Understanding the ‘Anorexic Voice’ in Anorexia Nervosa

Pugh, Matthew; Waller, Glenn

doi:10.1002/cpp.2034

Cited by 38 publications

(38 citation statements)

References 27 publications

(47 reference statements)

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“…Eating disorder (ED) patients tend to personify their illness and relate to it as an entity, as exemplified by the anorexic voice (Pugh & Waller, , ; Tierney & Fox, , ; Williams & Reid, ). In treatment, patients are often encouraged to externalize their illness, that is to regard it as a separate entity, as a means of encouraging objectivity and preventing over‐identification with the disorder (Scott, Hanstock, & Patterson‐Kane, ; White & Epston, ).…”

Section: Introductionmentioning

confidence: 99%

“…Patients feel affiliation towards their anorexic voice despite it being harsh and forceful, implying an emotional conflict analogous to what may be found in an insecure attachment relationship (Tierney & Fox, ). Pathological eating attitudes and illness duration are positively associated with patients perceiving the anorexic voice as helpful and omnipotent (Pugh & Waller, ), suggesting that the disorder may be perceived as a strong and wise (authoritative) secure base that patients are likely to comply with. Moreover, the difficulties that many patients experience when breaking the unhealthy bond with their inner anorexic voice suggest the working of separation anxiety (Tierney & Fox, ).…”

Section: Introductionmentioning

confidence: 99%

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The unsafe haven: Eating disorders as attachment relationships

2018

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Attachment behaviours are associated with the patient-ED relationship, in which attachment insecurity is correlated with greater eating disorder control and patient submission. Some patients seem to incorporate the actions of the ED in their self-image, suggesting the presence of introjection. The patient-ED relationship may help explain patients' anxiety and ambivalence about change, seen from an attachment perspective. In treatment, it may be important to explore alternative safe havens and secure bases to the ED, such as interpersonal relationships and activities.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The unsafe haven: Eating disorders as attachment relationships

2018

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“…As the illness progresses however, patients report that their disorder becomes tyrannical, criticizing and dominating, taking priority over other relationships, and resulting in social isolation (Serpell & Treasure, ; Serpell et al ., ). In anorexia nervosa, descriptions like these are especially frequent and commonly referred to as the ‘anorexic voice’ (Pugh & Waller, ,b; Tierney & Fox, , ; Williams & Reid, ). Living with the anorexic voice has parallels to living in an abusive relationship due to its coercive nature and impact on self‐esteem (Tierney & Fox, ).…”

Section: Introductionmentioning

confidence: 99%

“…Patients seem to feel affiliation towards the voice in spite of its negative attributes (Tierney & Fox, ). A more powerful and malevolent voice seems associated with lower BMI (Pugh & Waller, ), longer duration of illness, and more severe and enduring forms of anorexia nervosa (Pugh & Waller, ), while learning to defend against the voice appears important for recovery (Duncan, Sebar, & Lee, ). Descriptions of eating disorders as personified others are reported by patients with other eating disorder diagnoses as well (Serpell & Treasure, ; Serpell et al ., ), but much less is known about these groups.…”

Section: Introductionmentioning

confidence: 99%

Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image

2017

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ObjectivesIn published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self‐image.DesignStructural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder.MethodThe relationship between patients (N = 150) and their eating disorders was examined with respect to symptoms, duration of illness, and self‐image. Patients were also compared on their tendency to react with affiliation in relation to their disorder.ResultsPatients’ responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic.ConclusionsWhen encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real‐life relationship could have theoretical implications, and its exploration may be of interest in treatment.Practitioner points Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so.Patients tended to experience their disorder as controlling and domineering.Exploring the hypothetical patient–eating disorder relationship may prove helpful in understanding dysfunctional relational patterns.Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.

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“…) to produce an artificial model of anorexia. In some contexts, the "anorexic voice" performed defensive functions of mitigating the harmful effects from attacking one's self, or minimizing rejection or shame in interpersonal situations (Pugh and Waller 2017), or conversely, the voice was positioned as powerful and subjugated women's subjectivities. In positioning, themselves within the various narratives required recognition of possessing the qualities necessary to locate themselves within those gendered frameworks.…”

Section: Abject Bodiesmentioning

confidence: 99%

Women’s Constructions of Childhood Trauma and Anorexia Nervosa: a Qualitative Meta-Synthesis

2018

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A meta-synthesis was conducted to explore women's constructions of anorexia nervosa and childhood trauma. Following a systematic review of the literature, six studies were isolated and synthesized within a material-discursive-intrapsychic framework to produce five taxonomies: "objectified and controlled bodies," "the abject body," "embodied emotions and self-harm," "medicalizing the body-as-object," and "embodied meanings and new possibilities." The women's experience of anorexia, their bodies, and shifting subjectivities was a response to the materiality of childhood abuse. The women discursively constructed anorexia nervosa as a means of negotiating bodily distress associated with trauma and renegotiating their identities to produce a cohesive, embodied self. This meta-synthesis has implications for further research that elucidates how women make meaning from the transformations of their embodied subjectivities.Keywords Trauma . Anorexia nervosa . Women . Embodiment . FeminismThe association between childhood sexual abuse and anorexia nervosa (anorexia) has long been the preserve of feminist theorists who were amongst the first to raise the issue of abuse in the development of eating disorders (Wooley 1994). Their pioneering work set in motion a body of biomedical and psychological research that established higher rates of childhood trauma in all forms of eating disorders (Eds) that develop at an earlier age, with higher rates of comorbidities, suicidality, and a more severe form of the disorder (see Molendijk et al. 2017 for a Human Arenas (2018) 1:231-248 https://doi

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Understanding the ‘Anorexic Voice’ in Anorexia Nervosa

Cited by 38 publications

References 27 publications

The unsafe haven: Eating disorders as attachment relationships

The unsafe haven: Eating disorders as attachment relationships

Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image

Women’s Constructions of Childhood Trauma and Anorexia Nervosa: a Qualitative Meta-Synthesis

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