The Self Critical Voice

Key Features
The Self Critical Voice is a global negative self view that is unconditional and pervasive. Manifesting as schema level cognitions and coping responses, it is a key feature of a range of problems including eating disorders, chronic depression and personality disorders, in particular Narcissism, playing a pivotal role in the development and maintenance of these problems and also driving therapy interfering behaviours (Linehan 1993; Waller et al., 2007). However, despite its fundamental role in these intractable problems, the Self Critical Voice has received little attention, either in terms of formulation or treatment. This paper therefore aims to clarify the principle features of the Self Critical Voice and suggest a way of formulating its pivotal role in intractable problems that will facilitate treatment.

The Self Critical Voice is a particular train of thought that bullies, criticises and undermines the individual creating intolerable emotions that, in the absence of alternative coping strategies, are dealt with through the range of maladaptive behaviours (e.g. social withdrawal, bingeing, self harm, and self defeating interpersonal strategies). The thoughts generated by the Self Critical Voice are crude and repetitive and are accepted by the individual as absolute truths. Core themes of the Self Critical Voice include accusations of the individual fundamental worthlessness, predictions of imminent rejection by others and inevitable failure, themes reflected by the Young's (1990) schema domains of disconnection and rejection and impaired autonomy and performance .

Manifestations in intractable problems

The Self Critical Voice is a key feature in a number of severe and enduring problems including depression, eating disorders and personality disorders, in particular Narcissism. It is pivotal not only in the development of these problems but also in their maintenance over time. For example in depression the Self Critical Voice will initially trigger feelings of worthlessness, hopelessness and helplessness via allegation of fundamental worthlessness (e.g. “you are a useless, defective waste of space”) and will then interpret the individual's behavioural responses to these feelings (e.g. withdrawal, acceptance of mistreatment by others) as evidence to confirm its initial assertions thus re-triggering the depressive cycle. Overtime the existence of the Self Critical Voice and it's increasingly well established links with depressed mood and behaviour will guide the way the individual's processes information gradually reinforcing this experiential pathway until it is more influential than alternatives, resulting in the individual's unquestioning acceptance of the validity of the Self Critical Voice and the existence of a chronic and persistent depressive state.

In eating disorders the Self Critical Voice is similar to the concept of Core Low Self Esteem one of four mechanisms formalised in Fairburn et al.'s (2002) transdiagnostic model that co-occur with the eating disordered symptoms in a subgroup of patients with more entrenched pathology. Fairburn et al. (2002) focus primarily on how the global negative self view obstructs change. Firstly by creating a lack of belief in the patient’s own capacity to facilitate change (i.e. undermining a key principle of cognitive behavioural therapy; becoming your own therapist (Waller et al. 2007)). Secondly by driving them to achieve in their valued domains as a way of coping in the short term with the negative affect that it creates, thereby making change in these area extremely challenging. They also highlight its self maintaining quality (via cognitive biases). Less emphasis is placed on its role in the development of an eating disorder, however, its capacity to generate negative affect suggests that the Self Critical Voice will be pivotal in the development of an eating disorder for the subgroup that find such negative affect intolerable (e.g. Fairburn, Cooper & Shafran 2003, Corstorphine, Mountford, Tomlinson, Waller & Meyer, 2006).

The Self Critical Voice is also evident in individuals presenting with narcissistic traits, specifically narcissistic defences employed to maintain self esteem (O’Brien, 1987) (not the inflated self esteem identified in classic descriptions i.e. core narcissism, Waller & Campbell in press). To avoid the negative self perception and self blame generated by the Self Critical Voice, the individual switches between the defences of the Narcissistic Abused Personality (‘poor me’ defence) where others are perceived as demanding and lack in sympathy and the Poisonous Pedagogy (‘bad you’ defence) where others are criticised or attacked. Both of these defences alienate potential allies and friends thus impairing functional relationships and reinforcing the Self Critical Voices accusations of defectiveness and unloveability.
The Britsh CBT & Counselling Service