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Abstract: Voice hearing experiences are commonly reported by patients with anorexia nervosa (AN) and are associated with negative outcomes. The "eating disorder voice" (EDV) can be understood within relational frameworks. Relating therapy (RT) has offered encouraging outcomes when targeted at voice hearing experiences transdiagnostically but has not been evaluated in the context of AN. This study aimed to offer a preliminary and mixed methods exploration of RT for the EDV. RT was delivered to three participants with a diagnosis of AN who were distressed by an EDV. Weight, negative impact of voices, and eating disorder cognitions were assessed at baseline, posttherapy and at brief follow-up. Participant experiences were explored through exit interviews. Therapy was completed by all participants. Weight gain was reported by two participants and maintained at brief follow-up. Positive changes were not reported on other measures. Qualitative data were suggestive of positive experiences that facilitated assertive responding., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

A proportion of individuals given an eating disorder diagnosis describe the experience of an eating disorder 'voice' (EDV). However, methods for working with this experience are currently lacking. Voice Dialogue (Stone & Stone, 1989) involves direct communication between a facilitator and parts of the self to increase awareness, understanding, and separation from inner voices. Adapted forms of this method have shown promise in working with voices in psychosis. This study aimed to explore the experience and acceptability of Voice Dialogue amongst individuals with anorexia nervosa who experience an EDV. Nine women participated in a semistructured interview following a single Voice Dialogue session. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Three overarching themes were identified as follows: (i) "separating from the EDV"; (ii) "better understanding of the EDV"; and (iii) "hopeful, motivated, and afraid of recovery". The majority of participants found Voice Dialogue acceptable and helpful for exploring their EDV. Whilst preliminary, the results suggest that Voice Dialogue has potential in terms of helping individuals establish a more constructive relationship with their EDV and motivating change. Further research is needed to build upon these findings. Implications for addressing the EDV using voice-focused interventions are explored., (© 2021 John Wiley & Sons, Ltd.)

Individuals with anorexia nervosa often describe experiencing an internal "voice" of their disorder, which previous research has associated with multiple dimensions of eating pathology. This pilot study examined whether eating disorder measures use invoice characteristics at the outset of outpatient therapy predicted changes in disordered eating over the course of treatment. Participants were 14 individuals meeting ICD-10 criteria for anorexia nervosa. Participants completed measures relating to the severity of disordered eating and voice-related characteristics (perceived voice power and metacognitive appraisals about its nature) at the start and end of therapy. Results indicated that the perceived power of the eating disorder was reduced over the course of outpatient therapy, although its other characteristics remained stable. Greater levels of voice power, omnipotence and benevolence at the outset of therapy were related to greater improvements in eating attitudes. No voice-related characteristics were associated with changes in weight. These findings suggest that voice-related appraisals do not obstruct the effectiveness of outpatient therapies for anorexia nervosa. Further studies are needed to ratify these preliminary findings.

In common with individuals experiencing a number of disorders, people with anorexia nervosa report experiencing an internal 'voice'. The anorexic voice comments on the individual's eating, weight and shape and instructs the individual to restrict or compensate. However, the core characteristics of the anorexic voice are not known. This study aimed to develop a parsimonious model of the voice characteristics that are related to key features of eating disorder pathology and to determine whether patients with anorexia nervosa fall into groups with different voice experiences. The participants were 49 women with full diagnoses of anorexia nervosa. Each completed validated measures of the power and nature of their voice experience and of their responses to the voice. Different voice characteristics were associated with current body mass index, duration of disorder and eating cognitions. Two subgroups emerged, with 'weaker' and 'stronger' voice experiences. Those with stronger voices were characterized by having more negative eating attitudes, more severe compensatory behaviours, a longer duration of illness and a greater likelihood of having the binge-purge subtype of anorexia nervosa. The findings indicate that the anorexic voice is an important element of the psychopathology of anorexia nervosa. Addressing the anorexic voice might be helpful in enhancing outcomes of treatments for anorexia nervosa, but that conclusion might apply only to patients with more severe eating psychopathology. Copyright © 2016 John Wiley & Sons, Ltd., Key Practitioner Message: Experiences of an internal 'anorexic voice' are common in anorexia nervosa. Clinicians should consider the role of the voice when formulating eating pathology in anorexia nervosa, including how individuals perceive and relate to that voice. Addressing the voice may be beneficial, particularly in more severe and enduring forms of anorexia nervosa. When working with the voice, clinicians should aim to address both the content of the voice and how individuals relate and respond to it., (Copyright © 2016 John Wiley & Sons, Ltd.)

Objective: Internal "anorexic voices" are commonly described by individuals with eating disorders. This study examines whether the perceived power and nature of that voice are related to eating pathology in anorexia nervosa., Method: Sixty-three women and one man with an ICD-10 diagnosis of anorexia nervosa participated in this study (mean age = 27.3 years; mean BMI = 16.0). Participants completed questionnaires measuring severity of eating pathology, perceived voice power, and beliefs about voices, either at the start or during treatment., Results: A more powerful anorexic voice was associated with more negative eating attitudes in this clinical group. However, BMI was related to a moderating effect, with the interaction of greater voice power and malevolence being associated with a lower BMI., Discussion: These findings suggest the anorexic voice may function as a maintenance factor in anorexia nervosa. Cognitive models of hearing voices may be applicable to disorders other than psychosis. Further explorations are warranted. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:622-625)., (© 2016 Wiley Periodicals, Inc.)

Abstract Many individuals diagnosed with eating disorders describe their disorder as being represented by an internal 'voice'. In line with cognitive models of voice-hearing, previous research has identified associations between voice appraisals and eating psychopathology in anorexia nervosa. Whether these findings generalise to other eating disorder subtypes remains unknown. The aetiology of the internal eating disorder voice also remains unclear. Traumatic-dissociative models of voice-hearing, which link such experiences to decontexualised material arising from early traumatic events, might also be relevant to eating disorder groups. To determine whether cognitive models of trauma and voice-hearing apply across eating disorder subtypes, 85 individuals fulfilling ICD-10 criteria for an eating disorder completed self-report measures regarding eating disorder cognitions, voice-related appraisals, childhood trauma, and dissociation. The relative power of the eating disorder voice was found to be positively associated with experiences of childhood emotional abuse, and this relationship was partly mediated by dissociation. In addition, eating disorder voices appraised as powerful and benevolent predicted more negative attitudes towards eating across diagnostic groups, but were unrelated to disordered eating behaviours or weight. These findings suggest that the eating disorder voice plays a meaningful role in eating pathology across diagnoses and that this experience might be related, in part, to experiences of childhood maltreatment. Therapeutic implications are discussed. [ABSTRACT FROM AUTHOR]

AbstractAlthough prevalent among those given a diagnosis of anorexia nervosa (AN), the internal anorexic voice (AV) is little understood. This study aimed to explore the AV’s role in the development and maintenance of AN from a new perspective – that of the AV itself. Nine women with a diagnosis of AN participated. Data was collected via dialogical enquiry, which entailed direct, semi-structured interviews with participants’ AVs. Transcripts were analyzed using thematic analysis. Three themes build a picture of a symbiotic yet destructive relationship between AV and individual. Firstly, “Pragmatism” describes the AV’s supposedly invaluable, problem-solving persona. Secondly, “Relationship” depicts the valued yet fraught, unbalanced, and often unwanted bond between AV and individual. Thirdly, “Self-preservation” presents the AV’s drive to retain control for its own survival. In clinical practice, curiosity regarding relationships with AVs could highlight barriers to recovery and inform treatment. Future research should focus on diverse samples and consider ways of working with eating disorder voices to promote recovery. [ABSTRACT FROM AUTHOR]

Abstract: Evidence-based cognitive-behavioural therapy (CBT) for the eating disorders has an early focus on behavioural changes around food intake. However, patients' anxiety around such change might account for why they often seem unmotivated in treatment. In order to determine the impact of changing intake, this pilot study of patients with bulimic disorders (N = 19) or anorexia nervosa (N = 9) used a mixed quantitative and qualitative design to retrospectively examine their perspectives of the short- and long-term pros and cons of such change. As expected, change was seen negatively in the short-term (with particularly high numbers reporting anxiety), but there were few reports of long-term negative outcomes. In contrast, there were both short- and long-term benefits of changing eating. The patients described what was helpful in making changes and what they had learned as a result. In both cases, their descriptions mapped closely onto the content and process of evidence-based CBT for the eating disorders. Although there is a need for more extensive research, these findings suggest that patients (and therapists) might benefit from being aware of the contrast between the short- and the long-term pros and cons of changing eating within CBT for the eating disorders. [Copyright &y& Elsevier]