Exploring voices and relationships in anorexia nervosa

Part A: Part A is a systematic review of published literature on the role of relationships in recovery from anorexia nervosa (AN). Four online databases were systematically searched for relevant articles and meta-ethnography (ME) was used to synthesise the studies. Ten papers were identified as relevant to the review question. Three third-order ME constructs were generated: ‘initiating, maintaining or re-connecting to nourishing relationships’, ‘transforming or distancing oneself from difficult relationships’ and ‘nurturing the relationship with the self’. The findings suggest that both intra- and interpersonal relationships are important for recovery. Important relationships included family, partners, friends, peers and healthcare workers. The relationship with AN, the anorexic voice (AV) and the ‘self’ were pinpointed as crucial in the recovery process. Transformation within these relationships was often required for recovery to occur.

Part B: Part B is a qualitative study of the AV in recovery. Fourteen participants with a past diagnosis of AN were interviewed about their experience of an AV and how it changed with recovery. Reflexive Thematic Analysis was used to evaluate the interview data. Five themes were identified in the data: 1. Allegiance, 2. Relationship becomes toxic, 3. Realisation & motivation, 4. Recovering from the AV, 5. Reclaiming life. The results suggest that individuals often move through a series of stages in their relationship with the AV. Initially the AV is a comforting and supportive presence, but the relationship soon becomes abusive and toxic. A catalyst occurs which prompts realisation and provides motivation for change. Recovering from the AV is a complex and gradual process, which includes dialoguing with the voice, learning to modify responses to it, building a different relationship with the voice and separating from it. Recovery is often followed by an ongoing period of reclaiming life from the influence of the AV.