Saying that self-injury is common among those with eating disorders may seem redundant: Starvation, purging, inappropriate laxative use, and excessive exercise all harm the self and create many physical problems. In some cases, however, self-injury becomes more obvious and more dangerous. Twenty-five percent of those with eating disorders engage in these more overt behaviors.
Types of Self-Injury
The most well-known form of overt self-injury is cutting, the practice of using some form of sharp edge (whether razor blade, knife, scissors, or some other object) to draw blood. There are several alternatives to this practice, including burning, hitting oneself, and pulling out hair. Others find ways to harm themselves through being in relationships that are abusive to them or in creating "accidents" for themselves.
Why Would Someone Use Cutting For Self-Injury?
Most who participate in behaviors like cutting do so to get away from the stress that they experience elsewhere. While cutting or burning one's skin may not sound relaxing, the person may experience a great deal of relief from the process. Some who engage in cutting have the sense that the bad parts of themselves flow out with the blood. Further, they often feel so emotionally numb most of the time that anything that allows them to feel is welcome.
It is important to note that self-injury is usually not an effort to get attention. Most who engage in these practices do not want it to be known; they will experience shame if someone discovers what they are doing in secret. Also, those who self-harm are rarely trying to commit suicide. Self-injury is often simply a way to get through another stressful day.
Comfort and Ritual in Cutting
Ask a person who cuts about his routine and you may have trouble getting information. Cutting and other forms of self-injury often involve well-established rituals. For example, a person might check each door in the house to make sure no one is nearby, or he may clean his blade in a very specific way when the cutting has ended. The routine is another way to add comfort: Like disordered eating rituals, the comfort comes from having something that is familiar and predictable.
Dangers of Self-Injury
The physical dangers of cutting, burning, or hitting oneself are clear; there may be permanent damage to skin and internal organs. Less obvious is the effect on mental health. Because there is shame in self-harm, those who practice it isolate themselves to do so (much as a person who purges does). This can lead to deeper depression, which can feed greater forms of self-harm and disordered eating. Self-harm also keeps the person from opportunities to cope with stress in healthier ways.
Healing from Self-Injury
Treatment most often involves stabilizing behaviors to limit further self-harm, and then working through psychotherapy to address the underlying issues that cause stress. In some cases, medication to address depression, anxiety, and other issues is a helpful tool.
The Dance Between EDs and Self-Injury
It is perhaps not surprising that eating disorders and self-harm are linked so strongly. In both cases, individuals experience a great deal of stress and look for ways to relieve it. Harmful rituals provide the comfort of familiarity while feeding a sense of shamefulness - and reinforcing the behaviors themselves.
Sources:
Pale Reflections. "Self-injury." At pale-reflections.com. Accessed 12 October 2009.
Sansone RA, Levitt JL, and Sansone LA. Eating disorders and self-harm: A chaotic intersection. Eating Disorders Review 14 (May/June 2003).
