A Systematic Review of the Influence of Anorexic Voice on the Recovery of Anorexia Nervosa

A Systematic Review of the Influence of Anorexic Voice on the Recovery of Anorexia Nervosa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A Systematic Review of the Influence of Anorexic Voice on the Recovery of Anorexia Nervosa Athulya Thankamoney Dev, Claire Williams This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4371197/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND: Anorexia nervosa (AN) caused increased mortality, and high readmissions or relapse rates indicates a lack of psychological focus on current AN intervention. Pugh and Waller (2017) thematically analyzed the high frequency of inner-voice prevalent in the AN population, similar to voice hallucinations in other psychological disorders. These remained stigmatized and non-disclosed due to correlations with Schizophrenia. The emotional and psychological AV assisting novel AN intervention is needed. AIM: To review the relationship of AV with self and AN globally, with its influence on recovery using combined research methods. DESIGN: Inductive thematic analysis of qualitative evidence from included studies. The methodological quality and risk of bias assessments of different studies equipped with appropriate tools. SEARCH STRATEGY: Cochrane review, Ovid via MEDLINE, Embase, PubMed, CINAHL, Web of Science, PsychINFO, and ProQuest electronic databases searched for relevant studies selection. REVIEW METHODS: Nine studies (one cross-sectional, one systematic review, four qualitative, and three mixed methods) met the inclusion criterion set. The methodology quality and bias risk assessments employed selective appraisal tool for included combined research methods. All appraisal tools were carefully selected and followed for robust evidence synthesis. RESULTS: The thematic analysis concluded ‘Not one size fits all' and non-generalizable AV for different AN case. The fluctuating AV was studied subjectively since AN onset. The dissociation of AV in AN case significantly assures recovery. CONCLUSION: This review demonstrated improved recovery with better insights in AV’s relationship with patient and AV-inclusive therapies. The need for a novel AV-inclusive psychological therapeutic framework was analysed. The improved motivation, hope, support, and empathy assures treatment success. However, AV standardized framework for unidentified AV in AN patients can possibly trigger and worsen illness. Full Text Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4371197","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":304132578,"identity":"f1c1f6c4-a344-434a-95d0-d01e9ea22d50","order_by":0,"name":"Athulya Thankamoney Dev","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACHgaGByD6AAPjgw8VQAYzcwN+HWxALQkMDBJALcyGM86AtDASr4VNmrcNJERAC//83mMSiW12dXzHe8wkZ86rjeZvB2r5UbENpxaJY3xpQC3JEpJnzhhbfNx2PHfGYcYGxp4zt3Fbc4zHDKiFWcLgRlrizZnbjuU2ALUwM7bh1iIP0VIvYXD/WYI075xjufMJaTGAaDkMtIX5kDRvQ03uBkJaDI/lGFsknDsuOfNM8mHDGccO5G4EajmIzy9yh88Y3vhQVs3Pd/xg44MPNXW5884fPvjgRwUe74MAIxuceRhMHsCvHgT+wFl1hBWPglEwCkbBiAMAB/tgmybt3HYAAAAASUVORK5CYII=","orcid":"","institution":"University of Sheffield","correspondingAuthor":true,"prefix":"","firstName":"Athulya","middleName":"Thankamoney","lastName":"Dev","suffix":""},{"id":304132581,"identity":"571d1584-21b8-429d-b852-460abbcd1bfd","order_by":1,"name":"Claire Williams","email":"","orcid":"","institution":"University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Claire","middleName":"","lastName":"Williams","suffix":""}],"badges":[],"createdAt":"2024-05-05 10:03:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4371197/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4371197/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56963514,"identity":"f86d40e2-c05b-4ee8-9c8b-f749cdabf5c9","added_by":"auto","created_at":"2024-05-22 18:56:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":891840,"visible":true,"origin":"","legend":"","description":"","filename":"AMENDED0805journalmanuscriptanorexic.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4371197/v1_covered_df914901-a25b-4d21-b81c-283c9d94378f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Systematic Review of the Influence of Anorexic Voice on the Recovery of Anorexia Nervosa\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4371197/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4371197/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND:\u003c/strong\u003e Anorexia nervosa (AN) caused increased mortality, and high readmissions or relapse rates indicates a lack of psychological focus on current AN intervention. Pugh and Waller (2017) thematically analyzed the high frequency of inner-voice prevalent in the AN population, similar to voice hallucinations in other psychological disorders. These remained stigmatized and non-disclosed due to correlations with Schizophrenia. The emotional and psychological AV assisting novel AN intervention is needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAIM:\u003c/strong\u003e To review the relationship of AV with self and AN globally, with its influence on recovery using combined research methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDESIGN:\u003c/strong\u003e Inductive thematic analysis of qualitative evidence from included studies. The methodological quality and risk of bias assessments of different studies equipped with appropriate tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSEARCH STRATEGY: \u003c/strong\u003eCochrane review, Ovid via MEDLINE, Embase, PubMed, CINAHL, Web of Science, PsychINFO, and ProQuest electronic databases searched for relevant studies selection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eREVIEW METHODS:\u003c/strong\u003e Nine studies (one cross-sectional, one systematic review, four qualitative, and three mixed methods) met the inclusion criterion set. The methodology quality and bias risk assessments employed selective appraisal tool for included combined research methods. All appraisal tools were carefully selected and followed for robust evidence synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e The thematic analysis concluded ‘Not one size fits all' and non-generalizable AV for different AN case. The fluctuating AV was studied subjectively since AN onset. The dissociation of AV in AN case significantly assures recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e This review demonstrated improved recovery with better insights in AV’s relationship with patient and AV-inclusive therapies. The need for a novel AV-inclusive psychological therapeutic framework was analysed. The improved motivation, hope, support, and empathy assures treatment success. 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