Self-Injury and Eating Disorders: Some Common Threads

Reprinted from Eating Disorders Review
March/April 2007 Volume 18, Number 2
©2007 Gürze Books

Self-injurious behaviors (SIBs) are loosely defined as behaviors involving the deliberate infliction of physical harm on one’s own body without any intent to die as a consequence of that behavior. According to a team of researchers at the University of Padua, Padua, Italy, eating disorders are frequently found among young women who compulsively or impulsively attempt to harm themselves physically (J Clin Psychiatry 2007; 68:122).

Compulsive vs. impulsive SIBs

Compulsive SIBs, such as hair-pulling and severe nail-biting, are usually habitual, repetitive, and “automatic.” They are not associated with conscious intent or with an affective experience and are typical of compulsions. That is, there is a sense of mounting tension when the person tries to resist the behavior and relief of anxiety after the behavior. Impulsive SIBs, such as skin-cutting or head-banging, are usually episodic, involve little resistance, and provide some form of gratification beyond relief of tension or anxiety. Patients who admit to these behaviors say that the behavior helps them control negative emotions, such as depression or loneliness, and also satisfies other needs, such as the need for self-punishment and manipulation of others.

A community study

Angela Favaro, MD, PhD, Silvia Ferrara, PhD, and Paolo Santonastaso, MD studied a community sample of women 18-25 years of age living in the city of Padua. After interviewing 934 of the 1198 women from the large sample, the authors discovered that one-fourth of the women in the smaller group reported SIBs. Nail-biting and skin-picking were reported by 278 women, or 30% , and in 185 (20%) of the 934 women, respectively.

Interestingly, a lifetime history of eating disorders was found in a number of the women. Among 143 women who manifested compulsive SIBs, 3 reported a lifetime history of anorexia nervosa (AN) and 6 reported a lifetime history of bulimia nervosa (BN), while 15 women reported a lifetime history of any type of eating disorder. In the impulsive SIB group, 9 women had a lifetime history of AN, 11 had a lifetime history of BN and 31 reported a lifetime history of any type of eating disorder.

Suicide attempts

Among the entire sample of women, 20 reported suicide attempts; among this group, the frequency of AN was 5%, of BN, 30%, and of any eating disorder, 40%.The authors note that although many studies have reported a high frequency of SIBs among patients with eating disorders, this is the first study to show a specific, significant association between impulsive SIBs and eating disorders in a community sample.

The self-damaging behaviors typically found in eating disorders, including fasting, self-induced vomiting, abuse of laxatives and/or diuretics, showed a dimensional link with SIBs. This finding led the authors to hypothesize that in eating disorders compensatory behaviors and SIBS could share some characteristics and psychological functions. For example, both SIBs and eating disorders could reveal a need to control the body after the uncontrollable changes due to puberty, and they could both be associated with body dissatisfaction, ineffectiveness, and asceticism.

Finally, the authors stress the importance of keeping eating disorders in mind when assessing young women who attempt suicide.

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