Warning: This article contains descriptions of eating disorders, which some may find distressing.
The thoughts can start small: I’m not hungry, so I don’t need to eat. Just skip breakfast for today. If I go to the gym for two hours, then I can have a cookie.
But the thoughts can get louder. More relentless. Manipulative. Unkind.
“We call it the eating disorder voice,” says Sophie de Jong, a licensed mental health counselor in Honolulu who specializes in treating eating disorders (ED). “You might start to notice your food intake or your body a little more. Maybe you’re gradually restricting calories.”
Eating disorders are psychiatric illnesses characterized by eating behaviors that impact both physical and mental health. From binging or purging to obsessing over body image, the symptoms on the surface might all revolve around food. But eating disorders aren’t a choice; they’re a survival strategy.
Searching for safety
When an eating disorder develops, there are often other underlying factors, like low self-esteem and self-worth. Psychiatric illnesses can also co-occur, including anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Basically, the nervous system is overwhelmed and seeking protection and safety in any way it can.
“When life or emotions get unpredictable, food rules can offer stability when everything else seems out of control,” explains de Jong.
The obsession over body weight, calorie counting, and food rituals (eating slowly, cutting food into small pieces, etc.) can also function as a grounding tool, a way to numb uncomfortable emotions, or a distraction from painful memories when the body and nervous system are flooded.
“We all have coping mechanisms we reach for, whether that’s a mindful relationship with exercise, deep breathing, or social connection. But for some people, eating disorders might just be more accessible,” says de Jong. “It’s about safety and control.”
The intrusive voice
Eventually, an ED may stop feeling like something you do, and instead, start feeling like something you are. It’s become intertwined with your identity as your daily life is consumed by food rules, calorie counting, and rituals.
And then, there are those intrusive thoughts from the bullying ED voice that you truly believe: you’re a failure, nothing you do is good enough, that your worth is measured by your weight and how you look. De Jong likens the ED voice to living with an unwanted, overbearing voice in your head. The voice is always there; it’s going to the bathroom with you, into the kitchen, or as you get ready for bed.
“It’s just screaming and so loud. And when someone’s screaming at you, you can’t focus on anything else,” she says.
But here’s the good news: That ED voice doesn’t have to live with you forever.
Letting go
When an ED feels inseparable from who you are, the idea of recovery can feel threatening.
“Change is scary, and the eating disorder is what helped you survive for so long,” explains de Jong. “Living without it can feel terrifying.”
But treatment doesn’t mean giving up that safety; it offers insight around why and how it’s been protecting you and honoring that part, but also understanding there are more sustainable ways to regulate emotions and reclaim a sense of self beyond the ED.
“We use a lot of value work in therapy to tease out what’s disordered and what’s the true, authentic self,” says de Jong. “That means asking the questions, ‘Is that your ED’s values? Is that what ED voice wants you to do? Is it actually serving You?’”
Recovery isn’t linear. Logically, you may recognize that seeking therapy, nutritional counseling, and medical checkups is the optimal choice for your health and well-being. But that doesn’t mean your body knows that or can trust it.
When you begin to feel safe and emotionally secure, you’ll learn to trust your body. Hunger and fullness cues return. There are fewer rules of what you can and can’t eat, and more intuition. Eventually, the ED voice won’t be that sufferable voice anymore. Maybe it’s softer. If you pay attention, you can probably hear it from far away. But it’s a lot quieter and perhaps doesn’t speak as often.
“The voice may never fully disappear, but you’ll now understand what the voice’s purpose was, and how it tried to protect you,” says de Jong. “But you don’t need that kind of protection anymore. And you’ll choose to listen to your recovery voice instead. It’s more gentle and more aligned with who you are and who you want to be.”
If you or someone you know is struggling with an eating disorder, reach out for help as soon as possible. De Jong is accepting clients at the Hawaii Institute of Integrated Behavioral Health. Other resources include your primary care provider, therapist, Academy for Eating Disorders, Ai Pono Treatment Center (Hawaii Eating Disorder Center), or National Eating Disorders Association. Or visit HMSA’s Online Care® to speak with a licensed mental health specialist from the privacy and convenience of home.
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