The Scars of the Inner Critic: Perfectionism and Nonsuicidal Self‐Injury in Eating Disorders

Abstract

Nonsuicidal self-injury (NSSI) is quite common in eating disorder (ED) patients and we wondered whether this combined self-harming behaviour is related to perfectionism, a feature often found in ED patients. In addition, we examined associations between perfectionism and functions underlying NSSI and the possible mediating role of intrapersonal perfectionism in the association between perceived parental criticism and NSSI. In a sample of 95 ED patients, 38.9% reported at least one type of NSSI, and this subgroup reported significantly higher levels of parental criticism and evaluative concerns perfectionism (ECP) compared with ED patients without NSSI. ECP was positively related to the self-punishment and cry-for-help functions of NSSI. Finally, ECP was found to mediate the association between parental criticism and NSSI symptoms. Directions for future research and practical implications are discussed.

Nonsuicidal Self-Injury, Pain, and Self-Criticism

“…We already know from cross sectional studies, that people who engage in NSSI are more highly self-critical than people who do not engage in NSSI (Hooley et al, 2010;St. Germain & Hooley, 2012;Claes et al, 2011;Gilbert et al, 2010). However, it is quite possible that high levels of self-criticism are a consequence of NSSI rather than an antecedent of NSSI and this warrants consideration.…”

“…In a related program of research, Gilbert has also noted that self-harming behaviors are associated with self-criticism and negative feelings about the self . A form of self-criticism (evaluative concerns perfectionism) has also been linked to NSSI in a sample of inpatients with eating disorders (Claes, Soens, Vansteenkiste & Vandereycken, 2011). Moreover, using ecological momentary assessments, Nock, Prinstein and Sterba (2009) have reported that, in adolescents, the odds of engaging in NSSI were significantly increased in the presence of feelings of selfhatred and anger toward the self.…”

Non-suicidal Self-Injury and Eating Disorders: Dimensions of Self-Harm

“…Also, obsessive-compulsive and perfectionistic characteristics have been noted in both NSSI (Claes, Soenens, Vansteenkiste & Vandereycken, 2012;Hoff & Muehlenkamp, 2009) and ED samples (Boone, Soenens, Braet & Goossens, 2010;Serpell, Livingstone, Neiderman & Lask, 2002). Obsessive-compulsive characteristics may be demonstrated among individuals with more chronic and repetitive NSSI due to the reinforcing effects of the behavior, and individual's report that urges to self-injure can come on suddenly and be hard to resist (Washburn, Juzwin, Styer & Aldridge, 2010).…”

Autonomy and Autonomy Disturbances in Self‐Development and Psychopathology: Research on Motivation, Attachment, and Clinical Process

“…Individuals with such introjects are harsher in their self-judgments than in their judgments of others, and these self-judgments often form the precursors to depressive episodes (Beck, 1983). Their harsh self-judgments may even manifest outwardly, through engagement in nonsuicidal self-injurious behaviors, which reflect the scars of the inner critic (Claes, Soenens, Vansteenkiste, & Vandereycken, 2012). Accordingly it is hardly surprising that adolescent depression and low self-esteem are associated with low autonomy (e.g., Noom, Dekovic, & Meeus, 1999).…”