When a Sibling Has an Eating Disorder

Eating disorders effect the entire family, not just the individual diagnosed with the disease.  Each family member deals with unique emotions and challenges as he or she journeys with the affected loved through illness and toward recovery.  While parents play the role of primary caregiver, siblings play a different but often equally important role.  If brothers and sisters can navigate the confusing and often disparate feelings and thoughts that come along with having an ill sibling, they can become an invaluable companion and ally to that sibling in the fight against ED.

Finding out a sibling has an eating disorder can bring up a lot of different feelings.  A sibling’s first reaction might be fear or confusion, often stemming from lack of knowledge about the disease.  Confusion about why this has happened to the family can lead to feelings of guilt, anger and fear.  A sibling can often feel angry that the ill family member has taken priority in the family circle, or that the sibling with the eating disorder is to blame for unwelcome changes in family routines and/or the home environment in general.  “Healthy” siblings can feel isolated or neglected because the majority of the parents’ time and energy is given to the “sick” sibling.  Previously commonplace questions from parents, friends or teachers like “How was your day?” or “How are you doing?” can suddenly be conspicuously replaced by questions about the status of the ill sibling.

A variety of other emotions are likely to be experienced at different times as the ill sibling moves through the processes of diagnosis, treatment and recovery.  Commonly experienced emotions include grief and sadness, for a variety of reasons.  There are many losses that come along with eating disorders: loss of the “old” sibling relationship and loss of the way the family used to interact and function are difficult changes to seemingly unshakable institutions.  It isn’t easy for family members to see loved ones in distress, and eating disorders often cause a great deal of anguish for all involved.  The stress level in the home usually rises greatly when a family member is struggling with an Eating Disorder; often parents don’t have the time or energy to recognize the pressure the unaffected sibling is under.  The “healthy” sibling may be even further stressed by not wanting to talk about their uncomfortable feelings with their already-burdened parents.  They may feel pressured to be the “good” kid, and not cause any additional problems.

Sometimes they just have questions:  Why is this happening?  Is he/she ever going to get better?  What can I do to help?  What should I NOT do or discuss with them?  Often parents feel conflicted about whether or not to involve siblings in the treatment of the affected child.  There is no one “right” answer to these difficult questions, but the right treatment team can provide guidance and helpful information.


Teen Eating Disorder Signs

Early adolescence is a tumultuous time for teens and parents. Add a possible eating disorder into the mix, and things can feel downright out of control.  Eating disorders are sneaky.  Rarely does a teen with Anorexia or Bulimia identify a problem and ask his or her parents for help; far more commonly, the teen says that everything is fine, and repeatedly denies symptom use.  So what is a parent to do?  How does Mom or Dad know there might be a problem if the teen in question is denying anything is wrong?  Thankfully, there are some clues (both physical and psychological) that can alert parents to the need for more thorough investigation and evaluation.  Lets take a look at them by diagnosis.

A teen with Anorexia Nervosa will usually restrict food and have ›noticeable weight-loss.  Clothes will fit more loosely, or she may start wearing very baggy clothes to hide her body. She might spend excessive time in front of the mirror, and make disparaging comments about her body or appearance.  She may lose interest in doing social things or other previously-enjoyed activities. She may be moody, irritable or depressed, have difficulty concentrating, or look very sad or withdrawn.  Sometimes school performance drops, but other times grades continue along their typical trajectory (which may be quite good).

Her concern about weight gain or the desire to lose weight may come up in conversation with family or friends.  Any comments from others telling her she looks normal are met with disbelief; this cognitive distortion (inability to see her body the way others see it) is a core part of the disease.  She may stop getting her period.  Sometimes fine, thin hair called lanugo begins to grow over her body.  Her skin may become dry and dull, hair less shiny, and eyes sunken or hollow. Eating patterns change: she may skip meals, refuse to eat in front of others, take very small portions, or no longer eat the variety of foods she once did.  She may say she “already ate,” or “had a big meal earlier” in the day and just isn’t hungry.  Diet drinks and calorie-free caffeinated beverages are consumed frequently, sometimes in the place of meals or snacks.  

A teenager with Bulimia will have certain symptoms in common with one struggling with Anorexia.  Commonly shared warning signs include discomfort with her body, dieting behavior, moodiness and irritability, and frequent comments about her “need” to lose weight.  Additionally, she may eat unusually large amounts of food, eat particularly quickly, eat when she isn’t hungry, eat alone, and eat past the point of comfortable fullness.  Like the teen with Anorexia, she may not want to eat in front of others.  She may also go to the bathroom after meals or snacks (to purge by vomiting), or may exercise intensely and for long periods of time to “make up” for what she has eaten.  She may buy laxatives, diet pills, or weight-loss supplements, though these are commonly well-hidden from friends and family.  

Like a teen with Bulimia Nervosa, someone with Binge Eating Disorder may be observed ›eating unusually large amounts of food, ›eating quickly and past the point of comfortable fullness.  Experiencing negative feelings after overeating, or noticeable weight gain are also common.  Like with all eating disorders, an increase in emotional ups & downs, anxiety or irritablility is common, and often observable by friends and family members.

Non-eating-related behavioral changes can also be indicators of a possible eating disorder.  Behaviors such as ›self-harm (cutting or burning) and wearing long sleeves or bracelets at all times to hide self-induced injury are sometimes present in patients with eating disorders.  She may avoid discussion of stressors or emotional topics, which can be frustrating for concerned family members.  Development of an obsession w/ recipes and cooking shows could be warning a sign that your teen has a serious problem.  Going to “Pro-ANA / Pro-MIA websites” (sites that glorify eating disorders and give instructions on how to have one), as well as frequently getting on the scale to monitor his/her weight are also indicators that intervention is needed.

The bottom line is: eating disorders are serious, life-threatening conditions.  If you see any of the above signs, don’t hesitate - seek professional help right away!


Depression: Common Symptoms

Have you ever been worried about someone because they’ve started acting differently?  A friend, a loved-one, a coworker?  Maybe even a child or teen you know?  You might sense that something’s not right, that they’ve changed, and not in a positive way.  They might be more irritable or moody or perhaps just more withdrawn... and its not a fleeting change - it lasts for weeks, maybe even months.  This isn’t something to ignore, even if you’re not very close to the person; this could be Major Depressive Disorder, a very severe, debilitating and sometimes lethal illness that requires treatment.

Depending on how close you are to the person in question, you might notice a  persistent sadness about them.  Requests to hang out, or participate in activities once enjoyed are met with refusals, excuses and weak smiles, perhaps even promises of “next time, definitely,” or “I’ll take a rain check.”  The person’s appetite or body weight may change.  Their performance at work, and motivation to keep appointments may decline.  It may even seem like the person doesn’t care that things they once took pride in are slipping away.  

If the sufferer is school-aged, he or she may have difficulty articulating emotions or moods which can lead to acting out or misbehavior instead of

communicating about feelings.  School performance may decline, and a once diligent student may begin failing tests or not completing assignments.  Sometimes the depressed person’s body lets him or her know that things aren’t okay by increasing numbers and frequency of physical complaints such as stomachaches, headaches, and tiredness.  Sometimes a depressed teen will insist that they are fine, but admit to feeling"bored" on a regular basis.  Nothing, even previously enjoyable activities or people, seems to ease the boredom.  Finally, a school-aged child who was previously engaged with friends and extracurriculars may become socially isolated and drop out of activities.


Other symptoms the depressed person might be experiencing include problems sleeping (too much or too little, waking up early in the a.m. and being unable to fall back asleep).  They may feel incredibly tired, and once previously-easy tasks might feel overwhelming and exhausting.  It may be hard to get out of bed, or get off the couch.  Concentration is often impaired; reading, writing, working or even following conversations is difficult or impossible.  On the inside, the person suffering from depression may be experiencing feelings of worthlessness, hopelessness and helplessness.

In some cases, the depressed person may also experience recurrent thoughts of death or suicide, the most dangerous symptom of depression.


Having a friend or relative who suffers from depression is not an uncommon experience.  It is estimated that 20 million Americans suffer from this disorder, which is caused by a combination of genetic, biological, environmental, and psychological factors.  It is as legitimate a medical illness as high blood pressure, diabetes or cancer.  It is not a sign of weakness, or something that someone can just ‘get over.’ Telling someone to ‘pull themselves out of it’ only further demoralizes the sufferer.


Thankfully, there is help.  If someone you care about is depressed, it affects you too. The most important thing you can do is help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor.  Since individual therapy, group therapy, and treatment with an anti-depressant medication are all viable parts of a potential treatment plan to help your loved one, multiple visits may be necessary, especially in the beginning stages.  Seeking an appointment with a primary care doctor with whom your friend already has a relationship may be a good place to start.  Talking to a psychiatrist or psychologist in your area, or the counselor at your loved one’s school may also be useful.

Encourage your loved one to stay in treatment, or to seek different treatment if no improvement occurs after 6 to 8 weeks.

In the meantime, the following guidelines may be useful in dealing with the depressed person you care about:

  • Offer emotional support, understanding, patience, and encouragement.

  • Talk to him or her, and more importantly, listen carefully.  

  • Don’t say, “You shouldn’t feel that way,” or otherwise minimize or invalidate their experience.

  • Don’t dismiss feelings (even if they seem illogical or far-fetched), but point out realities and offer hope.

  • Never ignore comments about suicide, and report them to your loved one's therapist or doctor.  If suicide is imminent, call 911.

  • Invite your friend out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.

  • Offer to help your family member get to their doctor's appointments or remember to take medications.

  • Remind your loved one that with time and treatment, the depression will lift.


Borderline Personality Disorder

BPD:  a personality disorder is “an enduring pattern of inner experience and behavior” that meets the following criteria:


  • deviates from the expectations of the individual’s culture (e.g., is not what would be normally expected from a person in their particular culture)

  • is pervasive and inflexible (e.g., affects all aspects of a person’s life and is not easily modified depending on the situation)

  • has an onset in adolescence or early adulthood

  • is stable over time

  • leads to impairment or distress

problems in interpersonal relationships, self-image, emotions, behaviors, and thinking.


-Borderline personality disorder accounts for only about twenty percent of hospitalizations

-bipolar accounts for about fifty percent of hospitalizations.

-Borderline personality disorder is most common in young women

- bipolar is equally common in both men and women, as well as all age groups.

-both experience mood swings that may involve violent outbursts, depression, or anxiety.


1. People with BPD cycle much more quickly, often several times a day.

2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.

3. In people with BPD, the mood swings are more distinct. Linehan says that while people with bipolar disorder swing between all-¬encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."


Biologically, individuals with BPD are more likely to have abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes


BPD is associated with specific problems in interpersonal relationships, self-image, emotions, behaviors, and thinking.


  • Relationships

  • People with BPD tend to have intense relationships characterized by a lot of conflict, arguments, and break-ups. BPD is also associated with strong sensitivity to abandonment, which includes intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment.

  • Self-image

  • Individuals with BPD have difficulties related to the stability of their sense of self. They report many "ups and downs" in how they feel about themselves. One moment they may feel good about themselves, but the next they may feel they are bad or even evil.

  • Emotions

  • Emotional instability is a key feature of BPD. Individuals with BPD may say that they feel as if they are on an emotional roller coaster, with very quick shifts in mood (for example, going from feeling okay to feeling extremely down or blue within a few minutes). BPD is also associated with feelings of intense anger and emptiness.

  • Behaviors

  • BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous sex, or binge eating. In addition, people with BPD are more prone to engage in self-harming behaviors, such as cutting, or to attempt suicide.

  • Stress-Related Changes in Thinking

  • Under conditions of stress, people with BPD may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm), or dissociation (feeling spaced out or numb).


  • many people diagnosed with BPD have experienced childhood abuse or neglect, or were separated from their caregivers at an early age. However, not all people with BPD had one of these childhood experiences (and, many people who have had these experiences do not have BPD).

There is also evidence of genetic contributions and differences in brain structure and function in individuals with BPD.



Bipolar Disorder

Bipolar disorder, sometimes called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). 

Common signs and symptoms of mania include:

  • Feeling unusually “high” and optimistic OR extremely irritable

  • Unrealistic, grandiose beliefs about one’s abilities or powers

  • Sleeping very little, but feeling extremely energetic

  • Talking so rapidly that others can’t keep up

  • Racing thoughts; jumping quickly from one idea to the next

  • Highly distractible, unable to concentrate

  • Impaired judgment and impulsiveness

  • Acting recklessly without thinking about the consequences

  • Delusions and hallucinations (in severe cases)

A person must have had a manic (or hypomanic) episode to be diagnosed with Bipolar Disorder,  although the most common mood-state in people with this disorder is by far, Depression.  


Mood Swings: Is It Bipolar Disorder?

I can’t count the number of times I’ve heard people talk about mood swings (their own or someone else’s) and conclude that the person in question has Bipolar Disorder. While it is true that people who have Bipolar Disorder do have mood swings, there are very specific symptoms that distinguish the mood swings of someone with this severe and often debilitating disorder from the mood swings of someone with less intense issues.

Hopefully this article will work to help clarify what can be a very confusing (and important) topic.

First of all, Bipolar Disorder isn’t that common: about 4% of the US adult population carries this diagnosis, and somewhere between zero and 3% of children and adolescents suffer from the disorder.  (There is some debate over how exactly to classify these mood changes in younger people.)  It typically begins in late adolescence.

Like all mood disorders, having a family member with the disorder increases your risk for developing that same disorder (or another mood disorder).  Other factors that can contribute to the development of Bipolar Disorder include experiencing a stressful life event, being in your late teens or early twenties, and using alcohol and drugs

Bipolar Disorder is doesn’t always occur alone.  Many people with this condition also suffer from Anxiety Disorders (PTSD and Generalized Anxiety to name a few), ADHD, and Substance Use Disorders. People with the aforementioned diagnoses can also (independently of Bipolar Disorder) have ‘mood swings’, which further complicates the diagnostic picture.  It is important to treat the whole person, not just the disorder, so these other conditions need to be addressed also.  People with the aforementioned conditions (whether or not they have Bipolar Disorder also) can have mood swings.  This further complicates the diagnostic picture, making it even more imperative for someone with fluctuations in mood that interfere with their day-to-day functioning get evaluated by a mental health provider skilled in making these sometimes tricky distinctions.

The mood swings in Bipolar consist of Manic episodes alternating with periods of depressionmixed episodes (symptoms of depression and mania together) or relatively normal moods.  Although people who have Bipolar Disorder can certainly be irritable or have outbursts, their moods are generally more prolonged and last several days to weeks or even months. In rare cases moods may shift as many as several times per day, but it is much more common for mood states to last for longer periods of time.  The most common mood for someone with Bipolar Disorder to be in is a depressed one.  


Even though Depression is the prominent mood state seen in people with Bipolar Disorder, someone has to have had a period of Mania to be officially diagnosed with Bipolar Disorder.


What is Mania?  It is, in a sense, the opposite of Depression, but with some additional features.  Common signs and symptoms of mania include:

  • Feeling unusually “high” and optimistic OR extremely irritable

  • Unrealistic, grandiose beliefs about one’s abilities or powers

  • Sleeping very little or much less than normal, but feeling extremely energetic

  • Talking so rapidly that others can’t keep up

  • Racing thoughts; jumping quickly from one idea to the next

  • Being highly distractible and unable to concentrate

  • Impaired judgment and impulsiveness

  • Acting recklessly without thinking about the consequences

  • Delusions and hallucinations (in severe cases)

  • Thinking about sex a lot and acting promiscuously


For more information on symptoms of Depression, click here. Link to blog on depression.


Bipolar Disorder in children and adolescents can present somewhat differently from that in adults.  Its clear, though, in the description of possible manic symptoms in children and teens below that the similarities are many.


During a manic episode kids may:

  • Feel very happy or act silly in a way that's unusual for them

  • Have a very short temper

  • Talk really fast about a lot of different things

  • Have trouble sleeping but not feel tired

  • Have trouble staying focused

  • Talk and think about sex more often

  • Do risky things (drive fast, spend lots of money, have unprotected sex, use drugs or alcohol)

  • Have delusions of grandeur or paranoia

-aggression or temper tantrums.

- have sudden outbursts of anger or crying jags

- show agitation or restlessness

- perceive themselves to be fine, blaming conditions or people in their environment for their difficulties.

-can have psychotic symptoms (hallucinations, delusions)

- may be very difficult to tolerate / work with


Thankfully, Bipolar Disorder, once diagnosed, can be treated successfully with medications and psychotherapy.  There is no cure, but it can be managed (just like any other chronic illness).  Diagnosis may take several months to years, given the cyclic nature of the condition.  Staying on medication and maintaining a good relationship with a trusted psychiatrist are both musts!


A disorder commonly confused with Bipolar Disorder due to a great number of shared symptoms, is Borderline Personality Disorder.  For more on this topic, click here....


Effective Parenting classes

Behavioral parent training programs have been in use for many years and have been shown to be very effective.

Although many of the ideas and techniques taught in behavioral parenting classes are "common sense," most parents need careful teaching and support to learn and implement effective parenting skills in a consistent fashion. Help from a professional is often necessary, especially if your child is "oppositional," "explosive," or has ADHD.  Effective Parenting Classes at Developing Minds are specifically tailored to the needs of a particular child and family.  Classes focus on your individual areas of need, but topics covered typically include: improving communication skills (between parents, and between parent and child), boundary and limit setting, co-parenting teamwork/challenges, and dynamic use of rewards and discipline.

Individual classes are offered through a series of sessions at our clinic at the "Individual therapy" rate.

Group parenting classes (ideal for "mom's groups" or neighborhood organizations) offer the convenience of having a child mental health professional provide teaching and answer questions in a setting of your choice.  Call (919) 794-3919 for details.