Non-suicidal Self-Injury and Eating Disorders: Dimensions of Self-Harm

Abstract

Both non-suicidal self-injury (NSSI) and eating disorders (ED) are considered to be harmful behaviors falling within a behavioral spectrum ranging from self-care to self-harm. The high degree of co-occurrence of these behaviors, along with their shared body focus has motivated researchers to investigate and theorize about the potential shared factors driving their comorbidity. In this chapter, we present a conceptual model based upon the current empirical literature depicting distal and proximal psychosocial risk factors shared by NSSI and ED. This model provides a framework for understanding the co-occurrence of NSSI and ED, with the different components being further elaborated on and discussed with regards to treatment recommendations across the different chapters included in this volume. The chapter concludes with a short introduction and summary of each of the chapters within this book.

Occurrence and co-occurrence of nonsuicidal self-injury and disordered eating in a daily diary study: Which behavior, when?

“…By directly comparing NSSI and DE occurring within a single population using a naturalistic daily diary design, the current study takes a first step toward addressing this important gap in the literature (Claes and Muehlenkamp, 2014). Although our results should be considered preliminary due to the small sample size, the use of a single daily report, and the inability to directly examine emotion regulatory functions of these behaviors, we believe this study nonetheless makes several significant contributions that can direct future research in this area.…”

“…Given existing research demonstrating that negative affect typically decreases or stabilizes following NSSI and DE (Armey et al, 2011;Engel et al, 2013;Haines et al, 1995), as well as the theory emphasizing the emotion regulatory effect of these behaviors (see Claes and Muehlenkamp, 2014), it may be reasonable to suspect that worse mood occurred leading up to these behaviors rather than following it. Thus, with this assumption in mind, comparisons of mood trajectories on days with NSSI versus DE in this study suggest that NSSI may occur on days where mood becomes increasingly negative and agitated throughout the day.…”

“…Nonsuicidal self-injury (NSSI), defined as any deliberate and self-inflicted physical injury that occurs in the absence of an intention to die (International Society for the Study of Self-injury, 2007), and disordered eating (DE), defined as eating and weight control behaviors that are both maladaptive and atypical (Stice et al, 2009), frequently co-occur (Claes and Muehlenkamp, 2014). Among eating disorder patients, 32% to 70% endorse a lifetime history of NSSI (Claes et al, 2001;Favaro and Santonastaso, 1999), and 50 to 61% of people who engage in NSSI report a lifetime history of an eating disorder (Favazza and Conterio, 1989;Nixon et al, 2002).…”

“…Moreover, authors have proposed that NSSI and DE behaviors may be "functionally equivalent", meaning they occur in response to similar contingencies and result in similar reinforcing consequences (Claes and Muehlenkamp, 2014). Currently, we know little about the withinperson processes that may predict which of these behaviors occurs and under which circumstances.…”

Emotional reactivity in a clinical sample of patients with eating disorders and nonsuicidal self-injury

“…Similarly, Muehlenkamp et al (2012) found that emotion regulation deficits were associated with both ED and NSSI behaviors, and levels of emotion dysregulation and depression were highest among those who reported both behaviors. Thus far, however, it remains unclear if there are predisposing factors underlying emotion regulation deficits and the co-occurrence of EDs and NSSI (Claes and Muehlenkamp, 2013). …”