Exploring eating disorder voices: a qualitative study of individuals in recovery - Hearing ED's voice.

Abstract

The eating disorder voice (EDV) has been increasingly recognised as implicated in the development and maintenance of eating disorders (EDs). However, research has predominantly examined anorexia nervosa (AN), limiting understanding across other diagnoses. This study aimed to investigate the lived experiences of the EDV across EDs, including AN, bulimia nervosa, and binge-eating disorder, among individuals identifying as being in recovery for at least 12 months. Twenty participants completed semi-structured interviews or an equivalent written survey. Using Reflexive Thematic Analysis within an interpretivist framework to emphasise the co-constructed nature of participants' accounts, the data were analysed, and two key themes were generated. The first theme captured a shared experience across diagnostic groups of the EDV as an evolving force of power and control. Participants described their EDVs as a 'Punitive Master', a hostile coercive presence that intensified over time, culminating in 'Escalation and Crisis'. Divergence was identified between participants with AN and those with other EDs; those with AN described an earlier phase, which their EDV presented as a 'Deceptive Protector', offering a sense of safety, identity, or control before later shifting into the more punitive and destabilising form reported across the wider sample. The second theme depicted how participants separated from their EDV and fostered awareness and agency throughout their individual recovery management. While similarities in EDV experience exist across diagnoses, participants described diagnostic‑nuanced dynamics of power and recovery. The study argues the need for therapeutic approaches to explicitly address the EDV across the spectrum of eating disorders.