Dysfunctional self-talk associated with eating disorder severity and symptomatology

Background: While self-talk has been argued to play a crucial role in the development and maintenance of eating disorders (EDs), it has received limited research attention. This study aimed to explore the relationship of ED self-talk with ED severity and symptomatology.Methods: Analysis of the existing literature, supplemented with a small-scale pilot study, identified 24 distinct categories of ED self-talk. The main study involved the completion of on-line questionnaires by 172 women aged 18-49, recruited through clinical services, ED websites, and the general population. Participants were assigned to clinical (n = 83) and non-clinical (n = 89) samples, using the Eating Disorder Examination Questionnaire to screen for ED psychopathology.Results: Substantial differences in the levels of ED self-talk were found between the clinical and non-clinical populations. Principal components analysis, conducted within the clinical sample, revealed ED self-talk to have a two-component structure. Self-talk reflecting an 'abusive relationship' between the sufferer and the ED strongly predicted overall severity and several aspects of symptomatology. 'Ascetic attitudes' towards thinness were linked with compulsive exercising and lower BMIs but not with overall severity.Conclusions: Close examination of the 'abusive relationship' component suggests a need to loosen the connection between negative appraisals of the abused self and the abusive voice of the ED so that the former can fulfil their potential as a force for change. Further, in seeking to counter the impact of the ED voice, it is suggested that the seducer and abuser roles require primary clinical focus.