Effects of an arms-crossing technique added to Lamaze breathing on labour pain: a randomised controlled trial.

Eating disorders are psychiatric disorders characterised by maladaptive eating patterns and habits. The term ‘eating disorder’ incorporates several diagnoses under the DSM-5 []; Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), Otherwise Specified Feeding and Eating Disorder (OSFED) and Avoidant and Restrictive Food Intake Disorder (ARFID). Eating disorders are notoriously challenging to effectively treat, with high relapse rates and underwhelming treatment outcomes for many [–]. The compounding physiological aspects of the disorder create further complexity, as risk is often high; indeed, Anorexia Nervosa has the highest mortality rate of any mental health disorder []. While many can and do recover from eating disorders with appropriate support, psychological interventions available continue to show poorer long-term outcomes, and currently no therapeutic approach has been identified as a frontrunner in the treatment of eating disorders [, , ]. This could perhaps be because the underlying mechanisms of eating disorders are still not well understood []. Such underlying mechanisms could include, for example, the frequently reported experience of a voice in eating disorders [, ]. Individuals with eating disorders often report experiencing a voice, commonly described as an internal commentary, which focuses on weight, shape, and eating and how they relate to self-worth []. This phenomenon is also often referred to as the “Anorexic Voice”, although research indicates that the voice is often present across eating disorder types [, ]; thus, within the current paper, this phenomenon will be referred to as the ‘Eating Disorder Voice’ (EDV). How the EDV is experienced can vary; while a majority of individuals perceive the EDV as internal and a reflection of their own thoughts and beliefs, some report experiencing the voice as external and entirely separate to the self []. It is likely the voice experience exists on a spectrum, from entirely one’s own thoughts, to an entirely external voice []. Qualitative explorations of people’s experiences of the EDV [, ] suggest that the voice tends to emerge in the early stages of the illness, often during a time of vulnerability in the individual’s life. It can present as a comfort, a solution, a distraction from problems, and a companion and guide. However, the voice can become critical and dominating over time, punishing and degrading if the individual fails to meet the increasingly high expectations of the voice. Some report the voice can mimic the patterns of bullies and abusers in their lives [, ]. Often, individuals describe striving to avoid the voice’s wrath by submitting to its will []. It is unclear why this change in the voice occurs, but perhaps is representative of the ambivalent nature of people with EDs in relation to their disorder [].