“The voice claims me. I see therapists. These people challenge the voice, the thoughts. My intellect begins to understand the illusion. But the moment I begin to sense the almighty damage I am doing to myself . . . the voice becomes angry. It warns me of a dangerous world and reassures me how much safer I am within its net” .
These compelling words from someone who struggles with an eating disorder (ED) allude to an all important understanding of ED’s that has often evaded popular discussion. Rather than trivializing one’s struggle with their weight and body image, these words point to the idea of externalizing one’s relationship with their eating disorder as an separate entity.
Many who struggle with ED’s are aware already of that voice, and relate to it often, especially as it grows and demands jurisdiction over their thoughts and actions. In utilizing this understanding of the ED voice, and even in comparing the nature of it to those who are victims of abusive relationships, we may be able to further our understanding and our empathy for survivors of this vicious cycle. 
Also reflected above is the idea that often, an ED is experienced by it’s victim as controlling or domineering. Research suggests the notion that clear patterns exist in these cases that resemble highly negative and enmeshed actual interpersonal relationships. Recent studies confirm that such conditions exist not only in anorexia nervosa, but across eating disorder diagnoses. 
Some critics of externalization models for treatment of eating disorders, such as those used in narrative therapy, state that this view of the disorder allows it too much power, and absolves the individual of their responsibility to change. However in this model, and in viewing the ED as a relationship (with equal focus on both the actions and reactions of its members), the individual can be restored with the agency they need in order to feel capable of change, and practitioners can again hold them responsible.
It is believed that not only through identification of the ED as “other” and therefore not “self”, but also through learning to “rebel” against the voice, there exists a potential path towards recovery. Studies showed that those who were angry with their disorder were found to submit to it less, and were less symptomatic .
In 2011, Tierney and Fox presented their research that compared aspects of the power and control dynamics present in relationships that contain domestic violence, with writings from women who identified with the notion of an “eating disorder voice”. 
As one falls prey to the ploys of an eating disorder, they often believe the lies that the ED has positive intentions, encouraging efforts to lose weight and change body shape, while providing a newfound confidence and a sense of control. As the illness progresses however, it appears to parallel the very same processes that allow for an abusive relationship to prosper. Patients soon report that their disorder, like an abusive partner, becomes tyrannical, criticizing and dominating, demanding priority over other relationships, and furthering their social isolation.
As the ED progresses, its role is often likened to that of a strict taskmaster, demanding compliance and unquestioning obedience. Fear of being unable to meet the demands contributes to a sense of helplessness, undermining their confidence, and losing ability to trust in their own decisions and abilities.
This is not unlike a woman caught up in the throes of an abusive relationship, who slowly loses her identity (i.e. job, intelligence, friend groups) in order to pacify the needs of the abuser, to avoid provocation.
Women in abusive relationships often describe their experience as being confined in a prison: seen as property and under strict regulation. Those with an ED as the warden of the mind are also confined to a limited existence ruled by harsh dietary restrictions and exercise regimens, with grave punishments reserved for stepping out of line. Both abusers continue to operate by instilling fear of retaliation and fear of the unknown should their victim decide to seek help.
Often carrying with it the stigma of being difficult to treat, as well as a choice one makes, those with EDs often may have conflictual relationships with treatment providers due to clinicians’ own self-perceptions. Conversely, in drawing from Interpersonal Theory (“the way we treat others in life is informed by the way that important others have treated us”) , concerns for the therapeutic relationship exist also from the viewpoint of the client. Assuming that the ED has indeed taken over a dominant, controlling role in the person’s life, there is the risk for them to continue in their subservient, passive role, complying with treatment tasks but without commitment to change.
Deciding to leave an abusive relationship of any kind takes courage and tenacity, and may not occur until one finally makes a move to reach out and seek support. The process of recovery involves rebuilding one’s way of life, and one’s very identity, however in many cases, may involve returning to the safety of what is known, and the security of the prior relationship from time to time. Severing the ties and the means of control from the abuser takes time, to believe that life is possible without its demanding presence. For those battling an eating disorder, lasting recovery often requires enlisting the support of a dedicated recovery team, available through residential or a partial hospitalization program.
Conceptualizing eating disorders in this new way not only helps to increase empathy for the plight of the person trapped in an abusive and controlling relationship with their Eating Disorder, but also offers potential solutions for recovery. If you or your loved one is battling an ED, often the first step is to admit that the problem runs deeper than simple willpower, and requires professional support.
 Tierney, S., & Fox, J. R. (2011). Trapped in a toxic relationship: Comparing the views of women living with anorexia nervosa to those experiencing domestic violence. Journal of Gender
Studies, 1, 31–41. https://doi.org/10.1080/09589236.2011.542018
 Mantilla, E. F., Clinton, D., & Birgegård, A. (2018). Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image. Psychology and Psychotherapy: Theory, Research and Practice, 91(3), 302–316. https://doi-org.proxy.stetson.edu:2443/10.1111/papt.12161