Recovering patients describe their battles with an "anorexia voice"

People with anorexia find comfort in their illness at first, but then it becomes over-powering and they end up battling for control of their own minds. That's according to Sarah Williams and Marie Reid, who conducted an online focus group and email interviews with 14 people recovering from anorexia nervosa, aged 21 to 50 and including two men.

A consistent theme to emerge was that anorexia at first provided a sense of control and identity. The participants recalled enjoying striving for perfection. They saw thinness as an ideal that was within their means to reach. "Anorexia became a friend," said Natalie*. "When I was alone ... I knew that at least I had A." Jon said: "It was a way to control what was happening to me on a day to day basis, and also my weight."

Eventually though, rather than being a solution, anorexia became a problem all of its own. Said Lisa: "I call my anorexia 'the demon' who controls my thoughts, feelings, emotions and actions." Jon: "It's like there are two people in my head: the part that knows what needs to be done and the part of me that is trying to lead me astray. Ana is the part that is leading me astray and dominates me."

"Having developed the anorexic voice, participants came to feel that it was to an extent split from their authentic selves," said Williams and Reid. The research pair explained how their findings, placed in the context of similar results from past studies, provided useful ideas for therapeutic intervention. In particular, they suggested the need for recovering anorexia clients to acknowledge other positions beyond the anorexia voice and their own authentic self. "Wellness cannot simply be the absence of anorexia nervosa symptoms because this can intensify the inner battle with the anorexic voice," they said.

Williams and Reid advised using therapy to help build clients' sense of self. "This study suggests that this means developing the self beyond an ambivalent conflict between the authentic self and the anorexic voice," they said. "This would allow a new more positive dominant position to develop."

One approach that may be particularly suitable, according to Williams and Reid, is emotion-focused therapy (EFT). A technique used in EFT is for clients to address an empty chair, which represents their critical "anorexia voice". With the aid of the therapist, this can lead to a softening of the anorexic critic and the fostering of a new dominant position in the self. However, the researchers cautioned that there are "as yet ... no studies investigating the efficacy of externalisation techniques such as those used in EFT and this warrants further attention."
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Williams, S., and Reid, M. (2011). ‘It's like there are two people in my head’: A phenomenological exploration of anorexia nervosa and its relationship to the self. Psychology and; Health, 1-18 DOI: 10.1080/08870446.2011.595488

*The names used here are the pseudonyms that appear in the paper.

Post written by Christian Jarrett for the BPS Research Digest.