Exploring experiences of externalising and the anorexic voice

Part A
This review synthesised literature exploring people with anorexia nervosa’s (PwAN's), carers' and clinicians' experiences of therapeutic externalisation. Relevant literature was discovered using a systematic search of online databases which found 18 papers that met inclusion criteria. Meta-ethnography was used to synthesise the literature. Findings highlighted stakeholders' contradictory views on the impact of externalisation on PwAN's relationships and sense of identity, indicating that this technique has the potential to help or harm PwAN's recovery. Ways of understanding these contradictory views and the need for clinicians to adapt externalising techniques were emphasised. Review limitations, clinical implications and future research needs are outlined.

Part B
This qualitative study explored carers’ perceptions of the anorexic voice (ANV). Thirteen participants were interviewed, and their transcripts interpreted using Reflexive Thematic Analysis. Findings revealed that the ANV holds many meanings, and the construct attracted advocates and critics among carers. Advocates recognised the ANV as a powerful bully and found they could bring positive changes by altering their relationship with it. Carers outlined benefits, shortcomings and criticisms of the ANV, which under scrutiny, revealed significant overlap with perspectives on externalising. These findings are outlined in the context of existing literature, and the limitations, clinical implications and future directions are illustrated.