Negative childhood events and the development of the anorexic voice: A grounded theory

Abstract

Background: Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences. Aims: This study explores the relationship between adverse experiences in childhood and the development of the AV. Materials and Methods: Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.Results: Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood. Discussion: Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices. Conclusions: The findings have implications for a traumafocused approach when working with the AV.

The relationship between shame, perfectionism and Anorexia Nervosa: A grounded theory study

“…The findings of this study highlight some key points, such as the role of early life/ trauma in developing global shame and also how this relates to other phenomena within AN, such as the AN voice (e.g. Morrison et al (2022)). Further work is being undertaken that is investigating the interaction between global shame and self-disgust within body image.…”

Anorexia Nervosa in Juvenile Systemic Lupus Erythematosus (SLE): A Causality Dilemma

“…In SLE, a history of ACEs has been associated with poorer disease outcomes, greater NP involvement, and worse perceived health status [ 133 , 134 ]. On the other hand, as trauma also impacts mental health [ 135 , 136 ], patients with FEDs report experiencing more ACEs compared to the rest of the population, with severer forms of trauma being related to aggravated FED symptomatology [ 137 , 138 , 139 , 140 , 141 , 142 ]. Taken together, it appears that ACEs may trigger the development of both entities, indicating another possible route for a dual AN–jSLE diagnosis.…”

Changes in the eating disorder voice over time and the association of voice characteristics at baseline with clinical symptoms in patients with anorexia nervosa

“…This is somewhat different from what found in the psychosis literature, where maladaptive appraisals about the voice (including voice's malevolence) are associated with distress in voice hearers (Tsang et al, 2021). A recent model to explain the development of the eating disorder voice in anorexia nervosa proposes that the eating disorder voice might provide “an antidote” to painful emotions, enabling the individual to disconnect from internalised threatening experiences (Morrison et al, 2022). This might explain the lack of association between the characteristics of the eating disorder voice and psychological distress.…”

“…It was also found that greater levels of perceived power, omnipotence and benevolence of the voice at the beginning of treatment predicted greater reductions in eating disorder symptoms; however, the sample size was small (14 patients). Findings add to cross-sectional and qualitative studies which document that patients' beliefs, attitudes and behavioural responses towards the voice might contribute to illness maintenance and/or recovery (Chua et al, 2022;Forsén Mantilla et al, 2018;Morrison et al, 2022;Pugh, 2016Pugh, , 2020, through the association of the voice's characteristics with core symptoms of the illness, such as negative eating cognitions, body mass index (BMI), illness duration and compensatory behaviours (Aya et al, 2019;Noordenbos & Van Geest, 2017).…”

“…Patients describe the eating disorder voice as an internally generated commentary about body shape, weight and eating and their implications for self-worth (Noordenbos et al, 2014;Pugh, 2016Pugh, , 2020. In the earlier stages of the illness, the eating disorder voice is perceived as comforting and safe, whereas later becomes hostile and demanding as the illness progresses (Morrison et al, 2022;Tierney & Fox, 2010;Williams & Reid, 2012). Similarly, behavioural responses to the voice seem to change over time, with submissive attitudes being gradually replaced by greater resistance (Pugh, 2020;Tierney & Fox, 2011) and feelings of entrapment and powerlessness.…”