Self-injurious behavior and eating disorders: the extent and nature of the association

We have reviewed the literature on the association between self-injurious behaviors (SIB) and eating disorders from the psychological-behavioral perspective. Our aims were to investigate the extent and possible reasons for the association. A literature search was conducted using the following electronic databases (1989-2005): Medline, PsychInfo and EMBASE. References in identified articles were also screened. The reported occurrence of SIB in eating disorder patients ranged between 25.4% and 55.2%. The figures for occurrence of eating disorders in SIB patients ranged between 54% and 61%. These figures indicate that there is a strong association between these disorders. Impulsivity, obsessive-compulsive characteristics, affect dysregulation, dissociation, self-criticizing cognitive style and need for control were identified as potential factors involved in the association. Early trauma such as childhood sexual abuse and possibly certain characteristics of early family environment might contribute to the development of these factors. We present a hypothetical model which includes these factors and argue that the co-existence of eating disorders and SIB in patients results from several factors being present. SIB and eating disorder symptoms may provide a means whereby patients can deal with each factor simultaneously. The clinical implications of the findings are discussed.