Eating Disorders and Self-Injury

Eating disorders such as anorexia nervosa, binge eating disorders, bulimia nervosa or orthorexia seldom occur independently of other psychiatric symptoms or disorders. It is not uncommon for those struggling with an eating disorder to simultaneously engage in other forms of self-destruction such as cutting. Research has demonstrated a correlation between non-suicidal self-injury (NSSI) and eating disorders, particularly bulimia nervosa. Cutting is the most common form of NNSI, though other behaviors include scratching, burning, hair pulling, or the consumption of harmful substances or objects. Self-harming behaviors in the case of eating disorders in include self-induced vomiting, laxative or diuretic misuse, excessive exercise, restricting following a binge, or eating until the point of discomfort or pain. Studies have shown that roughly 15% of teenagers and 17-35% of college students have inflicted self-harmful behaviors and approximately one in three individuals who engage in these behaviors are known to cut. Approximately 30% of individuals who participate in binging and purging behaviors also choose to cut themselves or practice another form of self-harm behavior.

Signs and symptoms of self-harm include the following:

  • Fresh scratches, cuts, bruises or other observable wounds
  • Broken bones
  • Several scars resulting from cuts or burns
  • Frequent isolation
  • Social and familial difficulties
  • Use of long sleeves or pants to cover injuries
  • Claims to having recurrent accidents or collisions

Why do individuals engage in cutting?

Self-harm and eating disorder behaviors serve a purpose for an individual who is experiencing internal conflict. Frequently, they explain that the physical pain inflicted by self-injurious or eating disorder behaviors helps to distract or numb the emotional pain they may be experiencing. Other individuals may engage in self-harm behaviors as a way to punish the self in response to feelings of guilt or shame. With this, the individual struggling can often become trapped in a vicious cycle of self-destruction. For instance, an individual may be experiencing anxiety, and may believe the only method to cope is through binging, which provides a temporary relief. Following the binge and after the instant gratification dissipates, the individual may experience immense feelings of guilt and shame as a result of the binging behavior and calories consumed. In another effort to cope with the uncomfortable feelings, the individual may turn to cutting as a temporary escape or manifestation of self-hatred. Essentially, maladaptive behaviors are utilized as a way to express, change, or suppress unwanted or overwhelming emotions. Individuals with eating disorders and self-injury tend to display an inability to verbalize and process emotions, leading them to utilize their bodies as a form of expression. Along with problems with emotion regulation, those who struggle with eating disorders and self-injury commonly display tendencies towards body dissatisfaction, impulsivity, low self-esteem, feelings of emptiness, and cognitive distortions or self-criticism.

Treatment for cutting

Unlike most other mental health disorders, there is no defined treatment for self-harm that has been studied extensively with proven clinical results. Treatment is aimed at recognizing and treating the underlying cause such as low-self esteem, impulsivity, depression, family dysfunction and conflict, poverty or abuse. An individual will often enter therapy with complaints not associated with self-harm. These may include difficulty sleeping or feeling depressed. The self-harm injuries are often noticed or asked about by the therapist during the session and skills are learned over the course of time to prevent this self-harm behavior. Learning healthy coping skills and maintaining emotional equilibrium to help manage the feelings of anger, grief and loneliness can help prevent an individual from cutting in response to these negative emotions. The goals of treatment for individuals who practice eating disorders and self-injury are as follows:

  • Identify and manage underlying issues that trigger cutting
  • Learn skills to better manage distress
  • Learn how to regulate and cope with unhealthy emotions
  • Learn how to improve self-image and self-esteem
  • Develop skills to improve relationships and social skills
  • Develop healthy problem-solving skills