Eating disorders: sibling experience and implementing externalisation in FBT

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Lonergan, Katie
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University College Cork
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1. The Experience of Healthy Siblings of People with Eating Disorders: A Systematic Review and Thematic Synthesis Background: Within the area of eating disorders (EDs), research on carers has predominantly focused on the experience of parents and partners of those diagnosed with EDs. This led to siblings being referred to as the “forgotten” kin. Sibling relationships play an important and often long-standing role in peoples’ lives. Having a sibling with an ED can impact on healthy siblings in many ways including negatively affecting their quality of life, their sibling bond, and their physical, mental and emotional health. Aim: A meta-synthesis of qualitative studies was conducted to explore the experiences of healthy siblings of people who have EDs. Method: Seven databases (MEDLINE, PsychINFO, psycARTICLES, Psychology & Behavioural Sciences Collections, CINAHL, Social Sciences Full Text (H.W Wilson) and SocINDEX with Full Text) were searched for qualitative studies reporting on the experience of healthy siblings who have a brother or sister with a diagnosed ED. Thematic synthesis was used to analyse the studies included in this review. Results: 10 studies were included. Five core themes and twelve subthemes were identified. Themes related to the impact of the ED on both interpersonal and intrapersonal aspects of the healthy siblings’ lives. This included disruption to the sibling relationship and family life, experiencing difficult emotions, changes in the healthy sibling’s relationship with their own body, and coping skills. Conclusions: These findings are discussed in relation to the existing literature within the area and the implications for clinical practice. 2. Mental Health Clinicians’ Perspectives on Implementing Externalisation in Family-Based Treatment Objective: Family-Based Treatment (FBT) is a first line intervention for the treatment of adolescent eating disorders (EDs). FBT consists of a number of phases and interventions, including the use of externalisation, a therapeutic technique which aims to separate the person from the problem through the use of language and metaphor. There is a paucity of scientific research on this technique and consequently, little is known about how clinicians understand, conceptualise and support families to externalise the ED in the context of FBT. This research aimed to gain a deeper understanding of how clinicians employ this technique in the context of FBT. Method: Using thematic analysis, eight semi-structured interviews were conducted with FBT trained clinicians working in child and adolescent mental health services. Results: Three major themes emerged which related to how clinicians use externalisation, the impact it has on family functioning, and the barriers which make externalisation difficult to implement with families. Conclusion: Externalisation is a therapeutic technique which can support a family and young person’s (YP’s) recovery from an ED when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation such as the YP’s problem awareness, age, and duration of ED symptomatology.
Sibling , Externalisation , Systematic review , Thematic synthesis , Anorexia nervosa , Eating disorder , Family-based treatment , Clinician research
Lonergan, K. 2020. Eating disorders: sibling experience and implementing externalisation in FBT. DClinPsych Thesis, University College Cork.