Understanding ‘Ed’: A theoretical and empirical review of the internal eating disorder ‘voice’

Abstract

Many individuals with eating disorders make reference to an internal eating disorder ‘voice’ or ‘self’ (EDV/S): a phenomenon which is poorly understood. This paper reviews conceptual and empirical literature relating to the EDV/S. Criticisms and controversies surrounding such experiences are also discussed with reference to current research. In order to clarify how and why internal voices contribute to disordered eating, four theoretical frameworks which help contextualise the EDV/S are presented: cognitive theories of voices; interpersonal theories of voices; trauma-based theories of voices; and dialogical self theory. The paper concludes by proposing a preliminary, multifactorial model of the EDV/S which is composed of four maintaining factors: EDV/S dialogical patterns, EDV/S appraisals, EDV/S relating styles, and early trauma and associated interpersonal schemata. Directions for treatment and future research are discussed.