The experience of living with an anorexic voice: an interpretative phenomenological analysis
Background: Current Anorexia Nervosa (AN) research concurs early clinical descriptions of an eating disorder depicted for some individuals as an ‘internal voice’ (Tierney & Fox, 2010). The internal voice referenced in AN literature has more recently been referred to as the anorexic voice (AV). For the most part, the AV is recognised as internally generated, importantly, it is often reported as an experience altogether alien to one`s sense of self, distinct from one`s inner thoughts and dialogue hence why it is called a ‘voice’. Often depicted as hostile and intense, the AV is considered omnipotent, powerful and negative in relation to AN pathology (Noordenbos & Van Geest, 2017; Pugh & Waller, 2016; Pugh, 2020). These depictions of the AV have been largely valuable when investigating symptom severity as well as in the context of AV contributions to AN relapse. Much is still unknown about this phenomenon as awareness of its influential role in AN has emerged primarily in the past decade. Largely absent from AN literature are the intricacies of individual experience of the AV over the course of the entire AN illness trajectory (from onset, through maintenance, relapse and recovery) as recounted in first person narrative accounts. This suggests aspects of the AV currently overlooked could be unearthed by means of qualitative investigation and further contribute to the existing knowledgebase of both this phenomenon and its connection to AN. Aims: The study aimed to gain a rich and detailed understanding of the way in which individuals with AN experience the AV. This study aimed to capture the AV experience from the point of illness onset through to recovery, it also sought to provide the health professions with helpful insights into what individuals with AN who report an AV are possibly experiencing. Methodology: Six semi-structured interviews were conducted with women who identified as recovered from AN and who confirmed an experience of the AV in conjunction with their illness. The verbatim transcripts were analysed by using Interpretative Phenomenological Analysis (IPA). Findings: Three superordinate themes (The Perils of Self-Acceptance During Puberty; The Anorexic Voice Battleground; Healing Through Compassion) and ten subordinate themes emerged. Conclusions: The findings indicated an experience of the AV as closely aligned with AN symptom emergence. The AV was referred to as a separate internal ‘voice’, depicted by participants as unique from other inner thoughts and dialogue. Initially experienced as benevolently enticing AN engagement, as illness progressed, AV presence became malevolent. Eventually, the demanding AV narrative began to feel controlling, particularly within treatment when participants strived for a life without AN. Amidst feeling controlled by the AV, participants experienced a greater emergence of self-directed compassion during the recovery process. Participants relayed their experience of self-directed compassion as healing, an antidote to AV hostility. Participants reported how the AV presence was not directly addressed in treatment and so after treatment ended, the AV presences remained. The current study provides a foundational knowledge of the under researched area of the AV as experienced in conjunction with AN illness from first person narrative accounts. The findings, future recommendations and conclusions within this study are discussed in reference to the praxis of Counselling Psychology (CoP) and are applicable to aiding other health professions working with this clinical population.
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