Let me say first and foremost that there is no anorexic voice. This concept of a voice or person telling the patient to vomit or not to eat is an anthropomorphization of the physiological impulses experienced by the patient. Some therapists actually do believe there is an anorexic voice, much like a demon or alter ego that takes residence in the patient's subconscious. Some call it the Negative Mind, others imagine it to be Satan or a monster, or an evil taskmaster.
When you talk to patients that have been in eating disorder programs for some time, you'll find they talk about this "voice" quite a bit. Some patients who accept this dogma (which is taught as truth by many programs) will talk about this voice or monster inside them as if it were a literal person.
If you are a religious person, you may believe in a literal Satan or Devil, who tempts you to yield to temptation. If you do transgress and fall into sin, you will generally feel guilt or shame, and feel a need to confess your sin or to redeem yourself through some compensatory action. For some, the concept of an evil person tempting them simplifies the complex interactions of physiological impulses, personality, conscience, and upbringing, making their feelings easier to understand. The problem with oversimplifying things in this case is that many of our physiological impulses can only be partially controlled through self-discipline and willpower, so often a viscious cycle of temptation, transgression, guilt, and remorse ensues.
Indoctrinating an anorexic patient with the concept of the "anorexic voice", as happens in many eating disorder programs, may not be in the patient's best interest. I don't believe any patient wants to look emaciated and severely malnourished. However, even in such a state, the bloating, edema and constipation experienced by severely malnourished patients can make them "feel" fat. Like the beautiful teenage girl who thinks she's ugly because of one pimple on her nose, the anorexic patient looks at her bloated tummy and is fully convinced she must do more abdominal exercises. As her body wastes away, her stomach looks even bigger in comparison, necessitating more exercise (bloating is a common symptom of many gastrointesinal disorders).
Eating is no longer a pleasure, and even a few mouthfuls of food will make her feel like throwing up. She may feel full after barely starting to eat. Her bowel may be so blocked up that she wishes she could find a laxative to give her relief. If she does eat, it may take all of her concentration to keep the food down. She usually pays dearly for eating, almost always experiencing nausea, bloating, and stomach pain. Unknown to her, all of these feelings she is experiencing may be due to a chronic underlying illness. Confused, her therapist and doctors tell her these feelings are a result of emotional issues she has and that there may be a "voice" inside her head telling her to behave this way. It sort of makes sense to her, so eventually she comes to understand her dilemma by accepting this simplistic metaphor as literal. In a sense, this "Negative Mind", like Satan, becomes a much needed scapegoat and can be blamed for all the problems.
I believe if the correct diagnostic testing is performed on the patient, the reasons for the weight loss and eating difficulties will become readily apparent. The patient can then find comfort in knowing that they're not going insane, and that these dysfunctional attitudes toward eating and body perception are simply a result of what's happening in her body.
What are your experiences regarding the "anorexic voice" or 'Negative Mind"? Contact us and let us know.
When people are least sure,
they are often most dogmatic.
John Kenneth Galbraith
