Self-Harm and Bulimia Nervosa: A Complex Connection

Abstract

There is some evidence to suggest that eating disordered individuals are unusually likely to engage in self-harm behavior. However, the nature of the relationship among self-harm, bulimia nervosa, and related constructs such as borderline personality disorder and multi-impulsive bulimia nervosa remains unclear. This article briefly addresses the nature of this relationship and discusses two possible mechanisms for self-harm behavior in bulimia nervosa. Additionally, a protocol for managing such behavior in the treatment of eating disordered individuals is presented.

Eating Disorders, Addictions and Substance Use Disorders

“…Two lines of distinct but overlapping research have examined this issue, one involving a highly impulsive subgroup of bulimics called "multi-impulsive bulimics" and the other exploring the role of comorbid borderline personality as a potential mediator or contributor to sexual promiscuity in women with BN (Wonderlich, Myers, Norton, & Crosby, 2002). Two lines of distinct but overlapping research have examined this issue, one involving a highly impulsive subgroup of bulimics called "multi-impulsive bulimics" and the other exploring the role of comorbid borderline personality as a potential mediator or contributor to sexual promiscuity in women with BN (Wonderlich, Myers, Norton, & Crosby, 2002).…”

Personality Disorders and Eating Disorders: Exploring the Frontier

“…Given the presence of a personality disorder, will empirically confirmed interventions for eating disorders such as cognitive behavioral therapy really be successful in the absence of a reparative and psychologically intimate therapeutic relationship? Are other types of relationally-based treatments indicated, such as Interpersonal Therapy (Fairburn, 1997), psychodynamic therapy (Sansone & Johnson, 1995;Dennis & Sansone, 1997), or Integrative Cognitive Therapy (Wonderlich, Myers, Norton, & Crosby, 2002)? For specific types of personality disorders, should treatment necessarily be augmented with particular intervention strategies (e.g., Dialectical Behavior Therapy and borderline personality disorder; Linehan, 1993), and do these general techniques require modification when integrated into the treatment of eating disordered individuals?…”

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

“…Prevalence rates among non-clinical samples of adolescents and young adults range from 4% (Klonsky & Muehlenkamp, 2007) to 38% (Whitlock, Eckenrode, & Silverman, 2006; Lloyd-Richardson et al 2007), whereas prevalence rates among inpatient adolescents have been reported at 30 to 68% (Makikyro et al, 2004; Nixon, Cloutier, & Aggarwal, 2002). Of particular interest are findings that rates of NSSI tend to be quite high among a subset of persons with select psychiatric disorders including borderline personality disorder (Zanarini, Frankenburg, Ridolfi, & Jager-Hyman, 2006), and eating disorders; especially bulimia nervosa (BN; Anderson, Carter, & McIntosh, 2002; Claes, Vandereycken, & Vertommen, 2001; Favaro & Santonastaso, 1999; Wonderlich, Myers, Norton, & Crosby, 2002). …”