“There’s a battle going on inside my head—one voice tells me I don’t need to eat, while the other says I should follow my meal plan.”
“It’s like I have an angel sitting on one shoulder and a devil on the other.”
“I feel like I’m two people—one who knows I’m really in trouble and one who feels stronger and more powerful each day.”
Almost every person I’ve seen with an eating disorder has reported, or can relate to, the concept of this internal struggle. These “voices” are different from those heard or experienced in psychosis (i.e., no loss of contact with reality occurs). The negative, self-critical voices are due to an obsessional thinking style, which is often magnified and intensified by malnutrition. The voice of the eating disorder is a strong and powerful force that may need to be directly confronted for recovery to be successful.
Identify the voice
I find it can be helpful to assist clients, even as young as age ten, to identifythe self-critical voices early in the treatment process. It is important to recognize that the messages that say to restrict, or purge, or exercise incessantly, are spoken by the eating disorder. Especially with young clients who may not come to treatment voluntarily, it may be assumed that the battle is between themselves and parents or treatment providers, all of whom are urging them to gain weight. If you are suffering or in recovery, it is helpful to recognize that the battle is really within your own mind, and that the treatment team is involved to help you become strong enough to win this war. It can also be helpful to personify the eating disorder, perhaps by giving it a name, like Ed or Anna or the ED Monster.
By contrast, the voice that influences you to eat, and comply with your meal plan or exercise limitations, needs to be recognized and identified as the part of you that seeks recovery. Depending on motivation and the stage of the treatment process, this voice may be much weaker, or you may only hear the messages that you believe are what others desire.
The eating disorder voice may be more familiar, even more comforting, initially. Some of my clients will say, “I don’t know which voice to believe. How do I know which voice is Ed and which is mine?” I encourage them to sort it out this way: Which voice will help you become stronger and healthier? Which will lead you toward recovery? Which voice would your parents and treatment team want you to follow?
Differentiate the voice
I model listening to the recovery voice and encourage trying it out as well, even if you are not yet ready to embrace recovery. Statements such as “Ed is telling me not to eat, but I know I need to if I want to be strong enough to play tennis next week,”help differentiate the two voices. It can be quite empowering to begin to separate them. Eventually, the Ed voice becomes more distinct, which again can assist in aligning the sufferer and the treatment team on one side of the struggle, and Ed on the other.
By recognizing the distortions, or lies, that are present in Ed’s voice, you can separate them from your own. Those messages are nearly always black and white. “If you eat that pizza, you’re a pig. What a loser; you couldn’t make it a day without bingeing.”Recovery messages are less “all or nothing” statements and more about progress.
I assist my clients to recognize the A-B-C sequence (Activator, Belief, Consequence), and point out that Ed’s messages are beliefs or opinions, not facts. I then help them to understand that by changing beliefs, new consequences and choices are possible. “I had one piece of pizza, like my dietician and I planned. I know it’s part of my meal plan and okay for me to have. I don’t have to purge.”
Make the healthy voice stronger
Essentially, change involves fighting back against the negative, self-critical voice of the eating disorder. There are a number of things you can do to recognize this voice is not your own. I ask my patients to argue with the eating disorder. Talking out loud to Ed, especially at first when the voice is so strong, can be beneficial. It’s also helpful to journal, perhaps by making a list of “What Ed says is true” and “What I/Others say is true” on opposite sides of the page. Or create something visual, such as a map showing where you are, where Ed wants to lead you, and where recovery lies. As recovery continues and the healthy voice becomes stronger, try to recognize at the end of each day how positive choices were made. “Ed told me to purge, but I choose to keep the food down instead.” I encourage patients to stop the negative, eating disorder voice as soon as they hear it, and to substitute positive, affirming, self-caring comments instead.
Remember, developing negative self-critical talk is a learned process; therefore, it can be unlearned. It takes significant practice and repetition before the voice of recovery begins to feel authentic and strong, but it can be done.
For those clients who are open to their spiritual nature, it can be extremely helpful to frame this process in spiritual terms. Whatever your higher power or healing source or God, thinking of the message of hope and healing as emanating from that power can strengthen and authenticate it. One of my Christian patients and I share a fondness for a contemporary Christian song, The Voice of Truth, by the group Casting Crowns. When this patient struggles with the eating disorders old messages of self-loathing, she often listens to this song. Its message of hope for the future is a powerful antidote and provides the strength she needs to carry on:
“But the Voice of Truth tells me a different story;
the Voice of Truth says do not be afraid.
The Voice of Truth says ‘this is for My glory;’
And of all the voices calling out to me,
I will choose to listen and believe
the Voice of Truth.”
By Gail Hall, LMSW, DCSW
Reprinted with permission from Eating Disorders Recovery Today
Fall 2006 Volume 4, Number 4
©2006 Gürze Books
About the Author
Gail Hall, LMSW, DCSW, has been treating individuals with eating disorders for over 22 years. She is now the owner and director of CTED, LLC, an outpatient practice of therapists and dieticians specializing in the treatment of eating disorders.
Dr. Gnap website editor eatingdisordersrecoverytoday.com. Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago. Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance.