Almost all my patients talk to me of the “voice” that they hear. The (usually) harsh and critical voice that talk, shouts and cajoles all the time. Sometimes it is reported as a friend, sometimes more like a dictator. Patients often feel scared and trapped by this voice, compelled to do what it says in an effort to silence it. Often the voice feels more powerful than the person.
What is the relationship between the anorexic voice and anorexic symptoms.
In a paper that I was involved with we (Scott, Haystack & Thornton, 2014) found that the voice played a role as an “abuser” and also an “ascetic voice” – which highlighted a moral attitude to thinness. We found that the anorexic voice was strongly associated with eating disorder symptoms and severity.
What can be done to help with the voice. At Redleaf we teach patients to understand the voice as part of the eating disordered mindset. We teach people to take a defused stance from this pattern of thinking in order to have more of a choice between following the voice or not. We help people learn to reflect whether following that voice moves them in the direction of their values or away from them. Often what happens is if people act against the voice they learn that what the voice tells them is often not true or not as bad as predicted. Acting against the thoughts, by doing behavioural experiments, is one of the most effective ways to change the voice.
A recent study by Pugh & Waller (2016) also investigated the relationship between the anorexic voice and the symptoms of the eating disorder. In the most clinically interesting finding is that the anorexic voice was more powerful and more malevolent when weight was low. What this is likely to mean is that as you normalize your eating the power of the eating disorder voice will decrease. This study doesn’t give information as to how long this takes. Those who have undergone the process of nutritional restoration and weight regain will often report that the voice gets worse as it is challenged by healthy eating behaviour and recovery. However, after a period of weight being stable at a healthy weight and normal eating it has been my experience that the voice diminishes over time.
I would love to here the experiences of those that have recovered about how that voice changed during that recovery. I am curious about what others think are the key factors in this voice becoming less powerful.