Me and My Sister: Being a sister for Woman that Coping with an eating disorder

The purpose of this study was to examine the similarities and differences between sisters of young women with an eating disorder in the family and sisters of young women without an eating disorder in their body image, perception of the relationship with the sister, attachment style, differentiation of the self, and perception of parental attitude. In addition, the purpose of the study was to examine the contribution of personal resources to the sisters' body image perception and sister relationships and to examine the moderating role of parental attitude in the relationship between resources and body perception and sister relationships.

The present study is based on a quantitative study in which 29 sisters, young women aged 18-35, who have sisters with an eating disorder participated. The comparison group included 29 sisters of young women aged 18-35, whose sisters did not have an eating disorder. The qualitative study involved 5 sisters of young women with an eating disorder who agreed to be interviewed. The subjects and their families were contacted via social media, forums, and support groups for patients with eating disorders.

Each participant was asked to complete self-report questionnaires, which included demographic background variables, an attachment style classification questionnaire, a self-differentiation level questionnaire, a sibling relationship questionnaire in adulthood, which included the perception of unequal parental treatment, and a body image questionnaire.

The findings indicate that sisters of young women with eating disorders reported higher levels of avoidant and anxious attachment, higher levels of unequal father-mother treatment, as well as negative body image, and lower levels of warmth and closeness in sisters’ relationships compared to sisters without the disease. However, no significant difference was found between the two groups in terms of sisters’ conflict.

The regressions showed that among the sisters, the younger the sisters were, the more conflictual their relationships with their sisters were. Also, the greater the age gap between the sisters, the more warmth and closeness their relationships were. Among all the sisters, the more avoidant attachment and unequal maternal treatment they reported, the lower their levels of warmth and closeness with their sisters. Unequal treatment from the father predicted conflictual relationships with the sisters and more negative body image.

Regarding interactions, among the sisters of young women with an eating disorder, the higher the levels of unequal treatment from the mother, the more negative the perception of body image. Furthermore, among sisters who reported higher levels of unequal treatment by the mother, the higher the avoidant attachment, the lower the levels of warmth and closeness in the sister-sister relationship. Likewise, among sisters who reported higher levels of unequal treatment by the father, it was found that the higher the avoidant attachment, the more negative the body image.

These findings indicate that the consequences of an eating disorder in one of the daughters of the family on her sisters are expressed in many areas. Their attachment style is more anxious and avoidant. In addition, from their perception of their parents, it is evident that they felt discriminatory treatment by both parents towards them. Another difference was expressed in a more negative body image of sisters of a young woman with an eating disorder due to the emphasis in society in general and the family focus on nutrition, thinness, and external appearance. It is possible that the findings indicating low levels of warmth and closeness between sisters, but also low levels of conflict, are related to the fact that over the years, despite the complex relationship between them, the sisters focused on maintaining positive relationships with their sisters and avoided negative interactions and creating an atmosphere of tension with them. In other words, even if they avoided conflict due to their sensitivity to vulnerable sisters, they still did not develop warmth and closeness between them.

An overview of sisters’ relationships and body image perception reveals the importance of avoidant attachment and the parental attitude of the mother and father. Naturally, in this unique context, when the sister feels that the parents' resources are devoted to the sister with an eating disorder and she copes alone without parental support, anger, insult, and a desire to distance herself from her sister arise. Moreover, when this sister is characterized by avoidant attachment, she will have difficulty trusting others and sharing her distress, and thus she remains lonely and unsupported.

Despite the relatively small sample, in which 5 sisters of young women with an eating disorder were interviewed, the findings in the qualitative study indicate that some sisters noted the eating disorder as a turning point in which a change occurred, after which the relationship was undermined, while others noted that there was no change after the disorder erupted because the relationship was already shaky before.

Initially, they experienced feelings and sensations of sadness, pain, confusion, lack of understanding alongside optimism and hoped that the situation would change soon. Over time, feelings of fear, anger, worry, helplessness and sorrow for the sister who had to deal with the illness arose, as well as feelings of self-blame, frustration, failure and shame. Furthermore, the findings indicate that some sisters claimed that their perception of their body image had not changed, as their body image had been negative since adolescence and was characterized by great complexity, self-hatred, shame, discomfort, and comparison to the ideal of beauty and thinness accepted in Western society. On the other hand, others noted that their body image had improved from negative to more positive, as over the years and adolescence they had gone through a process of acceptance and acceptance and began to feel comfortable with their bodies.

The findings showed that on the family side, there was a feeling that their parents were not available to them, and therefore they competed for their attention. This experience created in them a feeling of anger and frustration towards the parents, the sister, and the situation. Some of them noted that they felt that due to the complex situation of dealing with the sister's ongoing illness, they understood that they had to take on a therapeutic role due to the family pressure that had arisen.

Regarding the social aspect, the findings reveal a feeling of loneliness. The interviewees mentioned difficulty connecting with people in general and with their peer group in particular, since they felt that their lives and coping were different. Some of them described difficulty explaining and mediating the situation to friends and acquaintances outside the family circle, and these feelings caused them to feel distant, lonely, and separated from their peer group.

The findings also show that the sisters adapted different and diverse ways of coping – openness and sharing with others versus hiding and isolating themselves, choosing to accept a parental role, and in return, choosing to leave the house and create distance from the family. Additional strategies related to seeking professional treatment and taking the initiative to learn about the disease because they felt helpless due to a lack of knowledge and tools, and because they did not receive assistance that would help them cope with their sisters’ eating disorder.

The findings showed that sometimes the sisters took on an active therapeutic role and great responsibility and helped the parents cope with their sisters' eating disorder. These tasks of caring for and caring for the sick sister probably developed in the sister a special sensitivity and a sense of desire to treat people. They noted that this feeling probably prepared the ground for future plans and the choice of a profession in the therapeutic field.

The study findings will allow professionals to learn about the relationships between the sisters and to pay attention as early as possible to the sisters' experience and the emotional, developmental and social consequences of their sister's eating disorder on their world, and thus to plan intervention programs that also address the other figures in the family, including the sisters.