A systematic review of the ‘eating disorder voice’ experience

Abstract

The ‘eating disorder voice’ experience has been reported by both clinicians and by patients with eating disorders (ED) as an important feature of eating psychopathology, however this has only become an area of research in the last decade. The main aim of this paper was to systematically review and synthesize the available literature on this topic. Systematic searches of seven electronic databases were performed up to June 2018. Thirteen peer-reviewed articles were identified. Findings suggested that the existence of an ‘ED voice’ is often recognized by patients with eating disorders and that this voice has a powerful, negative and omnipotent nature. Feelings of entrapment and defeat are commonly experienced in response to it and patients appear ambivalent towards it. The negative characteristics and responses to the voice are associated with eating disorder symptoms. Addressing the eating disorder voice using relational and interpersonal approaches has the potential to improve clinical and treatment outcomes for patients with eating disorders.

Keywords:

• Critical inner voice
• voice hearing experience
• eating disorders
• anorexia nervosa
• bulimia nervosa

Acknowledgements

Mrs Viviana Aya receives funding from the Psychiatry Research Trust (PRT) at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London (Grant Reference 29 Aya). Dr Valentina Cardi receives funding from the NIHR Maudsley Biomedical Research Centre (BRC) and from the National Institute for Health Research, Health Technology Assessment (NIHR HTA) program (TRIANGLE trial, project ref number 14/68/09). The views expressed in this article are those of the author(s) and not necessarily those of King’s College London, the PRT, the NIHR, or the BRC.

Disclosure statement

The authors report no financial interests or potential conflict of interest.

Notes

1 OSFED [Other specified feeding or eating disorder] is the DSM-5 diagnostic category that replaces the category formerly called EDNOS [Eating Disorder Not Otherwise Specified]. The original paper mentions the EDNOS category, but has been updated to the OSFED category for this systematic review.

2 OSFED [Other specified feeding or eating disorder] is the DSM-5 diagnostic category that replaces the category formerly called EDNOS [Eating Disorder Not Otherwise Specified]. The original paper mentions the EDNOS category but has been updated to the OSFED category for this systematic review.

3 OSFED [Other specified feeding or eating disorder] is the DSM-5 diagnostic category that replaces the category formerly called EDNOS [Eating Disorder Not Otherwise Specified]. The original paper mentions the EDNOS category but has been updated to the OSFED category for this systematic review.

4 OSFED [Other specified feeding or eating disorder] is the DSM-5 diagnostic category that replaces the category formerly called EDNOS [Eating Disorder Not Otherwise Specified]. The original paper mentions the EDNOS category but has been updated to the OSFED category for this systematic review.