Over and over again, people with eating disorders and the clinicians who treat them refer to “the eating disorder voice.” You won’t find it described in the DSM or really anywhere but it is very real piece of the ED picture. There are two different ways that “the voice” clinically manifests. The first is simply in beliefs and the second is in abusive self-talk.
Confused? You should be. It’s not easy to explain, but I am going to try!
Let’s start with beliefs. Sometimes in treatment, we attempt to differentiate between the beliefs of the person and the eating disorder. What is a thought based in the ED and what is a thought based in what we really value? These exercises are useful because sometimes, when we are in the middle of the eating disorder, the two are jumbled. It’s hard to tell the difference between what I really want and believe and what is simply a product of the eating disorder.
For example, a person with an eating disorder may say that no one has a right to be happy with a performance (work, school, whatever) unless it is perfect. Now, is this what the person really thinks or is this a function of an eating disorder? Occassionally, a person may truly believe that but often it has more to do with the perfectionism that plagues those with eating disorders. We strive (and fail) to be perfect at everything. Then we see other people, who are not even trying to be perfect, are happy and it makes us angry. “I try so hard and can’t be happy. They suck, Why are they happy?”
It’s not fair to other people but when the standards are set impossibly high for you, and no one else, it makes you a little angry. Thus, in treatment, we have to talk about why we are so angry about other people being happy and consider the possibility that the standards set us up to fail. We have to consider the idea that perfection is unattainable, that we are lovable, and that everything will be just fine if we are not perfect.
It’s a scary thing to face but the eating disorder beliefs have to be challenged and exposed for what they are. Only in removing the ED beliefs, can a person figure out what they really believe. Once the idea that perfectionism is not required to be happy or lovable, then we can start seeing that, for example, we might feel happiest when we are playing with a child or talking with a friend. The standards change and happiness is possible.
The second piece of the eating disorder voice is abusive self-talk. It might sound a little crazy but we all have self-talk all the time. Most of it relates to our ability handle the situation in front of us and most of the time, we are not aware of it.
Unfortunately, those with eating disorders are more aware of their self-talk and their self-talk tends to be more abusive. It is literally like someone is yelling at you all of the time, except in your head. It’s not psychotic. It’s not like someone with schizophrenia who hears a separate, distinct person. It’s still just you but you are very loudly yelling at yourself.
Have you ever made a really big mistake and been mad at yourself? You know how you say to yourself “Why did you do that? That was dumb? You need to fix this!” And then you regroup, shut down the yelling and start problem solving?
Well, that doesn’t happen in an eating disorder. You just yell at yourself…all the time…over everything. It’s unrelenting and cruel. It eventually tells you that you deserve to be punished and you have to punish yourself. It tell you that you do not deserve to eat, that you are worthless, and so on.
The worst part is that you believe it.
Obviously, the self-talk is much harder to treat. It’s like trying to fix a tape on repeat. (I just dated myself, I know.) It’s automatic, constant, repetitive, and loud. It basically meets all the criteria for sound torture.
So, what do you do? The best we know how to treat it is through mindfulness techniques. The person, usually with the help of the therapist, has to learn to nonjudgmentally identify when the self-talk is being abusive, and replace it with more positive self-talk. The goal is to systematically extend the amount of time that the self-talk is positive, until it is generally positive.
The eating disorder voice is very hard to describe but it’s very real. It’s real and devastating.
Have you ever experienced the ED voice? What was it like? How did you deal with it?