Title : An unusual perspective for understanding and preventing bulimia relapse: Unhealthy sibling loyalty
Abstract:
The relapse rate for bulimia treatment is more than 50%. This is regardless the type of treatment – whether inpatient, outpatient, family, or individual therapy. Years ago, working in an Eating Disorder clinic, I stumbled on a surprise: the role of siblings in the onset as well as recovery from bulimia. Over the next few years, I came to call this phenomenon Unhealthy Loyalty.
Family loyalty is like an invisible web of unwritten rules that weaves the family together (Boszormenyi-Nagy & Spark, 1984). The rules and expectations for the family are established by parents, often passed down through the generations. While loyalty can be healthy, enriching family members with a sense of connection and support, an unhealthy loyalty can be a shackle one drags along throughout life, that can inhibit one’s potential in some areas of life.
One of the unwritten rules of loyalty is to accept the roles parents, unconsciously, innocently, create for their children. As adults, most people can identify their childhood role, i.e. the smart one, goody two-shoes, trouble maker, comic, the responsible one. Once an adult, stepping in a sibling’s role can feel “disloyal.”
Unhealthy Loyalty is an unconscious process whereby a sibling limits oneself out of loyalty to a brother’s or sister’s early childhood role. To understand Unhealthy Loyalty, here is just one of many types of examples. As children, the older sister is the cute one and younger brother is the brain. As an adult, if the sister has the chance for a promotion at a time when her brother is not doing well professionally, she risks being more successful than he. To maintain her loyalty to their early roles, she unconsciously sabotages the promotion by developing bulimia -- hence, an unhealthy aspect of her loyalty. The sad irony is often the sibling could not care or even might be happy that she were successful.
Bulimia, then, can start as an unconscious unhealthy loyalty to a sibling, or the unhealthy loyalty can be triggered during recovery, initiating a relapse. By addressing the underlying sibling involvement through “Unhealthy Loyalty,” clinicians and mental health programs can help avert relapse.
(Since the core reference is the childhood sibling relationship, at least thus far, I have found no indication of any significant differences based on ethnicity, race, gender/gender preferences, or socio-economics.)
