Abstract
The high rate of non-suicidal self-injury (NSSI) among individuals with eating disorders is a well-documented and clinically significant phenomenon (Svirko and Hawton, Suicide Life Threat Behav 37:409–421, 2007). Several shared risk factors have been identified for disordered eating and NSSI. These common risk factors were examined within the context of etiological models that have the potential to explain why they so frequently co-occur. Thus, data on the relevance of the shared risk factors are reviewed within the framework of multiple conceptual models for eating disorders and/or NSSI. Moreover, empirical data and the explanatory potential for the overlapping nature of these maladaptive behaviors are evaluated for each model. A summary of the commonalities and limitations of the various etiological models is then presented. Finally, the chapter concludes by highlighting clinical implications and future directions for the advancement of knowledge regarding this pernicious problem, with a focus on the need for additional research and the development of integrative, comprehensive etiological models for non-suicidal self-injury and eating disorders.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39, 389–400.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.) text revision. Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Anderson, C. B., Carter, F. A., McIntosh, V. V., Joyce, P., & Bulik, C. M. (2002). Self-harm and suicide attempts in individuals with bulimia nervosa. Eating Disorders: The Journal of Treatment and Prevention, 10, 227–243.
Anestis, M. D., Selby, E. A., & Joiner, T. E. (2007). The role of urgency in maladaptive behaviors. Behaviour Research and Therapy, 45, 3018–3029.
Anestis, M. D., Smith, A. R., Fink, E. L., & Joiner, T. E., Jr. (2009). Dysregulated eating and distress: Examining the specific role of negative urgency in a clinical sample. Cognitive Therapy and Research, 33, 390–397.
Anestis, M. D., Fink, E. L., Smith, A. R., Selby, E. A., & Joiner, T. E. (2011). Eating disorders. In M. J. Zvolensky, A. Bernstein, & A. A. Vujanovic (Eds.), Distress tolerance: Theory, research, and clinical applications (pp. 245–260). New York: Guilford Press.
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., & Mitchell, J. E. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 384–405.
Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97, 90–113.
Bodell, L., Smith, A. R., Holm-Denoma, J. M., Gordon, K. H., & Joiner, T. E., Jr. (2011). Low social support and negative life events interact to predict bulimic symptoms. Eating Behaviors, 12, 44–48.
Bradley, B., Defife, J. A., Guarnaccia, C., Phifer, J., Fani, N., Ressler, K. J., et al. (2011). Emotion dysregulation and negative affect: Association with psychiatric symptoms. Journal of Psychiatry, 72, 685–691.
Bresin, K., & Gordon, K. H. (2013). Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personality Disorders: Theory, Research, and Treatment, 4, 62–66.
Bresin, K., Gordon, K. H., Bender, T. W., Gordon, L. J., & Joiner, T. E., Jr. (2010). No pain, no change: Reductions in prior negative affect following physical pain. Motivation and Emotion, 34, 280–287.
Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68, 609–620.
Burns, E. E., Fischer, S., Jackson, J. L., & Harding, H. G. (2012). Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse and Neglect, 36, 32–39.
Cawood, C., & Huprich, S. K. (2011). Late adolescent nonsuicidal self-injury: The roles of coping style, self-esteem, and personality pathology. Journal of Personality Disorders, 25, 765–781.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371–394.
Claes, L., Vandereycken, W., & Vertommen, H. (2005). Impulsivity-related traits in eating disorder patients. Personality and Individual Differences, 39, 739–749.
Claes, L., Vandereycken, W., & Vertommen, H. (2006). Pain experience related to self-injury in eating disorder patients. Eating Behaviors, 7, 204–213.
Claes, L., Klonsky, E. D., Muehlenkamp, J. K., & Vandereycken, W. P. (2010). The affect-regulation function of nonsuicidal self-injury in eating-disordered patients: Which affect states are regulated? Comprehensive Psychiatry, 51, 386–392.
Claes, L., Jiménez-Murcia, S., Agüera, Z., Castro, R., Sánchez, I., Ménchon, J. M., et al. (2012). Male eating disorder patients with and without non-suicidal self-injury: A comparison of psychopathological and personality features. European Eating Disorders Review, 20, 335–338.
Claes, L., Soenens, B., Vansteenkiste, M., & Vandereycken, W. (2012). The scars of the inner critic: Perfectionism and nonsuicidal self-injury in eating disorders. European Eating Disorders Review, 20, 196–202.
Corstorphine, E., Mountford, V., Tomlinson, S., Waller, G., & Meyer, C. (2007). Distress tolerance in eating disorders. Eating Behaviors, 8, 91–97.
Cowdrey, F. A., & Park, R. J. (2011). Assessing rumination in eating disorders: Principal component analysis of a minimally modified ruminative response scale. Eating Behaviors, 12, 321–324.
de Zwaan, M., Biener, D., Schneider, C., & Stacher, G. (1996). Relationship between thresholds to thermally and to mechanically induced pain in patients with eating disorders and healthy subjects. Pain, 67, 511–512.
Engel, S. G., Wonderlich, S. A., Crosby, R. D., Wright, T. L., Mitchell, J. E., Crow, J. E., et al. (2005). A study of patients with anorexia nervosa using ecological momentary assessment. International Journal of Eating Disorders, 38, 335–339.
Fairburn, C. G., Cooper, Z., Shafran, R., & Wilson, G. T. (2008). Eating disorders: A transdiagnostic protocol. In D. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed.). New York: Guilford Press.
Fulton, J. J., Lavender, J. M., Tull, M. T., Klein, A. S., Muehlenkamp, J. J., & Gratz, K. L. (2012). The relationship between anxiety sensitivity and disordered eating: The mediating role of experiential avoidance. Eating Behaviors, 13, 166–169.
Gordon, K. H., Selby, E. A., Anestis, M. D., Bender, T. W., Witte, T. K., Braithwaite, S., et al. (2010). The reinforcing properties of repeated deliberate self-harm. Archives of Suicide Research, 14, 329–341.
Gordon, K. H., Holm-Denoma, J. M., Troop-Gordon, W., & Sand, E. (2012). Rumination and body dissatisfaction interact to predict binge eating. Body Image, 9, 352–357.
Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37, 14–25.
Haines, J. W., Brain, C. L., & Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104, 471–489.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86–108.
Herts, K. L., McLaughlin, K. A., & Hatzenbuehler, M. L. (2012). Emotion dysregulation as a mechanism linking stress exposure to adolescent aggressive behavior. Journal of Abnormal Child Psychology, 40, 1111–1122.
Hoff, E. R., & Muehlenkamp, J. R. (2009). Nonsuicidal self-injury in college students: The role of perfectionism and rumination. Suicide and Life-Threatening Behavior, 39, 576–587.
Holm-Denoma, J. M., & Hankin, B. L. (2010). Perceived physical appearance mediates the rumination and bulimic symptom link in adolescent girls. Journal of the Clinical Child and Adolescent Psychology, 39, 537–544.
Holm-Denoma, J. M., Gordon, K. H., Bardone-Cone, A. M., Vohs, K. D., Abramson, L. Y., Heatherton, T. F., et al. (2005). A test of an interactive model of bulimic symptomatology in adult women. Behavior Therapy, 36, 311–321.
Hooley, J. M., Ho, D. T., Slater, J., & Lockshin, A. (2010). Pain perception and nonsuicidal self-injury: A laboratory investigation. Personality Disorders: Theory, Research, and Treatment, 1, 170–179.
International Society for the Study of Self-Injury. (2013). Definition of non-suicidal self-injury. Retrieved from http://www.isssweb.org/
Kemperman, I., Russ, M. J., Clark, W. C., Kakuma, T., Zanine, E., & Harrison, K. (1997). Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Research, 70, 175–183.
Kerr, P. L., & Muehlenkamp, J. J. (2010). Features of psychopathology in self-injuring female college students. Journal of Mental Health Counseling, 32, 290–308.
Kingston, J., Clark, S., & Remington, B. (2010). Experiential avoidance and problem behavior: A mediational analysis. Behavior Modification, 34, 145–163.
Lavender, J. M., & Anderson, D. A. (2010). Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. International Journal of Eating Disorders, 43, 352–357.
Linehan, M. M. L. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Lynam, D. R., Miller, J. D., Miller, D. J., Bornovalova, M. A., & Lejuez, C. W. (2011). Testing the relations between impulsivity-related traits, suicidality, and nonsuicidal self-injury: A test of the incremental validity of the UPPS model. Personality Disorders: Theory, Research, and Treatment, 2, 151–160.
Messmann-Moore, T. L., Walsh, T. L., & DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse and Neglect, 34, 967–976.
Muehlenkamp, J. J., & Brausch, A. M. (2012). Body image as a mediator of non-suicidal self-injury in adolescents. Journal of Adolescence, 35, 1–9.
Muehlenkamp, J. J., Engel, S. G., Wadeson, A., Crosby, R. D., Wonderlich, S. A., Simonich, H., et al. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47, 83–87.
Muehlenkamp, J. J., Claes, L., Smits, D., Peat, C. M., & Vandereycken, W. (2011). Non-suicidal self-injury in eating disordered patients: A test of a conceptual model. Psychiatry Research, 188, 102–108.
Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 10, 1–9.
Muehlenkamp, J. J., Peat, C. M., Claes, L., & Smits, D. (2012). Self-injury and disordered eating: Expressing emotion dysregulation through the body. Suicide and Life-Threatening Behavior, 42, 416–425.
Nelson, A., & Muehlenkamp, J. J. (2012). Body attitudes and objectification in non-suicidal self-injury: Comparing males and females. Archives of Suicide Research, 16, 1–12.
Nock, M. K., & Mendes, W. (2008). Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76, 28–38.
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.
Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140–146.
Nock, M. K., Joiner, T. E., Jr., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65–72.
Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study amongst adolescents and young adults. Journal of Abnormal Psychology, 118, 816–827.
Nolen-Hoeksema, S. (2003). Women who think too much. New York: St. Martin’s Press.
Orbach, I. (1996). The role of body experience in self-destruction. Clinical Child Psychology and Psychiatry, 1, 607–619.
Orbach, I., & Mikulincer, M. (1998). The body investment scale: Construction and validation of a body experience scale. Psychological Assessment, 10, 415–425.
Orbach, I., Gilboa-Schechtman, E., Sheffer, A., Meged, S., Har-Even, D., & Stein, D. (2006). Negative bodily self in suicide attempters. Suicide and Life-Threatening Behavior, 36, 136–153.
Peterson, C. M., & Fischer, S. (2012). A prospective study of the influence of the UPPS model of impulsivity on the co-occurrence of bulimic symptoms and non-suicidal self-injury. Eating Behaviors, 13, 335–341.
Rawal, A., Park, R. J., & Williams, J. M. G. (2010). Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behaviour Research and Therapy, 48, 851–859.
Raymond, N. C., de Zwaan, M., Faris, P. L., Nugent, S. M., Ackard, D. M., Crosby, R. D., et al. (1995). Pain thresholds in obese binge-eating disorder subjects. Biological Psychiatry, 37, 202–204.
Raymond, N. C., Faris, P. L., Thuras, P. D., Eiken, B., Howard, L. A., Hofbauer, R. D., et al. (1999). Elevated pain threshold in anorexia nervosa subjects. Biological Psychiatry, 45, 1389–1392.
Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31, 67–77.
Selby, E. A., & Joiner, T. E., Jr. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13, 219–229.
Selby, E. A., & Joiner, T. E., Jr. (2013). Emotional cascades as prospective predictors of dysregulated behaviors in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 4, 168–174.
Selby, E. A., Anestis, M. D., & Joiner, T. E., Jr. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46, 593–611.
Selby, E. A., Anestis, M. D., Bender, T. W., & Joiner, T. E., Jr. (2009). An exploration of the emotional cascade model in borderline personality disorder. Journal of Abnormal Psychology, 118, 375–387.
Selby, E. A., Bulik, C. M., Thornton, L. B., Crawford, H. A., Fichter, S., Halmi, M. M., et al. (2010). Refining behavioral dysregulation in borderline personality disorder using a sample of women with anorexia nervosa. Personality Disorders: Theory, Research, and Treatment, 1, 250–257.
Selby, E. A., Connell, L. D., & Joiner, T. E., Jr. (2010). The pernicious blend of rumination and fearlessness in non-suicidal self-injury. Cognitive and Therapy Research, 34, 421–428.
Selby, E. A., Bender, T. W., Gordon, K. H., Nock, M. K., & Joiner, T. E. (2012). Nonsuicidal self-injury (NSSI) disorder: A preliminary study. Personality Disorders: Theory, Research, and Treatment, 3, 167–175.
Smith, A. R., Fink, E. L., Anestis, M. D., Ribeiro, J. D., Gordon, K. H., Davis, H., et al. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206, 246–255.
Smyth, J. M., Wonderlich, S. A., Heron, K. E., Sliwinski, M. J., Crosby, R. D., Mitchell, J. E., et al. (2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology, 75, 629–638.
Svaldi, J., Dorn, C., & Trentowska, M. (2011). Effectiveness for interpersonal problem-solving is reduced in women with binge eating disorder. European Eating Disorders Review, 19, 331–341.
Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disorders: the extent and nature of the association. Suicide & Life-Threatening Behavior, 37, 409–421.
Wedig, M. M., & Nock, M. K. (2010). The functional assessment of maladaptive behaviors: A preliminary evaluation of binge eating and purging among women. Psychiatry Research, 178, 518–524.
Welch, S. L., & Fairburn, C. G. (1996). Impulsivity or comorbidity in bulimia nervosa: A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. British Journal of Psychiatry, 169, 451–458.
Whiteside, S. P., & Lynam, R. D. (2001). The Five Factor Model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689.
Wonderlich, S. A., Peterson, C. B., Mitchell, J. E., & Crow, S. J. (2000). Integrative cognitive therapy for bulimic behavior. In K. J. Miller & S. J. Mizes (Eds.), Comparative treatments for eating disorders (pp. 258–282). New York: Springer.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Gordon, K.H., Kwan, M.Y., Minnich, A.M., Carter, D.L. (2014). Etiological Models of Non-suicidal Self-Injury and Eating Disorders. In: Claes, L., Muehlenkamp, J. (eds) Non-Suicidal Self-Injury in Eating Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40107-7_4
Download citation
DOI: https://doi.org/10.1007/978-3-642-40107-7_4
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-40106-0
Online ISBN: 978-3-642-40107-7
eBook Packages: MedicineMedicine (R0)