For many with active eating disorders, they will describe the drive to create energy deficits as an internal, incessant, and cruel inner voice. And no, generally speaking those with eating disorders don’t hear voices in the sense that there are any auditory hallucinations as we might see for those with schizophrenia. However, the inner chatter of the mind that all human beings experience becomes much more single-minded, self-critical and downright cruel for those with active eating disorders.
In some recovery settings, the usual war analogies are trotted out and the patient is encouraged to “beat” her eating disorder and frame that vitriolic inner chatter as the enemy to be vanquished. Now many have success treating an eating disorder as an entity separate from themselves, but likely an equal number have found this framing backfires badly. If you are unable to vanquish the condition, then its presence becomes even more frightening and ominous because you have just confirmed it’s more powerful than the real self, or real you.
Given that eating disorders cannot be cured and are chronic lifetime conditions, they are never really vanquished or beaten, but rather integrated and neutralized when full remission is realized.
That’s great, but when your inner voice is circling around “Pants don’t fit! You ate the whole sandwich! [Insert list of large animals used as place markers for fatness here]!!! You’re lazy, ignorant, disgusting…” that it’s so noisy in your head you cannot actually think, you’d likely prefer a bit more tangible help than foggy concepts of integration and neutralization.
Four years ago I wrote a blog post The Genetic Superpowers: Another Way to Frame Eating Disorders as an attempt to integrate the theory offered by Dr. Shan Guisinger as to why the eating disorder genotype has persisted in our human populations 1, with how that might allow for someone with the condition to treat an eating disorder as an attribute of existence, rather than a foreign invader.
An attribute is an inherent characteristic or part of you. It could be a detrimental or useful attribute, but more commonly our attributes are both positive and negative. Whether an attribute expresses its positive or negative elements is usually dependent on the circumstances and environment at the time.
As an example, let’s take the attribute of being taller than average. This is an attribute that is generally experienced as a positive one. Taller people earn more than average and are seen as more intelligent and as superior leaders by others. 2, 3 But tallness is experienced as a negative attribute, for the tall person, in sardine/coach class on all commercial airlines.
Chronic conditions, of which an eating disorder is one of many such conditions that sit under the anxiety disorder umbrella, are much more complex attributes than tallness of course. By framing an eating disorder as an attribute, I am in no way suggesting that it’s a benign or functional attribute. These conditions reside in a different class of attribute entirely from unchangeable attributes such as tallness or eye color. Chronic conditions are mutable and malleable attributes and we are tasked with actively engaging with these attributes to neutralize their life-limiting unmanaged expression and impact on self and others.
So how do you navigate constant hate-filled, cruel and vindictive eating disorder chatter if you don’t treat it as the enemy, but rather as a complex attribute that is most decidedly expressing a whole bunch of negative outcomes on you and everyone around you?
Step one is to identify that the chatter is the appropriation of a regular inner voice by the threat response system in the brain. Folks who are ‘normal’ and don’t deal with eating disorders can find themselves having inner voice pep talks thrown at them—chatter without the threat response. It might look something like this: “You need to get those dishes done now before you start your baking. Remember the last time you tried to work around them? Disaster. Don’t be an idiot, just do them now.”
Just as with behaviors such as body checking, inner voice chatter is common to all human beings, but it’s the degree and how it gets hijacked by the threat response system that differentiates your inner voice chatter from that of those who don’t have eating disorders.
So that regular person decides to listen to her inner voice and does the dishes before she begins baking—no more chatter. She might also decide to ignore her inner voice and work around dirty dishes yet again while she bakes. That might elicit an “I told you so!” from the inner voice if the process becomes a disaster yet again, or disaster might be averted this time around and the inner voice stays quiet. That’s how an inner voice works when it has not been hijacked by the threat response system.
For you, the inner voice has become a puppet to a very misaligned threat response system that fires up every time you approach and eat food. Now the inner voice is no longer a bit self-satisfied and superior; it’s shrill, constant, invasive and will. not. let. up.
Step two is to recognize that your job is to be the adult to your hijacked inner voice that’s acting out like a panicked toddler. There’s a recent set of viral videos of people putting cucumbers beside their unsuspecting cats while their cats are eating out of their food dishes. Many people find the reactions hilarious. I find them cruel. Like most mammals, cats have very hard-wired threat response systems to anything that approximates the shape of a snake. These cat owners find the massive threat response “cute and funny”, me not so much. There are also plenty of parents who are happy to film and post to YouTube their children experiencing massive emotional meltdowns and tantrums, and again me not so much. Yes a cucumber is not a snake (‘lol’) and the world will not end because a beloved stuffie has to be stitched up, but a compassionate adult doesn’t discount how real the distress is for the terrified cat or distraught toddler.
I’ve had one of my cats bite me at the vet’s. And if you’re a parent, well we’ve had plenty of cruel things said to us by our children when they are massively distressed as well. And we’ve all likely lost our cool with a distressed animal, child or partner and really regretted it after the fact. We’re human. But as adults, it’s our job to try to maintain calm compassion and be the instigator for attempting to resolve the distress, rather than up the ante by lashing out with retaliatory cruelty.
Step three is to maintain your meta-cognitive skill, your sense of humor and your self-compassion. Meta-cognition is the ability to think about thinking and think about feeling. If, in the middle of a heated argument, I think to myself “Wow, I’m really angry,” I am practicing meta-cognition. Meta-cognition allows for us to watch our thoughts and feelings as observers and it therefore gives us the opportunity to choose what, if any, behavior we might want to enact in response. For example, as soon as I think to myself “Wow, I’m really angry,” I’ve opened up several possibilities for myself as to next steps. I could choose to say I am taking a break from the argument to go cool off; I could choose to apply physical shifts to lower the intensity of the anger (unclench my fists and jaw, breathe more deeply and take a moment to calm down a bit); or I could choose to switch the anger off and change the subject because I realize the argument is pointless.
There is a way that we can see humor in a situation that is humane or we can express uncaring humor at the other’s expense. Watching a toddler fling himself onto the floor in screaming and writhing agony because his beloved stuffie has an area where the stitches have come loose does have an element of adorable cuteness that can actually diffuse any and all irritation you might have with the kid. But the humane expression of that humor is to find yourself filled with compassionate, smiling love for the distraught kid and not to grab the camcorder.
The same holds true for the incessant, whining, shrill, panicked, endless inner voice hijacked by the eating disorder in your own mind. It’s just flung itself down on the ground writhing in absolute agony over a sandwich. Poor thing. Your meta-cognition can tell you that the threat is not real and your humor and compassion can allow you to diffuse your irritation and show that inner voice a bit of calm consideration:
“I know you are having a tough time believing this right now, but the sandwich is good for us. It’s all going to be okay. We’re in absolutely no danger and everything is going to work out. How about we watch that golden retriever puppy video you like so much?”
1. Guisinger, Shan. "Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa." Psychological Review 110, no. 4 (2003): 745.
2. Lundborg P, Nystedt P, Rooth DO. Height and earnings: The role of cognitive and noncognitive skills. Journal of Human Resources. 2014 Dec 21;49(1):141-66.
3. Blaker NM, Rompa I, Dessing IH, Vriend AF, Herschberg C, Van Vugt M. The height leadership advantage in men and women: Testing evolutionary psychology predictions about the perceptions of tall leaders. Group Processes & Intergroup Relations. 2013;16(1):17-27.