NSSI and Eating Disorders
Jessica Garisch & YWS Team
© Youth Wellbeing Study
Overview
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Commonalities
Research
YWS findings to date
Shared strategies for therapy
Clinical implications
Useful resources
Commonalities
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Some researchers include ED in their definition of self-injury
Common aetiology? Common (clinically useful) models?
Commonalities in therapy?
Contagion concerns
Societal/media influence
Shared (mis)understandings
– E.g. “attention seeking” (e.g. “starved for attention” magazine headlines)
– “Why don’t you just eat/stop cutting yourself..?”
• Co-morbidity
– Research with eating disordered adult outpatients found 33% reported
a history of NSSI (Claes et al., 2013).
– Rates of NSSI among adolescent ED outpatients may be higher (e.g.
41%; Peebles, Wilson & Lock, 2010).
Theoretical models: Eating Disorders
*Key features that cross over with NSSI:
Perfectionism
Low self-esteem
Mood intolerance Self-criticism
Models of Eating Disorder
Eating Disorder: Basic model
The Experiential Avoidance Model (EAM) (Chapman, Gratz & Brown 2006)
Integrated theoretical model of the development and
maintenance of NSSI (Nock, 2010)
Physical effects: Anorexia
Physical affects of NSSI
• Tissue damage
• Insufficient stress response in people who self-injure?*
(this research is in it’s infancy)
– Reduced cortisol secretion in people who self-injure. Chronic life stressors
and trauma can lead to reduced cortisol baseline levels => also reduced
baseline levels in individuals who self-injure
– Lower in levels of endogenous opioids (and can be restored by NSSI);
?altered stress response. Require more stimulation to attain natural
endorphins?
• Dulled physical response over time? Need to increase severity of
NSSI to have similar affects (e.g. on endogenous opioids)
(in anorexia there is dulled attention/recognition of physical responses
+ body adjusts to being low weight..)
* See Groschwitz& Plener (2012) for a review
Research literature: Some Commonalities
Eating Disorders
NSSI
Perfectionism
Perfectionism
Self-punishment + low self-esteem
Self-punishment + low self-esteem
Genetic component (have isolated a gene(s))
? Genetic component remains unclear
Social learning – food rules/body culture
Social learning? Highest correlate of NSSI is
friends/family NSSI ? Modeling of regulation
Higher rates of anxiety (related to
development of OCD behaviours)
Higher rates of anxiety (+ NSSI ↑ Anxiety
over time)
Increased rates of depression (secondary to
eating disorder and as precursor)
Increased depressive symptoms among
people who self-injure (causality unclear)
Bullying a risk factor (teased about
weight/shape)
Bullying a co-variate (occurs alongside NSSI)
Higher in females; peak in teens
No sex differences? Peeks in teen
Females more often present to services?
Higher rates of trauma or abuse history
NSSI correlated with trauma + abuse history
Common themes in therapy
• Treatment difficulties
– Motivation to change (service) identified problem
– Ambivalence
• Including physical assessment
• Use of CBT/ CBT-E (Fairburn), DBT (Linehan)
• Chaining techniques (chain incident of NSSI; purge;
binge; restricting/skipping meal; body checking, etc.)
• Use of mindfulness (e.g. mindful eating in bulimia)
• Focusing on addressing issues of self-worth,
perfectionism, secondary/co-morbid issues,
incorporating family therapy
Clinical Implications
• Where there is NSSI/ED screen for both
• Both are coping mechanisms that will need to find a
replacement before a client can successfully rid
themselves of this behaviour.
– In NSSI/ED behaviours change what have they been
replaced with?
• Heterogeneity is key: no one-size-fits all
YWS : investigating this relationship
• We’ve included questions on eating and body concerns in
Wave 2 of the longitudinal survey
• Perhaps this theme will come out in qualitative interviews?
Useful Resources (for eating disorder)
• Central Regional Eating Disorder Service Website
• http://www.credo-oxford.com
• www.something-fishy.org
Some that EDANZ recommend to families
• www.feast-ed.org
www.aroundthedinnertable.org
• www.aedweb.org
• Here's a short you-tube video on meal support:
• http://youtu.be/2O9nZAWCkLc
• Questions? Comments?
• Thanks for listening 