Exploring Racial Inequity and Social Injustice of Well Siblings in the Context of Eating Disorder Treatment in Social Work

Background and Purpose: This presentation explores the service provision for siblings of individuals receiving treatment for eating disorders (EDs) and equitable access to services in social work practice. EDs has the highest mortality rate of any psychiatric disorder. With onset often occurring in adolescence, the implications for practice raise questions about available services to siblings. What happens to siblings when existing models of ED treatment target only the affected individual? This is an important question for practice as social workers are at the frontlines of child protection and mental health services. Issues of access and availability of parallel treatment for ‘well’ siblings are issues of social justice as the implications of the deprivation of access to services for maintaining sibling wellness have been seldom considered. Significant cultural and societal factors are linked to body image, ED development, and treatment utilization; yet, existing literature does not give consideration to race. The findings from relevant literature are shared to understand how social work participates in ED treatment. From a racial and social justice perspective, the implications of current treatment practices on sibling wellbeing are examined.

Methods: A scoping review of the peer-reviewed literature of 17 articles was completed to answer the clinical problem of treatment for siblings exposed to EDs. The search terms were: sibling* OR brother* OR sister* OR twin* AND cope* OR coping OR outcome* OR behavio* AND anorexia OR “eating disorder” OR “eating disorders.”

Results: This review aimed to synthesize the impacts of EDs on siblings and to explore social work’s contributions to sibling research in the ED realm. Core themes emerged to characterize the sibling experience. Siblings reported difficulties understanding the illness and perceived differences in treatment by parents relative to their unwell member. Changing familial processes occurred due to the illness’ pervasiveness, and siblings tended to adopt uncharacteristic roles to cope with ED symptoms and adverse family responses. Impacts on siblings were reported to include emotional and psychological distress, body image issues, parental concerns, and some positive outcomes. Siblings also provided recommendations to improve support. Of the extant literature, race is largely unrepresented with only three studies reporting ethnicity. When ethnicity was reported, it was disproportionately White.

Conclusions and Implications: Social justice in clinical practice with families facing EDs means recognizing the profound needs of family members. This review challenges the notion of siblings as ‘the forgotten kin’ by promoting a distinctive view of siblings as indicators of family function and valued members in recovery. The omission of racial identity perpetuates racial inequity and social injustice and compounds existing inequities for ED treatment and support amongst siblings. The literature suggests a stark disconnect between social work’s provision of frontline service and its contribution to research informing clinical practice. Investigating siblings’ responses to the illness is vital to implementing appropriate clinical interventions, and innovative social policy changes in support of sibling populations rely on sound research. Social work’s expertise of family systems and anti-oppressive practice can empower the demand for sibling-centred services with research addressing existing policy gaps.