Understanding self-harm and eating disorders

Self-harm: A deep dive

Self-harm can refer to any number of actions someone takes to purposely physically hurt themselves. This behavior is sometimes also referred to as non-suicidal self-injury, as people who self-harm generally do not intend to end their own lives, though they tend to be at higher risk of attempting suicide.^1,2,5

Some common ways people self-harm include:^1,2

• Cutting themselves
• Punching themselves or other objects (like walls)
• Purposely breaking bones or bruising themselves
• Burning themselves
• Pulling their hair out
• Poking sharp objects into their body

Self-harming is not considered a mental health disorder. Instead, the behavior is thought of as a maladaptive coping mechanism, which can be triggered by traumatic experiences, anxiety, stress, depression, or mental health conditions, including eating disorders.

Underlying causes of self-harm

Many psychological and environmental factors can lead to someone purposely causing themselves physical pain. Often, the behavior is used as a coping mechanism, as many people who self-harm have trouble managing their feelings and emotions.²

In light of those struggles, someone may harm themselves as a way to:²

• Feel a sense of control over themselves or their situation
• Block out the pain of upsetting memories
• Release negative feelings, such as loneliness, hopelessness, and anger
• Punish themselves
• Feel something, if otherwise feeling "empty" or "numb" inside

When dealing with so many overwhelming feelings, it can be difficult to ask for help, and many people who self-harm also use the behavior, consciously or subconsciously, as a way to show others that they're struggling.²

Signs and symptoms of self-harm

Self-injury can manifest in a number of different ways, depending on the types of self-harm someone is using, how frequently they're self-harming, and their desire to hide their behavior, among other factors. It can also present as both physical and behavioral symptoms.

Physical indicators of self-harm include the following:^1,2

• Scars, especially along the wrists or arms
• Fresh cuts, bruises, bite marks, or burns
• Frequent "accidents" that cause physical harm

Behavioral indicators of self-harm include the following:^1,2

• Wearing long-sleeve shirts or long pants, even in hot weather
• Keeping a sharp object on hand for no apparent reason
• Regularly making excuses for injuries
• Expressing feelings of worthlessness or helplessness
• Emotional or behavioral instability or unpredictability

The intersection of self-harm and eating disorders

Self-harm and eating disorders are not necessarily related, but the two share a number of risk factors, and self-harming may present as a symptom of eating disorders.

Like those who self-harm, people with eating disorders also generally struggle with emotional regulation. Different types of self-harm and eating disorder behaviors are both seen as maladaptive coping mechanisms. As such, a history of trauma, anxiety, depression, substance use, and some mental disorders are risk factors for both.

These connections should all be taken into account when considering treatment for self-harm and eating disorders. Those who self-injure as a symptom of an eating disorder may benefit from different or additional types of care. Addressing the root causes of these issues is nearly always the best way to achieve lasting recovery.

Psychological connections between self-harm and eating disorders

Types of self-harm and eating disorder behavior are often related, and there are a number of psychological conditions that work to develop or drive both.

A negative or distorted body image has long been understood as a critical factor in most eating disorders, and a recent study found it also plays a large role in self-injury behaviors.³ Whereas negative body image helps inform unhelpful thoughts around body weight and self-worth in eating disorders, it can also lead someone to devalue or even dissociate from their body, potentially resulting in a higher pain tolerance and possibly encouraging self-harming behaviors.³

Negative and distorted body image is also closely related to negative self-esteem, and this is another major factor in both self-harming and eating disorders. Some researchers consider chronic low self-esteem to be a necessary prerequisite to developing any type of eating disorder, and it was found to be a common symptom across adolescent girls and boys who self-harm.^3,4

Many people with both behaviors also frequently feel they have inadequate control over their lives or circumstances. In any situation, your body and perspective are the only things you can truly control, and many therapy techniques are designed to help patients realize this and use it to create positive change. People who self-harm and struggle with eating disorders may inflict these negative behaviors upon themselves as a way to connect with a sense of control.

Who is at risk for self-harm and eating disorders?

Eating disorders and self-harming behaviors can impact people of any gender, race, or ethnicity and any body shape, weight, or size at any point in life. But, as the two share a number of risk factors, certain people may be at a higher risk of experiencing both.

Females, and especially younger girls, were found to be at higher risk of using self-harming behavior, with an average age of onset of just 13 years old.⁵ Similarly, eating disorders are thought to impact more females than males, and puberty is considered a critical period for developing these conditions.⁶ Overall, adolescents who participated in self-harming behavior were found to be at a higher risk of having an eating disorder.³

A history of trauma is prevalent in both populations, as well, as it can serve as a catalyst for developing maladaptive coping mechanisms. Both eating disorders and self-harming behavior have been linked to peer influence, with those who have friends who participate in these behaviors being at a higher risk of participating themselves.^2,7

Several mental health conditions also frequently co-occur with both eating disorders and non-suicidal self-injury. Depression, substance use disorder, post-traumatic stress disorder (PTSD), other anxiety disorders, and certain personality disorders can make someone more likely to experience self-harming behaviors or eating disorders. Unfortunately, the risk of suicide attempts is also higher among both these groups.^5,8

Treatment for self-harm and eating disorders

Eating disorders and self-harm can have a significant impact on someone's life, but they don't have to be a life sentence. Several treatments can help people struggling with one or both of these conditions.

Mental health counseling is the preferred first-line approach for both eating disorders and self-harming behavior. Working with a mental health professional can help patients learn to recognize their harmful patterns, redirect or learn to accept their negative thoughts, and develop new, healthier coping mechanisms, as well as directly address the underlying drivers of their conditions. Some common therapeutic approaches for these issues include:

• Cognitive behavioral therapy (CBT)
• Acceptance commitment therapy (ACT)
• Dialectical behavioral therapy (DBT)
• Interpersonal psychotherapy (IPT)
• Family-based therapy (FBT)

Other types of therapy may be used as a complementary treatment, particularly approaches that emphasize a connection between mind and body. Patients with eating disorder behaviors will also likely benefit from nutritional counseling and education. And in some cases, medication may help alleviate symptoms that drive disordered or harmful behavior.

If you or a loved one are struggling with an eating disorder or self-harming behavior, it's important to seek help. These behaviors help maintain feelings of hopelessness, sadness, and self-loathing, but with the right kind of support, you can make positive changes that help you learn to love yourself and your body.