Non‐suicidal Self‐injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender

Abstract

The study explored lifetime prevalence of non-suicidal self-injury (NSSI) in female and male individuals with eating disorders (ED) and compared ED symptoms, general psychopathology and personality traits across individuals with and without a history of NSSI. The incremental discriminative capacity of gender on the manifestation of lifetime NSSI was also studied. A total sample of 1649 consecutively admitted ED patients (1515 women and 134 men) participated in the current study [339 ED + NSSI (ED with NSSI) and 1310 ED - NSSI (ED without NSSI)]. Specific self-report measures were included and other clinical and psychopathological indices. The observed lifetime prevalence of NSSI was 20.6% (20.9% in women and 17.2% in men). NSSI was not associated with ED type or gender. However, ED + NSSI patients exhibited more impulsive behaviour, substance-abuse disorders and additional impulse-control disorders, were younger and had more previous treatments. Age was shown to affect the presentation of NSSI. Additionally, ED + NSSI patients exhibited more severe ED and general psychopathological symptoms and had more dysfunctional personality traits when compared with ED - NSSI. ED + NSSI was found to be positively associated with harm avoidance and self-transcendence but negatively with reward dependence, self-directedness and cooperativeness. Thus, the variables with stronger capacity to identify the presence of ED + NSSI were younger age, harm avoidance, self-directedness and self-transcendence. A lack of association between sex and ED subtype with the presence of NSSI was observed.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

“…Notably, similar ER difficulties have been postulated for EDs and NSSI behaviors; namely, both reveal difficulties in thinking, planning, or implementing adaptive coping strategies (Solano et al, 2005; Claes et al, 2010; Muehlenkamp et al, 2012; Vansteelandt et al, 2013; Claes and Muehlenkamp, 2014; Kostro et al, 2014; Islam et al, 2015; Cucchi et al, 2016). Within this clinical population both maladaptive food intake and NSSI behaviors can be implemented as a maladaptive ER strategy that enables the individual to avoid, manage or lessen unpleasant emotions (Chapman et al, 2006; Andover and Morris, 2014; McKenzie and Gross, 2014).…”

“…Additionally, NSSI behaviors are highly prevalent among patients with disordered eating (Kostro et al, 2014; Claes et al, 2015b; Islam et al, 2015; Cucchi et al, 2016) and both ER difficulties, as well as high anxiety scores, may account for this association (Solano et al, 2005; Muehlenkamp et al, 2012; Vansteelandt et al, 2013). In line with these results, previous studies have also suggested that trait and state anxiety are triggering factors for NSSI behaviors (Selby et al, 2012; You et al, 2016), with trait anxiety described as a predisposing factor for the occurrence of NSSI (Fliege et al, 2009; Salman et al, 2014).…”

“…Psychometric and anthropometric measures [such as body mass index (BMI)] were also taken. Similar to Islam et al (2015), the existence of current or lifetime regular NSSI behaviors was assessed by means of a clinical interview by experienced psychologist and psychiatrists. We considered NSSI behaviors to be self-cutting, burning, hitting, and scratching, not performed with a suicidal intent.…”

“…Increasing evidence supports preceding emotion regulation (ER) models (Linehan, 1993; Gross, 1998) that postulate that ER difficulties often lead to the implementation of less appropriate strategies (e.g., maladaptive food intake or deliberate self-harm) to mollify unpleasant emotions. Likewise, deficits in ER observed among individuals suffering from EDs have been hypothesized to underlie the high prevalence of non-suicidal self-injury (NSSI) behaviors, which range from 21 to 59% in this clinical population (Kostro et al, 2014; Claes et al, 2015b; Islam et al, 2015; Cucchi et al, 2016). Still, among individuals with clinical EDs, those who engage in NSSI have higher dietary restrictions and higher rates of binging and/or purging symptomatology (Stein et al, 2004; Selby et al, 2010).…”

The Moderating Role of Purging Behaviour in the Relationship Between Sexual/Physical Abuse and Nonsuicidal Self‐Injury in Eating Disorder Patients

“…As Jacobson and Luik (2014) highlighted, up to 72% of individuals with an ED also engage in NSSI and up to 54% of individuals who engage in NSSI report ED symptomatology. More recently, Islam et al (2015) found that lifetime prevalence of NSSI in eating disorders patients was 20.6% and that NSSI was not associated with ED type or gender. More recently, Islam et al (2015) found that lifetime prevalence of NSSI in eating disorders patients was 20.6% and that NSSI was not associated with ED type or gender.…”