Eating disorders are serious illnesses with some of the highest mortality rates of any mental illness. Death from an eating disorder can result from any of a number of associated physical or medical consequences of the eating disorder and also from suicide. Many people with eating disorders engage in self-injurious behaviors. While people who self-injure do not want to die and their self-injury is not a suicide attempt, self injurious behaviors are dangerous, distressing, and associated with risk for suicide attempts or completed suicide.
Self injury among eating disorder sufferers can take many forms, commonly cutting, burning, or scratching the surface of the skin. Many of the behaviors that are a part of a person’s eating disorder, such as purging, laxative abuse, or excessive exercise can also be considered self-injurious. People who self-injure may also be diagnosed with non-suicidal self-injury (NSSI) in addition to their eating disorder. NSSI is defined as five or more days of intentional self harm to the body without suicidal intent over a time period of a year; the behavior must also be accompanied by negative emotions, premeditation, or obsessing about the behavior.
There are a number of risk factors that are associated with self-injury. Many of these risk factors are shared with eating disorders. Among those people diagnosed with an eating disorder, individuals who binge and/or purge are the most likely to engage in self-injury. Difficulty managing and expressing negative emotion is one of the most significant risk factors for self-injury. Many people who self-injure suffer from depression, experience body dissatisfaction, and they may have a tendency toward obsessive-compulsiveness, impulsivity, and self-criticism. There is also an association between self-injury and a history of trauma, emotional, physical, or sexual abuse, or substance abuse. These risk factors also tend to be associated with more severe eating disorder symptoms. Finally, self-injury tends to be more common among adolescent and female eating disorder sufferers.
Why Would Someone Hurt Themselves?
From an outsider’s perspective, it can be difficult to understand why someone would self-injure. It is thought that self-injury is a way of managing or coping with negative emotions such as anger, sadness, loneliness, shame, guilt, and overall emotional pain. There is evidence that the same two parts of the brain are used to process emotional and physical pain, partially explaining why there is relief from emotional pain following self-harm. The act of injuring oneself is often described as being helpful at expressing intense emotions, blocking out, or escaping from negative emotions. Others describe self-injury as providing relief from a sense of numbness, or lack of emotion. Thus, many people who are unable to handle intense feelings or find that they are unable to express their emotions verbally will find short-term relief in self-injury such as cutting. For some, self-injury is also described as a form of self-punishment. Finally, self-injury may serve to communicate distress to loved ones for someone who otherwise has a difficult time doing so.
Many people find it difficult to stop harming themselves once they start. The reason it can be difficult to stop is because self-injury can feel like an effective way to cope. Self-injury can result in a sense of relief, or even a peaceful or calm feeling. However, those positive feelings are temporary. The person will likely continue to self-injure until they address the underlying issue and find healthier ways to cope.
Getting Help With Self-Injury
Coming forward with a problem like self-injury can be very difficult as there is often stigma attached to self-injury. Many people who self-injure may also experience guilt and shame related to this behavior and assume that no one will be able to understand how they could harm themselves. Despite this difficulty, given the seriousness of eating disorders and self-injury, it is important that someone struggling with these problems seek support, in most cases, from a qualified mental health professional.
Treatment for self-injury is typically focused on finding ways to regulate and cope with negative emotions. A therapist can also help to identify the different factors that trigger and contribute to the self-injurious behavior. Keeping track of these triggers and urges may be part of the therapy process. Cognitive behavioral therapy (CBT) is an effective type of therapy that focuses on the patterns of thoughts and behaviors associated with negative emotions and self-injury. There is also an enhanced form of CBT (CBT-E) that is an effective treatment for eating disorders including bulimia nervosa, binge eating disorder, and distressing eating disorder symptoms. Dialectical behavior therapy (DBT) is another effective form of therapy for the treatment of self-injury and/or eating disorders that focuses on regulating emotions and developing coping skills. Some people may benefit from medication in addition to therapy.
It is important to find a therapist who has experience in treating eating disorders and self-injury and prioritizes eliminating self-injury as part of therapy. Equally important is feeling comfortable and open with your therapist. It can take time to find the right fit, and you should not hesitate to find another therapist if you do not feel safe discussing your problems in therapy.
In addition to seeking professional help, there are many different coping strategies that people use on their own to manage the urge to self-injure. Some examples include relaxation strategies, talking to a friend or calling a crisis hotline, and expressing emotion in productive ways such as journaling.
If you are in crisis, feeling the urge to self-injure or take your life, please don’t hesitate to call the national suicide prevention hotline (in the United States) at 1-800-273-TALK.
For one person’s personal experience with self-injury and a review of the history and science of self-injury, see science writer Carrie Arnold’s excellent article.
Written by Dr. Elisha Carcieri – 2015
Kostro, K., Lerman, J. B., & Attia, E. (2014). The current status of suicide and self-injury in eating disorders: a narrative review. Journal of Eating Disorders, 2(1), 19.