SELF INJURY BEHAVIORS WITH EATING DISORDERS Arzu Ayhan 1803394

1. SELF INJURY BEHAVIORS WITH EATING DISORDERSArzu Ayhan 1803394 Instructor : Prof. Dr. DEAN OWEN Course : PSYC 374

2. Outline • Eating Disorders & Self Harm • Typology • Information about Anorexia and Bulimia Nervosa • Statistical Information • Factors of Eating Disorders as a Self Harm • Biological Factors • Sociocultural Factors • Experiential Factors • Psychological & Dispositional Factors • Effects of Eating Disorder • Physiological • Psychological • Overcoming • Conclusion

3. Eating Disorders & Self Harm • Self harm is defined as the act of causing self injury to one's own body. • Also, it is defined as ‘an expression of personal distress, usually made in private, by an individual who hurts him- or herself’ (UK NICE, 2004). • Self harm is also referred to as self injury, self abuse, self inflicted violence, self mutilation and parasuicide.

4. Types of Self- Harm • Cutting • Biting • Scratching • Burning • Hitting • Self poisoning • Branding • Wound interference • Pulling hair or picking skin • Trichotillomania (Hair-Pulling Disorder) - OCRD • Excoriation (Skin-Picking) Disorder – OCRD

5. Eating Disorders & Self Harm • The practice of an eating disorder (Anorexia Nervosa, Bulimia Nervosa)could also be considered self harming behavior. • Similar to self harming behavior, the eating disordered behavior is participated in to help the individual cope with, take control of, block out and release unwanted feelings and emotions. (Favaro & Santonastaso, 2000)

6. Eating Disorders & Self Harm • Anorexia Nervosa • Important features of Anorexia Nervosa include: • Self-starvation • A refusal to maintain a minimal body weight • A pathological fear of gaining weight • A distorted body image in which sufferers continue to insist they are overweight • Onset in early to middle teens • Mortality rates are high (5-8%)

7. Eating Disorders & Self Harm • BulimiaNervosa • Characterized by a fear of gaining weight and a distorted body image • Main feature is periods of binge eating followed by periods of fasting or purging • Typical onset is in late adolescence or early adulthood

8. Statistical Information • Approximately 25 percent of individuals who suffer from eating disorders like Anorexia, Bulimia or Compulsive Overeating also participate in self harming behavior. • More common in females than males. • 25-30% of females claim to be currently dieting or attempting to lose weight (McVey et al., 2004) • 13.4% of girls and 7.1% of boys engage in disordered eating patterns as a self harm (including fasting, dieting, overeating or binge eating) (Neumark-Sztainer & Hannan, 2000)

9. Statistical Information • Out of 1,432 eating disorder patients examined between the ages of 10 and 21, the study revealed that nearly 41 percent had documented incidents of intentionally harming themselves.

10. Factors of Eatingdisorders as a Self Harm • Biological Factors • Sociocultural Influences • Media Influences, Body Dissatisfaction & Dieting • Peer Influences • Familial Factors • Experiential factors • Psychological & Dispositional Factors

11. Biological Factors • Genetic Component • Heritability component may be >50% (Klump et al., 2001) • Role of the Lateral Hypothalamus • Lesions to the lateral hypothalamus cause appetite loss resulting in a self-starvation syndrome • Endogenous Opioids • A compound that the body releases to reduce pain sensation • Starvation may increase the levels of opioids, thus producing a state of euphoria. • Neuroendocrine Dysfunction • Hormonal dysfunction or life stressors causing hormonal dysfunction

12. Sociocultural Influences • Media Influences, Body Dissatisfaction & Dieting • Peer Influences • Familial Factors

13. Media Influences, Body Dissatisfaction & Dieting • Increases in eating disorders associated with changes in media representations of the ideal female body shape • Body shape dissatisfaction associated with watching TV shows that present idealized female images (Tiggerman & Pickering, 1996)

14. The Role of Body Shape Dissatisfaction • Defined as “the gap between one’s actual and ideal weight and shape” • Most theories of eating disorders implicate body dissatisfaction • Body dissatisfaction is likely to trigger dieting (e.g. Stice, 2001)

15. Peer Influences • Adolescent girls tend to learn their attitudes to slimness and dieting from their peers (Levine et al., 1994)

16. Familial Factors • Eating disorders have a tendency to run in families • Eating disorders may best be understood by considering family dynamics (Minuchin et al., 1975) • The sufferer may be embedded in a dysfunctional family structure that actively promotes the development of eating disorders

17. Eating Disorders & Family Systems Theory • Families with eating disorders may show at least one of the following characteristics (Minuchin et al., 1975): • Enmeshment - parents are intrusive, over-involved in their children’s affairs, and dismissive of their children’s emotions and emotional needs. • Overprotection - members of the family are over-concerned with parenting and with one another’s welfare, and this can often be viewed by the child as coercive parental control. • Rigidity - there is a tendency to maintain the status quo within the family. • Lack of Conflict Resolution - families avoid conflict or are in a continual state of conflict.

18. Experiential Factors • Anorexia and bulimia sufferers report more negative life experiences than healthy controls (Rastam & Gillberg, 1991; Welch et al., 1997) • Higher incidence of childhood sexual abuse is found in those with bulimia and anorexia (Brown et al., 1997; Steiger et al., 2000)

19. Psychological & Dispositional Factors • Perfectionism • Negative or Depressed Affect • Low Self-Esteem • Shyness • Neuroticism • Dependence & Non-Assertiveness

20. Physiological Effects of EatingDisorder as a Self Harm • Tiredness, cardiac arrhythmias, low blood pressure and slow heartbeats • Dry skin and brittle hair • Kidney & gastrointestinal problems • The development of lanugo (a soft, downy hair) on the body • The absence of menstrual cycles (amenorrhea) • Hypothermia, often resulting in feeling cold even in hot environments

21. Effects of Eating Disorder

22. Overcoming • Individuals with severe eating disorders often require medical treatment prior to psychological interventions. • Pharmacological Treatments • Antidepressants are the most common form of drug treatment (e.g. fluoxetine [Prozac]) • However, pharmacological treatments with anorexia have tended to be less successful (Pederson et al., 2003).

23. Overcoming (Cont…) • Family therapy • One of the most common interventions used with eating disorders • Based on the view that eating disorders hide important conflicts within the family • Exploring these issues in family therapy helps to alleviate eating disorder symptoms (Dallos, 2004)

24. Overcoming (Cont…) • Cognitive Behavior Therapy • teach the eating disordered individuals who self harm because of eating disorders like Anorexia, or Bulimia through treatment how to get through difficult emotions and feelings without the need to self harm. • can help the individual redefine the feelings and develop, and then implement, effective coping mechanisms to loosen the hold self harming has on the individual's life.

25. Conclusion • Sufferers often deny their disorder or illness • Anorexia Nervosa and Bulimia Nervosa often share similar risk factors, and sociocultural factors related to body shape ideals may be central

26. Reference • Dallos, R. (2004).Attachment narrative therapy: integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders, Journal of Family Therapy, 26, 1, 40-65, doi: 10.1111/j.1467-6427.2004.00266.x • Díaz-Marsá, M., Luis, J., & Sáiz, J. (2000). A Study Of Temperament and Personality in Anorexia and Bulimia Nervosa. Journal of Personality Disorders,14, 4, 352-359, doi: 10.1521/pedi.2000.14.4.352. • Favaro, A., Santonastaso, P. (2000). The spectrum of eating disorders in young women: A prevalence study in a general population sample, Psychomatic Madicine, 65, 4, 701-708. • Levine, M., Smolak, L., & Hayden, H.(1994). The Relation of Sociocultural Factors to Eating Attitudes and Behaviors among Middle School Girls, The Journal of Early Adolescence, 14, 4, 471- 490, doi: 10.1177/0272431694014004004 • Rastam, M., Gillberg, C. (1991). The family background in anorexia nervosa: a population-based study, Journal of Am Academy Child Adolescence Psychiatry, 30, 2, 283-289. • Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect.Journal of Abnormal Psychology, 110, 1, 124- 135. • Tiggemann, M., Pickering, AS. ( 1996). Role of television in adolescent women’s body dissatisfaction and drive for thinness, Journal of Eating Disorder, 20, 2, 199- 203.