I was meeting with a young woman in a counseling session and we were talking about her “Eating Disorder Voice.” This phenomenon has been reported in the eating disorder field fairly commonly (Aya, 2019). The young woman I was working with was attempting to see things more objectively and to divorce herself from the cognitive distortions that were so often present in her mind and internally expressed through her ED voice. She was able to say, “My eating disorder wants me to believe I’m fat,” or “My eating disorder tells me that eating carbs is bad for me.”

In our discussion I asked her what her eating disorder sounded like in her head. She thought about it for a moment and told me it sounded like a very intelligent, forceful and persuasive authority figure. She also said that this made it hard to accept what her dietitian was telling her about the food that was on her meal plan or what I was asking her to believe about her own self objectification.

As we sat and talked I asked her to engage in a short exercise. First, I asked her to write down what a typical conversation with her eating disorder might look like. She created that dialogue and read it to me. It went something like this:

Client: My dietitian just added a new snack item to my meal plan to challenge my reluctance to eat a certain food.

ED: You know you can’t trust your dietitian. She’s just like some of your other providers and they all want you to be fat. And, you know that eating that will definitely make you fat.

Client: But they seem like they have my best interest at heart.

ED: Hey, haven’t I been there for you? Are you really beginning to doubt my wisdom? Remember when we first started this relationship and you started getting all those compliments about your looks? You’re going to lose all of that acceptance if you eat that snack. You know that, don’t you?

Client: Wow, I don’t want that. Now I’m really scared to eat that.

ED: Good for you! All of that stuff the dietitian and doctor and therapist are telling you about your health are just scare tactics to try and control you, anyway. You listen to me. I know what’s best for you.

The next thing I asked her to do was to allow me to read the part of her eating disorder. As I read my lines I spoke in the silliest cartoon voice I could imagine (I do a mean imitation of Patrick from Sponge Bob), and had her read her lines as herself.

The result was a lot of laughter and a new perspective on how less intimidating and disempowered that eating disorder voice sounded. My assignment was to have her try to be mindful of that voice and to try and hear it in the same way, as that cartoon character, each time.

In a study from 2021 researchers provided evidence that conversations with the “Eating Disorder Voice” using the open chair method or other means has benefit in helping people struggling with an eating disorder understand the nature of those cognitive distortions and develop a more skilled internal argument around the urges to behaviors the eating disorder voice promotes (Ling, Serpell, Burnett-Stuart, & Pugh, 2022). Another study identified how the eating disorder voice tends toward dominance over the individual and disempowerment of the individual (Pugh, 2020). Addressing the authority of the eating disorder voice, whether by checking the facts, conversing directly, or disempowering and discrediting the authoritative nature of the voice can be helpful interventions.

The eating disorder voice is so often belittling, disempowering, and, quite frankly, a bully. It attempts to make one believe that the people who care the most are uncaring, that the objective truth that these behaviors are harmful is untrue and that recovery is not possible. It really isn’t worth taking that voice seriously.

References

Aya, V. U. (2019). A systematic review of the ‘eating disorder voice’experience. International Review of Psychiatry, 31(4), 347-366.

Ling, N. C., Serpell, L., Burnett-Stuart, S., & Pugh, M. (2022). Interviewing anorexia: How do individuals given a diagnosis of. Clinical Psychology & Psychotherapy, 600-610.

Pugh, M. (2020). Understanding ‘Ed’: a theoretical and empirical review of the internal eating disorder ‘voice’. Psychother Sect Rev 65, 12-25.

*The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders and not intended as endorsement by iaedp™ Foundation, Inc. or its Board of Directors.*