The Anorexic and Bulimic “Voice”

It is my belief that in bulimia/BED, the urges to binge are the one and only cause of binge eating. Most of the time, these urges have a “voice” – one that sounds like your own – which strongly encourages the destructive eating behavior. In bulimia/BED, the woman usually views the voice as her enemy; she knows (at least on some level) that the voice is not expressing what she truly wants. In Brain over Binge, I briefly talk about how this situation is sometimes different in anorexia, because many anorexics believe the voice that encourages the destructive eating behavior (restriction/starvation) is expressing what they truly want – to lose weight. I recently came across a summary of a study which aimed to systematically examine this voice in anorexia, and I wanted to share it here along with some insights for binge eaters.

This study aimed to investigate experiences of and reflections on living with an anorexic voice. Participants were invited to write about their anorexic voice in the form of a poem, reflection, letter, or descriptive narrative. The written contributions were then analyzed by researchers. The study found that anorexics bestowed both positive and negative attributes to their anorexic voice; it was found that anorexics viewed the voice more positively in the beginning stages of the disorder and more negatively over time as the disorder developed. The participants felt an affiliation toward the voice, which researchers said could explain their ambivalence to change. The researchers recommended that therapists persist in their endeavors to penetrate the tie between anorexic patients and their anorexic voices.

I think that once the anorexic patient begins to view her anorexic voice negatively in any way, that is the opportunity for the patient to penetrate the tie. Just as in bulimia, the anorexic doesn’t lose volitional control of her actions; she retains the ability to override the anorexic voice. Whereas to stop binge eating, one must not act on the urges to binge; to stop anorexia, one must act (eat) in spite of the urges to starve. She must put food in her mouth despite what that voice is telling her; but to do this, she has to believe (at least on some level) that the voice is wrong.  If she thinks that voice is right – if she has an affinity for it – she will continue following it.

Even though individuals with bulimia/BED usually don’t have much trouble viewing their destructive voice as negative, I thought this study could still be useful for binge eaters, especially those who are just learning to separate themselves from their urges to binge. Like the participants in this study, you could write a poem, a reflection, a letter, and/or a descriptive narrative that reflects on your experience with the voice that urges you to binge. Getting to know the voice is helpful in order to recognize the many ways it presents itself. You could write about what you hear (in your head) that encourages you to binge; you could list all the “reasons” the voice gives you to binge; you could describe all the sensations you experience when you hear that voice. It is my hope that in doing this, you will realize that all of this “neurological junk” is not truly you, and you do not have to follow that voice.