Laura Kiesel was only 6 years old when she became a parent to her infant brother. At home, his crib was placed directly next to her bed, so that when he cried at night, she was the one to pick him up and sing him back to sleep. She says she was also in charge of changing his diapers and making sure he was fed every day. For the majority of her early childhood, she remembers, she tended to his needs while her own mother was in the depths of heroin addiction.

From as early as she can remember, Kiesel says she had to take care of herselfpreparing her own meals, clothing herself, and keeping herself entertained. At school, she remembers becoming a morose and withdrawn child whose hair was often dirty and unkempt.

It was a dark time made even bleaker by her mother’s violent outbursts. “During dope sickness, she would unleash a lot of fury onto me,” said Kiesel, a 38-year-old freelance writer. “I became the buffer or scapegoat of her rage to divert it [from] my younger (much more defenseless) brother.” (Kiesel’s mother is no longer living.)

At one point, she says she learned to take her small brother and kitten into their bathroom and barricade the door to keep them safe. “I felt a lot of weight on my shoulders, like my brother could die without me there,” Kiesel remembers.

She started breaking out in severe hives for months at a time, which she believes were triggered by the “burden of loneliness and responsibilities at that age.” Becoming responsible for an infant at such a young age came with a toll, she explained. “I sometimes picked on my brother or was quick to shove or slap his arm because I was overwhelmed and didn’t know how to handle the shrieks of a 2-year-old when I was 8.”

Eventually, at age nine, Kiesel and and her 3-year-old brother were taken in by their grandparents, but the trauma of their former living situation stayed with the children. By the time Kiesel was 14, she says she suffered from daily panic attacks, OCD, and depression. It wasn’t until she was older, she says, that she began to understand the connection between her childhood experiences and numerous chronic illnesses.

Kiesel’s story is one of what psychologists refer to as destructive parentificationa form of emotional abuse or neglect where a child becomes the caregiver to their parent or sibling. Researchers are increasingly finding that in addition to upending a child’s development, this role reversal can leave deep emotional scars well into adulthood. Many, like Kiesel, experience severe anxiety, depression, and psychological distress. Others report succumbing to eating disorders and substance abuse.

“The symptoms look similar to some extent, from cradle to grave,” said Lisa M. Hooper, a professor at the University of Louisville and prominent parentification researcher. Some of these behaviors start out in childhood, and become exacerbated in adulthood, she explains.

“Children’s distrust of their interpersonal world is one of the most destructive consequences of such a process,” writes Gregory Jurkovic in his book Lost Childhoods: The Plight of the Parentified Child.

While there is a large body of literature that focuses on the neglect children experience from their parents, there’s less examination of how this neglect puts kids in roles of parenting each other. And there is virtually no empirical research on how this affects relationship dynamics later in life—both with siblings and others. Scholars agree that there are gaps in sibling research—primarily an incomplete understanding of how these relationships and roles are affected by abusive family environments. Hooper noted that “the literature is very scarce in this area.”

In Kiesel’s case, looking after her brother as a kid has led to a tenuous and chaotic relationship with him over the years, fraught with bouts of estrangement and codependency. Though they remain close,  there were periods where she and her brother didn’t speak for months at a time. “My brother is constantly on the edge of some crisis (a health crisis from his drinking, homelessness, etc.) so it is a worry that never goes completely away,” she told me in an email.

Her brother, Matthew Martin, 32, acknowledges the role their upbringing has played in these dynamics. “She was the only protector that I had,” he recalls. “My mother was a hard-core addict from very early on.” Throughout his childhood and early teens, he says he relied on Kiesel for the emotional support his mother couldn’t provide.

“We’ve had our fair share of arguments about [my addictions] and it’s hard, because she wants me to have some longevity. She wants me to be around for her the way that she was for me.”

* * *

From the age of eight until she left home at 15, Rene, who asked to be identified by only her first name because she was concerned about upsetting her family, says she would pick up her three younger siblings from day care, bring them home, feed and bathe them, read them stories, and put them to bed. “Basically, I played the role of mother,” said the 50-year-old Oregon resident. She remembers standing on a chair as a child and cooking dinner for her entire family. In spite of the enormous burden of responsibility, she recalls it as a role she cherished. “I have really fond memories, particularly of reading them stories in bed at night.”

But Rene’s home life was far from peaceful. She says her mother’s alcoholism prevented her from properly caring for her five children, placing the task of child-rearing on the shoulders of Rene and her older brother. (Rene’s mother is no longer living.) But just as Rene took care of her younger siblings, she and her older brother relied on each other for emotional support.

“I think that it’s important to recognize that a lot of parentification is codependent,” she said, “Perhaps one sibling is the one who does the dishes and cleans the house, and takes care of the mom who is sick or drunk.” She explains that the other sibling might be the one who provides more emotional support, either by listening to problems or comforting.

Just as Wendy assumed the role of “mother” for the Lost Boys in Peter Pan, parentified siblings often forge symbiotic relationships, where they meet each others’ needs for guardians in a lot of different ways.

“We know that siblings can buffer each other from the impacts of stressful relationships with parents,” said Amy K. Nuttall, an assistant professor in human development and family studies at Michigan State University. This may account for why some parentified siblings who come from abusive homes end up maintaining close, albeit complex, bonds into adulthood, with some “continuing to attempt to fill parental needs at the expense of their own.”

Still, Nuttall adds, others may distance themselves from their families altogether in order to escape the role.

Rene found herself homeless after she was kicked out of her mother’s house when she was 15 years old. She says her siblings still blame her for leaving them behind. “When you think about it, if you’re parentified and you leave your younger siblings, it’s like having a parent abandon them,” said Rene. For years after, she was plagued by feelings of guilta common experience among people who have been parentified.

Sibling relationships usually generate a lifelong bond, yet for Rene, freedom from caretaking responsibilities came at a cost: the loss of her family. “I don’t have a relationship with my siblings anymore,” she says.

* * *

Unpredictable childhood trauma has long-lasting effects on the brain. Studies have shown that people with adverse childhood experiences are more likely to suffer from mental- and physical-health disorders, leading people to experience a chronic state of high stress reactivity. One study found that children exposed to ongoing stress released a hormone that actually shrank the size of their hippocampus, an area of the brain that processes memory, emotion, and stress management. Individuals who have experienced emotional or physical neglect by a parent are also at a greater risk of suffering from chronic illness as adults.

“Chronic, unpredictable stress is toxic when there’s no reliable adult,” said Donna Jackson Nakazawa, the author of Childhood Disrupted and a science journalist who focuses on the intersection of neuroscience and immunology.

Nakazawa has conducted extensive research on the body-brain connection, with a focus on studies initiated by physicians Vincent Felitti and Robert Anda. Their work on adverse childhood experiences (ACEs) has since grown into a burgeoning field with hundreds of peer-reviewed studies. The findings show that people who experienced four categories of childhood adversity—neglect and physical, sexual, and emotional abuse—were twice as likely to be diagnosed with cancer and depression as adults.

More links have been found between childhood stressors and adult heart disease, diabetes, migraines, and irritable bowel syndrome.

Jordan Rosenfeld, a 43-year-old author from California, attributes her own digestive issues to her childhood. When her mother was in the throes of substance abuse, she says, there were times she didn’t have food to eat. By the time she left home at 18, she began suffering from chronic pain after eating.

In adulthood, Rosenfeld noticed it was hard to regulate her emotions around hunger. “If I’m out with friends and we can’t decide on a restaurant, and I’m hungryI can actually go into a little bit of a meltdown,” she said. “And I can trace that back to literally not having been fed as a child at various junctures.”

From an early age, Rosenfeld recalls having to remind her mother when they needed groceries and pulling her out of bed in the mornings to get to school on time. “I did a lot of that kind of parenting her, in a way, because what I was trying to do was get parented myself.” Because of this, she says she often distrusts that other people will take care of things. “That’s why I tend to step up and do it myself.”

Jordan’s mother, Florence Shields, remembers it was a depressing time in both their lives. “I had welfare for a while and I think that my diet—because of drugs and alcohol—wasn’t very good, and she probably got the brunt of that.” As a recovering alcoholic, Shields, who is now retired and lives in Petaluma, California, says she lacked the tools for parenting due to her own upbringing and history of tragedy.

When she became a mother at age 24, Shields was still grieving the loss of her older brother who died unexpectedly when she was 18. Opioids and alcohol were a way of coping with this loss, she says.“It’s like that grief is in there with you because that person is with you for the rest of your life, so when sad things come up, there he is.”

While both Rosenfeld and her mother have since attended therapy sessions together as adults, the effects of parentification continue to this day. Shields recognizes that her earlier struggles with addiction have profoundly influenced her daughter’s behavior. “Jordan is very orderly and in control,” she said by phone. When Rosenfeld’s father later remarried and had children of his own, Rosenfeld learned to project her role of caretaker onto her siblings. “I spent a lot of time babysitting them as a teenager and I think it’s been a challenge for me to separate out feeling like I’m a parent to them.”

This has often caused rifts between the siblings into adulthood, Rosenfeld says. “I’ve always been somebody who thinks it’s my job to offer help, care, and advice even when it’s not asked for.”

* * *

How does someone learn that becoming self-reliant is safer than trusting others? Nakazawa believes that in destructive parentification, “you don’t have a reliable adult to turn to.” And if a child’s early experiences at home consisted of making sure everyone else’s needs were met, then the “child doesn’t feel seen.”

This sense of responsibility and compulsive caretaking can follow them into future relationships as well. “You tend to project it onto other people in your life,” Rosenfeld says. This isn’t surprising, claims Jenny Macfie, an associate director of clinical training at the University of Tennessee and another prominent parentification researcher, as “adults who report role confusion in their childhoods may have difficulty with their identity development,” and this in turn, can affect a person’s romantic relationships.

For the first half of her marriage, Rosenfeld found herself regularly putting her partner’s needs ahead of her ownessentially mirroring her childhood role.

Others echoed this experience; Kiesel says she struggles with learning how to establish firm boundaries with partners and believes this is directly tied to caring for her brother at a young age. Similarly, Rene says finding the right balance between expectation and autonomy has been a constant problem in her relationships. She’d like to find a partner but has doubts. “It’s very easy for me to get into caretaking roles with people who basically exploit my nature.”

But these effects often go beyond the individualstudies by Nuttall and others have found that destructive parentification in a family can carry over to other generations as well. “Mothers who were overburdened by taking care of their parents during childhood have a poorer understanding of their infant’s developmental needs and limitations,” explained Nuttall. This, consequently, “leads to a parenting style that lacks warmth and sensitivity.”

* * *

As of today, there is scarce research on treatment or prevention efforts. How can a parentified sibling heal? Nakazawa believes that recognizing how these psychological puzzle pieces all fit together can be a step in the right direction. “Physically and mentally, the architecture of the brain has changed, the immune system has changed, and without that validation, you can’t begin an appropriate healing journey.”

Some people have found community through Al-Anon, a support group for the loved ones of alcoholics. “The group has a really strong focus on explaining what codependency is and offering solutions for learning new behaviors,” explained Rosenfeld. She’s attended the meetings for over a year now and says she’s noticed a tremendous change in her habits and awareness of how to set boundaries. “I’ve learned that I can’t just blame people in my life with substance-abuse issues for causing me suffering; I have a choice in taking care of myself,” she says.

Despite negative outcomes associated with parentification, researchers say that going through that experience also confers some advantages that can help people later in life. Hooper believes that people who have been parentified as children possess a greater capacity for resiliency and self-efficacy. Nakazawa echoes this. “Current [American] culture thinks of resiliency as gutting it out and getting through, and one foot in front of the other,” she says. “But resiliency is learning and making meaning from what happened.”

A common thread found in people with these shared childhood experiences is a heightened sense of empathy and an ability to more closely connect to others. This is not to say that the negative impacts of their childhood are diminished, says Nakazawa, but that many are able to forge meaning out of their suffering. “People begin to see that their path to well-being must take into account the way in which trauma changed their story,” she explains, “And once they’re able to do that, they can also see how resiliency is also important in their story.”

For Kiesel, the freelance writer who cared for her brother from a young age, counseling and Al-Anon have helped her feel less personally responsible for her brother, though she laments the lack of support networks for siblings who have been parentified and have their own specific needs.

Though her relationship with her brother remains tenuous because of his addictions, she continues to look out for him by regularly calling and checking in on him every month.

Martin admits that to this day, she remains the voice of positivity and reason in his life. “I'm struggling with my own demons, but like my sister says, there is a future there for me.”  

As Kiesel explains: “Our mother and grandmother died a few months apart, and our grandfather a little over a year later—so essentially, we're all we have left.”