Self-Injury in Bulimia Nervosa

Reprinted from Eating Disorders Review
March/April 1999 Volume 10, Number 2
©1999 Gürze Books

Self-injurious behavior (SIB) is defined as deliberate self-harm without lethal intent. Unlike suicide, SIB provides relief and has some meaning for the patient, and is often repeated. SIB can be further divided into compulsive and impulsive acts. Compulsive SIB, for example hair-pulling and severe nail-biting, is habitual and repetitive. In contrast, impulsive SIB, such as cutting or burning one’s skin, is episodic and somehow gratifying to the patient. Often such impulsive behavior is triggered by a specific event.

A study differentiates the types of self-injury

Angela Favaro, MD, and Paolo Santonastaso, MD, recently studied 175 patients with bulimia nervosa consecutively referred to an eating disorder outpatient unit (Comprehensive Psychiatry 40:57, 1999). Seventy percent of the patients (123) reported at least one form of SIB. The most common forms were severe nail-biting (46%), hair-pulling (35%), and suicide attempts, mostly from overdosing (17%). Compulsive SIB was even more common than impulsive SIB. Persons who engaged in impulsive SIB were significantly more depressed and often had a history of attempted suicide, whereas those who used compulsive SIB had a shorter duration of illness and a greater lack of interoceptive awareness on the Eating Disorders Inventory. This association seemed to indicate that self-injury was not just a way to “release tension,” but also a way to experience one’s body, and to seek a sense of reality and identity, according to the authors.

The authors note that it is important to pay close attention to suicidality and depression in bulimic patients. Suicide is one of the most commonly reported causes of death among bulimic patients, and about a fourth of patients report they have attempted suicide more than once. They also point out that bulimia nervosa and SIB seem to be two specifically associated phenomena that share some pathogenetic features, but do not appear to be linked by a cause-and-effect relationship

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