The Development and Assessment of a Scale to Measure the Experience of an Anorexic Voice in Anorexia Nervosa

  • Kay Gant

Student thesis: Doctor of Clinical Psychology


This thesis sought to develop and assess a novel scale to measure the experience of an anorexic voice in anorexia nervosa. It consists of three standalone papers. Papers one and two have been prepared for submission to two separate journals relevant to the methodology and research area for each, and comply with the journal guidelines. Paper one is a thematic synthesis of qualitative literature exploring "inner speech" for individuals with a diagnosed psychological disorder. Following a standardised procedure for thematic synthesis, six databases were searched and 10 studies were included. In total, three analytical themes were identified within the data: 1) Withdrawing to an inner world, 2) A fragmented and conflicted self and 3) Re-connecting with the outside world. The results found several similarities regarding the nature, function and negative consequences of engaging with critical inner dialogues across clinical samples. IS as both a coping mechanism and a maintaining factor of psychological distress was a key finding. The results indicated therapeutic approaches facilitating acceptance of internal experiences and disengagement from critical internal dialogues may be helpful. Paper two is a two-stage quantitative study that describes the development and assessment of a novel scale, the Experience of an Anorexic VoicE Questionnaire (EAVE-Q). Using data collected in an earlier qualitative study, Stage 1 generated scale items and tested for face and content validity using cognitive interviews with seven individuals with a diagnosis of anorexia nervosa. In Stage 2, 148 individuals with a diagnosis of anorexia nervosa were recruited from mental health services, eating disorder charities, the community and online to complete the EAVE-Q and measures of eating disorder symptoms, mood and quality of life. The dimensionality of the scale was assessed using principle axis factoring and associations between the EAVE-Q domains and clinical outcomes were evaluated. Factor analysis derived an 18 item scale with five domains. Two domains related to negative consequences of the AV, two to positive functions and one to the externalisation of the AV from the self. There were significant associations between individual EAVE-Q domains and eating disorder symptoms, mood and quality of life. The results highlighted the value in further research to refine the EAVE-Q, and to use this in future research to assess if changes in AV experiences are associated with clinical change over time. Paper three is a critical appraisal of this research. It includes reflections on the research process, discussion of the methodological limitations, and consideration of the implications of the findings for existing theory, future research and clinical practice.
Date of Award31 Dec 2016
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorGillian Haddock (Supervisor) & Filippo Varese (Supervisor)


  • Anorexia nervosa
  • Scale development
  • Anorexic voice
  • Eating disorders

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