Negative childhood events and the development of the anorexic voice: a grounded theory

Background Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal ‘anorexic voice’ (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences.

Aims This study explores the relationship between adverse experiences in childhood and the development of the AV.

Materials and Methods Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

Results Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood.

Discussion Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices.

Conclusions The findings have implications for a trauma-focused approach when working with the AV.