Self‐Injurious Behavior and Eating Disorders: The Extent and Nature of the Association

Abstract

We have reviewed the literature on the association between self-injurious behaviors (SIB) and eating disorders from the psychological-behavioral perspective. Our aims were to investigate the extent and possible reasons for the association. A literature search was conducted using the following electronic databases (1989-2005): Medline, PsychInfo and EMBASE. References in identified articles were also screened. The reported occurrence of SIB in eating disorder patients ranged between 25.4% and 55.2%. The figures for occurrence of eating disorders in SIB patients ranged between 54% and 61%. These figures indicate that there is a strong association between these disorders. Impulsivity, obsessive-compulsive characteristics, affect dysregulation, dissociation, self-criticizing cognitive style and need for control were identified as potential factors involved in the association. Early trauma such as childhood sexual abuse and possibly certain characteristics of early family environment might contribute to the development of these factors. We present a hypothetical model which includes these factors and argue that the co-existence of eating disorders and SIB in patients results from several factors being present. SIB and eating disorder symptoms may provide a means whereby patients can deal with each factor simultaneously. The clinical implications of the findings are discussed.

Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis

“…To date, epidemiological data on the occurrence of NSSI in the context of ED have been scarce; NSSI estimates across ED studies have varied widely; and all reviews on the topic have been narrative (Sansone & Levitt, 2002;Svirko & Hawton, 2007;Kostro et al 2014). These limitations translate into a complete lack of aggregate and weighted quantitative data on NSSI in ED, which highlights the absence of a confident estimate of the true prevalence of NSSI among individuals with ED.…”

“…Although we examined a variety of potential predictors of NSSI, we were particularly interested in the roles of: (a) diagnosis (anorexia v. bulimia) and diagnostic subtype within anorexia (eating-purging v. restrictive), in line with evidence that NSSI is more prevalent in individuals with binge and purge behaviours, i.e. patients with BN or those with the binge eating-purging subtype of AN (Svirko & Hawton, 2007); (b) history of attempted suicide, in line with evidence that NSSI shows a positive association with suicide risk in various unselected and clinical populations (Jacobson & Gould, 2007;Turner et al 2013;Kostro et al 2014); and (c) history of substance abuse, in line with evidence that individuals with substance disorders are more likely to self-injure (Klonsky & Muehlenkamp, 2007). Quantifying, for the first time, the association of NSSI with each of the above predictors makes a valuable contribution to the evidence base, which is again limited by the lack of weighted aggregate data.…”

Self Injurious Behavior in Adolescent Girls with Eating Disorders

“…4 ED inpatients, n=185, mean age=21a, some form of SIB in their recent history Favaro et al (2007) 4.8-13.9 community sample, n=934 Claes & Vandereycken (2007a) 38.6 (BN) ED n=70, mean age 22a Svirko & Hawton (2007) 25. 4-55.2 …”

Bulimia Nervosa and Personality: A Review

“…The relationships between eating disorders and suicidal behaviour and non-suicidal selfharm have been examined primarily in eating disorder samples. Some studies suggest that suicide attempts and non-suicidal self-harm are found in more than half of bulimic patients (Franko & Keel, 2006;Svirko & Hawton, 2007). These rates appear higher in bulimia nervosa compared to anorexia nervosa, although it seems that there are similar rates of this behaviour in the anorexia nervosa purging-type as in bulimia nervosa (Favaro & Santonastaso, 2000;Nagata, Kawarada et al, 2000).…”

“…Possible common factors are impulsivity, obsessive-compulsive traits, dissociation, trauma, conflict in the family environment and sensitivity to cultural factors, among others. Both self-harm and eating disorders may represent failures in emotion regulation, and both forms of body practices could act as an attempt to a more affective coping (Dohm, Striegel-Moore, et al, 2002;Franko & Keel, 2006;Levitt, Sansone, et al, 2004;Svirko & Hawton, 2007).…”