When an Eating Disorder Becomes a Friend

By Brenna Williams, B.A.

Think about this: What do you look for in a friend? Maybe you look for someone who is kind and trustworthy. Maybe you think a good friend would always be supportive and lift you up when you feel down. Maybe you search for people who are particularly fun to be around and tell great jokes. Whatever you look for, usually our friends are people who make us feel good about ourselves. But what happens when an eating disorder becomes your friend?

Sometimes people with eating disorders experience an inner critical voice, commonly called “the anorexic voice” or “the disembodied voice” in research (Pugh & Waller, 2016; Pugh & Waller, 2017), but more commonly named “Ana,” “Mia,” or “Ed” by those with eating disorders (Williams & Reid, 2012). While this voice is most commonly found among individuals with anorexia nervosa, it is found among all eating disorders (Pugh & Waller, 2017). This eating disorder voice is not a hallucination, but a perception of thoughts in the second or third person (Pugh & Waller, 2017). It says things like “You’re so fat,” “You have to be thinner,” “You shouldn’t have eaten that,” and “No one will love you unless you are perfect.” It may be difficult to think of this voice as a friend. It’s saying things that would make any person upset. So why do people with eating disorders commonly view this voice as a friend (Williams & Reid, 2012)? It may have to do with the onset of the voice.

The voice develops with the eating disorder, starting off by praising the person for losing weight or restricting their food intake (Tierney & Fox, 2010). Ultimately, the voice assists the person in gaining a sense of control over their lives and reinforces them in their disordered eating behaviors. It also offers support and companionship during a time where many people with eating disorders may isolate themselves from others (Damiano et al., 2015). However, as the eating disorder continues to progress, the voice becomes more critical (Tierney & Fox, 2010). The voice shifts from being a friend to a foe (Williams & Reid, 2012) and begins to repeat harsh words similar to the ones mentioned above. Not only that, but the voice becomes grows even more harsh if the person attempts to recover (Tierney & Fox, 2010). As a result, the voice has been theorized to be a maintaining factor of eating disorders (Pugh & Waller, 2017). The voice could also be a potential reason for the high remission and relapse rates among people with eating disorders (Keel & Brown, 2010; Keel et al., 2005).

​There is hope, however! Researchers are beginning to study the voice in an effort to better understand it (Pugh & Waller, 2017). As we being to better understand the voice, we will also be better able to treat it and potentially reduce remission and relapse rates. It may be difficult to break the relationship with this friend/foe and recover from an eating disorder, but it is possible!

Please tell us about your experience with the eating disorder voice in the comments!