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Eating disorders are devastating mental health conditions that often occur alongside other serious concerns, such as anxiety disorders, depression, and chronically low self-esteem. Unfortunately, any or all of these conditions can lead to self-harm behaviors.
Self-harm and eating disorders are both dangerous, and both can become deadly without appropriate care. However, some treatments can help someone overcome different types of self-harm behavior, eating disorders, or both.
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
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:
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.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Resources
Self-Harm. (2023, April 24). Substance Abuse and Mental Health Services Administration. Accessed October 2024.
Self-Harm. (n.d.) MedlinePlus. Accessed October 2024.
Eating disorder behaviors—i.e., binging and purging, severely restricting food intake, or abusing laxatives—are arguably types of self-harm, as they involve treating the body in a way that causes physical harm. But eating disorders themselves are mental health disorders: complex conditions developed from a number of interconnected causes and symptoms. An eating disorder leads to eating disorder behaviors, but the two are not the same.
On the other hand, self-harm is considered a type of behavior—specifically, a type of maladaptive coping mechanism. It often manifests as part of mental health disorders, including eating disorders, but is not itself considered a disorder.
