The development and assessment of a scale to measure the experience of an anorexic voice in anorexia nervosa

An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the 'anorexic voice'

OBJECTIVES

Many individuals with eating disorders (EDs) report the experience of an 'Anorexic voice' (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity.

DESIGN

165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N  = 141)] and those who have not [non-AV group (N  = 23)].

METHODS

The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity.

RESULTS

Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors.

CONCLUSIONS

The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.

Listening, learning, caring: exploring assemblages of, ethics of and pathways to care for avoidant restrictive food intake disorder (ARFID)

Care has been theorised in relationship to eating disorders as a central consideration across diagnoses. In the context of avoidant restrictive food intake disorder (ARFID) specifically, there is room to further develop the nuances around layers of care involved in working towards well-being. In this paper, we engage with the stories of 14 caregivers of people with ARFID, exploring their pathways to care (or lack thereof) through the healthcare system in Aotearoa New Zealand. We explore the material, affective and relational aspects of care and care-seeking, engaging with the power and politics of care as it flows through care-seeking assemblages. Using postqualitative methods of analysis, we discuss how while participants were seeking care, they received (or, at times, did not receive) treatment, and unpack how care and treatment are not always synonymous. We work up extracts from parents' stories surrounding their caring for their children and how their actions were, at times, interpreted in ways that made them feel blame and shame rather than care. Participants' stories also offer glimmers of care within a resource-strapped healthcare system, which invite us to consider the potentiality of a relational ethics of care as an assemblage-shifting moment.

Relating Therapy for Distressing Voices in the Context of Anorexia Nervosa: A Case Series

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.

A proof-of-concept study for the use of a computerised avatar to embody the eating disorder voice in anorexia nervosa

PURPOSE

This study assessed (1) the experience of the eating disorder voice in people with anorexia nervosa or in remission, and (2) the feasibility of creating and interacting with a computerised representation (i.e., avatar) of this voice.

METHODS

Twenty-one individuals with anorexia nervosa and 18 individuals who were in remission participated in the study. They reported on the characteristics of their eating disorder voice and created a personalised avatar (a visual and auditory representation of the eating disorder voice), using a computerised software. Participants assessed closeness of match between the voice and the avatar, perceived distress and acceptability of re-exposure to the avatar.

RESULTS

Patients felt less powerful than their eating disorder voice and unable to disregard the voice's commands. The experience of the voice was associated with negative, as well as some positive emotions, reflecting the prototypical ambivalence towards the illness. Individuals in remission had an opposite pattern of responses. They attributed only negative emotions to the voice, felt more powerful than the voice, and able to disregard its commands. Overall participants reported that there was a good match between the voice and the sound of the avatar. Patients expressed willingness to repeat exposure to the avatar.

CONCLUSION

Individuals with anorexia can create personalised digital avatars representing the eating disorder voice and are willing to engage therapeutically with the avatar. The next step is to test the feasibility of repeated exposure to the avatar to address the power and distress associated with the eating disorder voice.

LEVEL OF EVIDENCE

Level III.

Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review

PURPOSE

Cognitive restraint has potentiating and deleterious effects on working memory (WM) in anorexia nervosa (AN). Conflicting evidence may be due to heterogeneity of tasks examining different WM components (e.g., verbal/auditory versus visuospatial), and differences in adolescent versus adult AN. Additionally, differential cognitive profiles of restricting versus binge/purging subtypes, comorbid psychiatric disorders and psychotropic medication use may confound findings.

METHODS

To address these conflicts, 25 studies, published between 2016 and 2021, investigating WM in children, adolescents and adults with AN were systematically reviewed using PRISMA guidelines.

RESULTS

In 71% of WM tasks, no difference in performance between AN patients and age-matched controls was reported, while 29% of WM tasks showed worse performance. Adults with AN displayed deficits in 44% of the verbal/auditory tasks, while performance remained unaffected in 86% of visuospatial tasks.

CONCLUSION

Examining age groups and WM subsystems separately revealed novel findings of differentially affected WM components in AN. Comorbidities and psychotropic medications were common among AN participants and should be regarded as critical confounding factors for WM measures. Future studies examining different components of WM, acknowledging these confounding factors, may reveal specific deficits in AN to aid treatment improvement strategies.

LEVEL OF EVIDENCE

I, systematic review.

An open invitation to productive conversations about feminism and the spectrum of eating disorders (part 2): Potential contributions to the science of diagnosis, treatment, and prevention

The role of feminism in eating disorders research, treatment, and advocacy continues to be debated, with little agreement in sight about the role-or lack thereof-of feminist eating disorders work. In these debates, the opportunity to open fruitful conversations about eating disorders that generate new possibilities for researching, treating, and preventing them is missed. This article is the second in a series of two papers that invite such a discussion. In this article, we focus on five key contributions that feminist eating disorder work has made and can make moving forward. These are contextualizing treatment, attending to lived experiences, expanding the meanings of "sociocultural influences," diversifying methodologies, and situating recoveries. We do not propose to offer a "final word" on feminisms and eating disorders, but instead to start conversations about how we understand, research, and treat eating disorders.