire suggest that the well siblings score higher on two roles, the Hero and Lost Child, and lower on the Mascot and Scapegoat roles relative to a comparison group (N = 33). Being a sibling caregiver emerged as a risk factor to assume certain dysfunctional roles in the family. Implications for future research and therapy are discussed.
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Affiliation(s)
- Avihay Sanders
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
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25
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Withers A, Mullan B, Madden S, Kohn M, Clarke S, Thornton C, Rhodes P, Touyz S. Anorexia nervosa in the family: a sibling's perspective. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.839187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Dimitropoulos G, Freeman VE, Bellai K, Olmsted M. Inpatients with severe anorexia nervosa and their siblings: non-shared experiences and family functioning. EUROPEAN EATING DISORDERS REVIEW 2013; 21:284-93. [PMID: 23576477 DOI: 10.1002/erv.2230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/15/2013] [Accepted: 03/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aims of this study were the following: to identify perceptions of patients with anorexia nervosa (AN) and their siblings regarding differential experiences within and external to the family including sibling interactions, parental treatment, relationships with peers and events that are unique to each sibling; (2) to compare how patients and their siblings perceive eating disorder symptoms, parental affection/control, social support and stigma; and (3) to test associations with family functioning for patients with AN and their siblings. METHOD A total of 26 patients paired with their siblings were recruited from an Eating Disorder Program and administered standardized instruments measuring different experiences within and external to the family, the impact of eating disorder behaviours, stigma, social support and family functioning. RESULTS Patients rated high on the differential experience of jealousy in contrast to their siblings. Patients scored higher than their siblings on eating symptoms, whereas siblings scored higher on social support. The impact of AN on the family, stigma towards the individual and family, and social support accounted for 37% of the variance in family functioning from the sibling perspective after controlling for age and gender. Of these variables, impact of AN on the family made the largest contribution. DISCUSSION Family-based and sibling-based interventions that aim to reduce the effects of the illness on the sibling relationship and the family are recommended.
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Svensson E, Nilsson K, Levi R, Suarez NC. Parents' experiences of having and caring for a child with an eating disorder. Eat Disord 2013; 21:395-407. [PMID: 24044596 DOI: 10.1080/10640266.2013.827537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eating disorders (ED) are serious conditions that affect both patients and their families. Little is known about the influence of these disorders on family life in a Swedish population and the ways that affected families actually attempt to cope. The aim of this study was to specifically investigate parental experiences of having and caring for a child with ED. A qualitative approach was used and rich narratives were obtained from interviews with 10 parents. Results promote insights into lived experiences concerning social disruption, emotional impact, and coping strategies related to ED. This knowledge can be utilized to further develop programs to help affected families.
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Affiliation(s)
- Elin Svensson
- a Department of Child and Adolescent Psychiatry , Umeå University , Umeå , Sweden
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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. EUROPEAN EATING DISORDERS REVIEW 2012; 21:20-7. [PMID: 22786711 DOI: 10.1002/erv.2191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few previous anorexia nervosa (AN) studies include siblings. OBJECTIVE To investigate if adolescents with AN retrospectively perceived their parents as less caring and more controlling than their siblings, whether perceived parenting was related to psychological problems, and how AN had influenced their everyday lives. METHOD Forty-six former patients (mean age 23.1 years) and 21 siblings participated in the study by completing the Parental Bonding Inventory (PBI) and a questionnaire on the influence of AN during the acute phase. RESULTS Former patients and their siblings had similar PBI results. Better adaptive functioning and lower levels of internalising psychological problems were correlated with higher ratings of parental care in both patients and siblings. Both patients and siblings reported that the illness had created conflict and caused concern, but had also provided valuable experiences. CONCLUSION Perceived parenting was associated with psychological problems in young adulthood but not with eating disorders. Our PBI results for both former patients and siblings were quite similar to non-clinical control groups. Health personnel treating adolescent AN should be aware of siblings' perspectives and needs.
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Affiliation(s)
- Inger Halvorsen
- Regional Department of Eating Disorders, Department of Mental Health and Addiction, Oslo University Hospital, NO-0424 Oslo, Norway.
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Quality of life among caregivers of patients with eating disorders. Qual Life Res 2011; 20:1359-69. [DOI: 10.1007/s11136-011-9873-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2011] [Indexed: 11/26/2022]
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