Eating Disorders and Self-Harm Behavior: There was a discussion recently on an online weight loss message board regarding obesity/binge-eating and self-harm behaviors. One person posted that her therapist told her that her binge-eating was a form of self-harming behavior. This person equated self-harm to cutting behavior or abusing drugs/alcohol, etc., and hadn’t previously conceptualized binge-eating as a self-harm behavior. By sharing her story, she encouraged others to analyze their own eating behaviors and join in the discussion. Many people don’t think of obesity and binge-eating as a form of self-harm. Guess what? It is!
What Creates an Eating Disorder? The etiology of eating disorders is complex. Certainly there are biological components that play a huge role. For many, our biology serves to reinforce the use of eating disorders as a coping mechanism. Although there are some biologically based conditions that are known to cause certain eating disorders, for the most part, biology alone doesn’t answer the questions as to why people overeat, binge-eat, and have eating disorders. The issues are often more complex and deep-seated, and they vary from individual to individual. While some people may insist that their behavior is volitional, there are often unconscious factors at play.
Defense Mechanisms: We all engage in a variety of defense mechanisms on a daily basis to cope with life. To function appropriately without resorting to harmful behaviors, we must learn a variety of healthy coping skills. In her book The Body Betrayed, Kathryn Zerbe, M.D. (1995) discusses how one defense mechanism (reaction formation) serves to protect the self:
…For example, we may not be particularly enthralled with our mother’s new boyfriend or a present from a relative. But to avoid causing pain to those we love, we try to stave off negative impression and feelings and to exchange our loathing for acceptance. This process, which is called reaction formation, protects the self from the full experience of life’s unpleasantness and promotes civility in human interactions. Simply put, we turn an attitude or interest into its opposite, which is more personally and socially acceptable. This indispensable skill enables us to maintain friendships without having to be absolutely – and brutally – honest about everything that comes to mind. Haven’t you tried to act happy sometimes when someone phones, although you really wished you’d missed the call? Or you may tell a co-worker that her outfit is attractive, then wonder later why you said so because it was really hideous.
Reaction formation manifests itself in many different ways. The more we know about ourselves, the more we recognize we may not be, for instance, as unbigoted or as freethinking as we might believe we are. Only under the greatest self-scrutiny, such as in therapy or psychoanalysis, do we uncover what lies behind our reaction formations.
Prevalence of ED & Self Injury: There is definitely a crossover between other forms of self-injury and eating disorders (ED). According to an article published in Eating Disorders Review (Randy A. Sansone, MD, John L. Levitt, PhD & Lori A. Sansone, MD, May/June 2003 Volume 14, Number 3, and reprinted on bulimia.com), the prevalence rate of eating disordered individuals who also engage in non-lethal self-injury is approximately 25%.
Self-Injury, as defined by Dr. Barent Walsh’s book Treating Self-Injury, A Practical Guide (2006) is “intentional, self-effected, low-lethality bodily harm of a socially unacceptable nature, performed to reduce psychological distress”. In contrast to suicidal persons, the intent of the self-injuring person is not to terminate consciousness, but to modify it.
“The overwhelming majority of self-injurers report that they harm themselves in order to relieve painful feelings. The type of emotional distress they want to relieve falls into two basic categories. The majority of those who self-injure report hurting themselves in order to relieve too much emotion (Favazza, 1987; Walsh & Rosen, 1988; Alderman, 1997; Conterio & Lader, 1998; Brown, 1998, 2002; Brown, Comtois, & Linehan, 2002). The minority report harming themselves in order to relive too little emotion or states of dissociation (e.g., Conterio & Lader, 1998; Shapiro & Dominiak, 1992; Simeon & Hollander, 2001)” (Walsh, p. 7).
Direct & Indirect: Self-harm can be classified into direct and indirect forms. Direct forms refer to behavior that involves immediate tissue damage. Indirect forms, on the other hand, refer to behaviors in which the damage is generally accumulative rather than immediate. Intent is often very ambiguous. Types of indirect self-harm can include substance abuse and eating disorders that damage physical health (Walsh, p. 23). Risk-taking behaviors, such as getting into a car with strangers, walking alone in dangerous areas, sexual risk-taking, driving at excessively high speeds or walking in areas with high-speed traffic, are all forms of indirect self-harm as well.
Breaking through defenses to uncover the reasons behind self-injurious behavior, including eating-disordered behavior, is a necessary component to discovering and addressing some of the root causes of the behavior. If we don’t honestly examine it, how can we possibly change it? As painful as that can be, it’s worthwhile work. Sometimes it’s necessary to go there, or as my analyst put it, to “pick off the dysfunctional scab and let the issues breathe”. (He has a way with words.)
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