Overview
• Commonalities• Research • YWS findings to date• Shared strategies for therapy• Clinical implications• Useful resources
Commonalities• 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-esteemMood intolerance Self-criticism
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 CommonalitiesEating 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 teenFemales 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