Childhood trauma, emotions, and the eating disorder voice

Many individuals with an eating disorder report experience of an internal 'voice' which represents their disorder. However, research exploring the aetiology of this phenomenon is still limited. Past research has identified associations between adverse childhood experiences, emotional difficulties and eating pathology. Recent qualitative evidence suggests that the 'voice' specifically may be of relevance in this model; developing during difficult times in an individual's life and offering a sense of safety and guidance amidst adversity and associated emotional difficulties. The present study aimed to examine the relationship between childhood adversity, emotions, and the eating disorder voice experience.

In total, 148 participants (recruited via social media and Cardiff University) completed self-report measures exploring childhood trauma, beliefs about emotions, difficulties with understanding, expressing, and regulating emotions, eating disorder voice appraisals (specifically, perceived power of the voice), and eating disorder pathology. All participants had self-reported experience of an eating disorder voice, but the sample varied in terms of diagnoses and presentations.

The relative power of the eating disorder voice was found to be significantly positively associated with childhood emotional abuse (but no other forms of abuse), and this relationship was partially mediated by difficulties with emotion regulation. Greater voice power was significantly positively correlated with eating disorder pathology.

These findings provide preliminary evidence of associations between childhood experiences, emotion regulation difficulties, and the eating disorder voice. Further research seeking to elucidate this complex phenomenon is recommended. Limitations, future research directions and clinical implications are discussed.