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Coping with the anorexic voice

Mon, 05 Dec 2022 00:00:00 +0000

Let me introduce myself – I am Jordan, a current third year trainee clinical psychologist at Cardiff University. I have an interest in early intervention and preventative approaches. I also spent a significant portion of my life struggling with an eating disorder and anorexic voice, which has led me to my interest in researching this area. I would like to tell you a little bit about this journey, and why I think this area is so important to understand.

Like many others, the onset of my eating disorder began in my teens, and plagued me for several years. Reflecting back on these experiences now, my relationship with my eating disorder, and the anorexic voice, changed drastically. At first it felt like a friend. Telling me how I could be better, look better, feel better if I only did what it said. I got a sense of a “high” from following its advice. It was a constant companion, always lingering in the background. At times, I could turn the volume of the voice down or even ignore it completely. What I didn’t realise was how over time, the anorexic voice began to take more and more control. I felt trapped and completely entwined with the voice. It was loud, it was demanding, it was nasty. It was no longer a friend, but a critical and scathing devil on my shoulder. It would constantly belittle me, yell at me, controlling what I could and couldn’t eat. It was misery. Lots of my memories from this time are hazy, but I remember the feelings. I remember feeling scared, I remember feeling overwhelmed, I remember feeling tired of fighting the voice in my head. I remember sitting and crying because I couldn’t fight against the voice any longer.

Now, it’s important to note that there is a positive end to this story. With lots of support and psychological therapy, I took back control from the voice and was able to recover. I have considered myself fully recovered from my eating disorder for several years. I have been able to learn from my experiences and move forward to work clinically with other individuals in distress. As a trainee clinical psychologist, I am on the path to helping other people in the way that I was helped.

And that is why this research is so important to me. Qualitative research with individuals with eating disorders has described the experience of the anorexic voice, reflecting exactly what I described above. The anorexic voice is perceived as becoming more malevolent, more powerful and louder over time (Tierney & Fox, 2010). The anorexic voice is also considered a major barrier to therapeutic interventions and impacts recovery rates.

By understanding how individuals may try and cope with this highly distressing experience, it informs our understanding of the anorexic voice and ultimately can help us improve therapeutic interventions. If we can pick apart what contributes to the change in the anorexic voice from caring and supportive to critical and powerful then we may be able to think about how we can lessen its impact and maybe stop it all together.

In order to do this, I have developed my large-scale research project to explore the impact of the ways of coping with the anorexic voice. I am looking for anyone over the age of 18 with current experience of the anorexic voice to take part. You do not need to have a formal diagnosis of an eating disorder, nor do you need to currently or have previously received treatment for your eating disorder. The study consists of two parts, the first is a series of questions that can be completed online and will take approximately 10 minutes.

If you are eligible for part 2, the researcher will contact you by email and invite you to complete some further questions and online tasks using Qualtrics and Zoom, taking about 20 minutes. This will help us to understand the impact of the ways individual try to cope with the anorexic voice. Participation is greatly appreciated!

If you have any further questions or would like to take part you can either email me at holtj2@cardiff.ac.uk or you can access part 1 directly through this link: https://cardiffunipsych.eu.qualtrics.com/jfe/form/SV_2fuszCv2OuszcPQ

Let’s talk about Autism and Eating Disorders

Mon, 05 Dec 2022 00:00:00 +0000

I am a trainee clinical psychologist trying to navigate my way through my third year of clinical training. When it came to deciding my long-scale research project, I was excited when an opportunity to combine two interests of mine came up. The more I researched into the link between eating disorders (ED) and autism, the more surprised I became at the prevalence of autistic traits in people struggling with an eating disorder, and the large proportion who go undiagnosed until they present to eating disorder clinics. Approximately 20% of people with an ED are autistic (Dattaro, 2020). Cognitive rigidity, attention to detail, sensory sensitivities, and poor social functioning, appear to be the most closely shared traits between the two conditions (Tchanturia et al., 2020).

A paper of particular interest looked at understanding the link between autism and eating disorders. Brede et al. (2020) interviewed autistic women with experience of Anorexia Nervosa (AN), parents and healthcare professionals, to understand how AN develops and persists in autistic people. Themes obtained from the interviews, allowed the researchers to develop an autism-specific model of restrictive eating difficulties, which suggests a direct and indirect pathway to developing restrictive eating in autistic individuals. The direct pathway suggests that the likelihood of extreme restrictive eating developing may be increased by autism-related challenges that focus around food and ED-related behaviours. The indirect pathway proposes that restrictive eating is utilised as a maladaptive coping mechanism to address the way in which autism-related challenges are thought to result in negative emotional consequences. Alongside this, external factors, such as bullying, being misunderstood and stressful life events, may play an important role in the indirect pathway. The researchers hypothesise that autistic people may develop restrictive eating behaviours as the effects reduce autism-related difficulties by allowing people to numb down emotional and sensory experiences and introduce calmness by obtaining a sense of control and predictability. This paper provides an insight into the autism-specific mechanisms underlying restrictive eating difficulties, through the first-hand accounts of individuals, families and clinicians.

Babb et al. (2021) used the same sample to investigate their experience of eating disorder services. Three themes emerged from the interviews: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement with services. Recommendations for future research suggest the need for developing tailored eating disorder interventions to specific needs for autistic people. As standard treatment is based on typical ED presentations and motivators, it is unsurprising that treatment outcomes are reported to be considerably worse if autism is present (Nielsen et al., 2015). These pieces of research are a step further into understanding the interconnected nature of these two conditions and recognising why standard eating disorder therapies may not be as effective for autistic individuals.

The PEACE pathway was developed to support the clinical comorbidity between autism and AN by improving autism identification, staff training, treatment modifications, and service-user experiences (Tchanturia et al., 2020). The aim is to improve clinician understanding and confidence in supporting autistic individuals with an eating disorder by implementing evidence-based strategies developed through the pathway. Reading about the PEACE pathway sparked my own interest in thinking about particular psychological therapies, such as Cognitive Behavioural Therapy for eating disorders (CBT-E) and the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA), and how they could be tailored to support autistic people with an eating disorder. Studies which have adapted CBT for autistic people with other mental health conditions, such as social anxiety (Bemmer et al. 2021) have reported significant improvements in presentation. If we can make modifications to specific therapies, my hope is that this may improve outcomes for autistic service-users recovery.

For my long-scale research project, I am looking to speak to healthcare professionals who have experience of delivering CBT-E and/or MANTRA to autistic service-users. I am interested in hearing about your experiences and expert knowledge. Email me at settersc@cardiff.ac.uk or find me on twitter @setters_chloe for more information.

Chloe Setters

References

Babb, C., Brede, J., Jones, C. R. G., Elliott, M., Zanker, C., Tchanturia, K., Serpell, L., Mandy, W., & Fox, J. R. E. (2021). ‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals. Autism, 25(5), 1409-1421. https://doi.org/10.1177/1362361321991257

Bemmer, E. R., Boulton, K. A., Thomas, E. E., Larke, B., Lah, S., Hickie, I. B., & Guastella, A. J. (2021). Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder. Molecular Autism, 12(11). https://doi.org/10.1186/s13229-021-00418-w

Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K., Serpell, L., Fox, J., & Mandy, W. (2020). ‘For me, the anorexia is just a symptom, and the cause is the autism’: Investigating restric- tive eating disorders in autistic women. Journal of Autism and Developmental Disorders, 50, 4280–4296. https://doi.org/10.1007/s10803-020-04479-3

Dattaro, L., 2021. Anorexia’s link to autism, explained | Spectrum | Autism Research News. [online] Spectrum | Autism Research News. Available at: https://www.spectrumnews.org/news/anorexias-link-to-autism-explained/ [Accessed 2 December 2022].

Nielsen, S., Anckarsäter, H., Gillberg, C., Gillberg, C., Rastam, M., & Wentz., E. (2015). Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study. Molecular Autism, 6(14). https://doi.org/10.1186/s13229-015-0013-4

Tchanturia, K., Smith, K., Glennon, D., & Burhouse, A. (2020). Towards and Improved Understanding of the Anorexia Nervosa and Autism Spectrum Comorbidity: PEACE Pathway Implementation. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00640

The thin-ideal and its relationship with disgust

Mon, 21 Feb 2022 00:00:00 +0000

This research project presented an experimental study of the link between disgust and body image in a sample of undergraduate students who had high or low eating disorder (ED) symptomatology.

Body image dissatisfaction (BID) is a key risk factor for the development and maintenance of an ED. A key factor in the development of BID is ‘thin-ideal internalisation’ . Thin-ideal internalisation refers to the extent to which an individual internalises socially defined ideals of attractiveness (e.g., being thin). Recent theory and research has begun to explore the role of the emotion disgust in the development and maintenance of BID. Therefore, this study aimed to examine the role of disgust on a key factor of BID, thin-ideal internalisation.

Student participants were induced to experience the emotion disgust (or a neutral emotion within the control group) using a short, validated film clip (known as a mood induction). The Implicit Association Task, a computerised tool used to measure concepts that may not be outwardly communicated or expressed, was used to measure implicit thin-ideal internalisation. In total, 181 students participated from across the UK.

Statistical analysis indicated that, as expected, participants in the high ED group experienced greater implicit thin-ideal internalisation than those in the low ED group. Analyses revealed that those participants who were induced to feel the emotion of disgust experienced greater implicit thin-ideal internalisation than those participants in the control (neutral emotion) group. Contrary to expectations, it was also found that mood induction and implicit thin-ideal internalisation did not depend on ED condition. Findings suggest that experiencing disgust is associated with greater thin-ideal internalisation, regardless of whether an individual has symptoms of an ED or not.

This appears to be the first study to present such findings. Therefore this research does require replication. However, the novel study findings present a number of potential implications for clinical practice, including a greater role for disgust in assessment and intervention for BID and EDs. There are also potential implications for the theoretical understanding of the development of BID and the mechanisms of emotional processing (e.g., the implicit nature of emotions). It is hoped that this research will generate further research and theory development within emotion and body image.