Bodies under Siege: Women, Eating Disorders, and Self-Injurious Behavior

Eating disorders (EDs) and self-injurious behavior (SIB) are a major public health concern, especially among adolescents and young adults. The vast majority of individuals with EDs and SIB are female: 90-95% of those diagnosed with anorexia nervosa (AN), 80-90% of those diagnosed with bulimia nervosa (BN), and more than 70% of those who engage in SIB are young women and girls. Indeed, EDs and SIB are frequently comorbid: it has been estimated that 50-66% of individuals who self-injure either meet the diagnostic criteria for an ED or have a history of one. Of those with EDs, especially BN and binge/purge-type AN, a full 72% report at least one instance of SIB. These behaviors are clearly related, but how? To answer this question, the following must be examined: our culture of body loathing, the phenomenological similarities of these behaviors, and various perspectives on their shared etiology and pathogenesis. A review of the literature reveals 3 predictive variables that are of particular importance (alexithymia, dissociation, and the impulsive/compulsive spectrum), which are discussed in depth. This paper concludes with a discussion of the approaches used to successfully treat these behaviors, both psychotherapeutic and pharmaceutical