Cutting into the Mirror: Association of Body Image Concerns with Non-Suicidal Self-Injury in Adolescents and Young Adults with Eating Disorders

Non-suicidal self-injury (NSSI) is a transdiagnostic behavior often found in patients with eating disorders (EDs). Both conditions plateau in adolescence and share psychopathological traits. Our study focuses on body image concerns, a complex psychopathological construct associated with both NSSI and ED, as a shared risk factor between the two. This study included 73 participants aged 14-24 recruited from the Eating Disorders Day Hospital, University Hospital of Bari, Italy, divided into two groups: those with an ED and NSSI (ED + NSSI) and those with an ED without NSSI (ED-only). Using standardized assessments such as clinical and demographical data, the Body Uneasiness Test (BUT-a), and the Eating Disorder Inventory (EDI-2), this study found that the ED + NSSI group exhibited significantly higher body image concerns in all main scales and subscales of BUT-a and EDI-2. Moreover, the ED + NSSI group presented higher scores on psychopathological traits associated with a more severe ED, namely Ineffectiveness, Social Insecurity, and Asceticism. Finally, patients in the ED + NSSI group were diagnosed with a higher degree of depressive disorders. These findings highlight significant associations between body image concerns and NSSI in patients with an ED, also showing a higher risk of psychiatric comorbidities and a more severe ED profile in these patients.