As well as it being EDAW, today (1st March), is also Self Harm Awareness Day (sometimes called Self-Injury Awareness Day). Self-harm in an unhealthy and potentially dangerous coping tool that is thought to have been used by as many as 13% of young people. Self-harm – a little like Eating Disorders – can present in many ways. A person might scratch or cut their skin, they may bite or burn or bruise themselves, some individuals even take intentional – none suicidal – overdoses.
Whether or not there is a relationship between self-harm and Eating Disorders is a question that often comes up on our workshops. So, I figured that today was the perfect opportunity to address this topic here on the blog.
Research suggests that there is a massive variation in prevalence of self-harm among those with Eating Disorders; fluctuating anything from 13% – 68%. Clients with Bulimia Nervosa are believed to be the most likely to also engage in self-harming behaviours. This is because self-harm is considered to be related to impulse control, in much the same way as binging and purging is. Presenting together, this can result in quite a chaotic presentation from clients who may use both coping tools at once, or flip between them.
Often when working with clients who are struggling with both behaviours, it is not uncommon for self-harming to worsen as a therapist attempts to support the client to engage less with their Eating Disorder behaviours. I typically see this as evidence for the client’s need to first be equipped with some effective healthy alternatives before actual reduction in eating disorder symptoms can be attempted. This is a process that needs to be embarked upon following a clear explanation to the client of the therapeutic intention, and their commitment to that process. ‘Failing’ to change a behaviour because the client isn’t ready, willing and able can often result in disengagement from therapy. It can be a complex dynamic.
Self-harm for those with Eating Disorders can also increase as their body changes throughout the recovery journey. This might be evidence of the client’s feelings – perhaps of hate, disgust and guilt – towards themselves. If physical changes (for example, weight changes) happen as part of eating disorder recovery, it is also important that the client is offered the opportunity to process how they feel about this, and about themselves. Without both elements being considered together, the multifaceted nature of the person’s struggle may be overlooked, and therefore relapse to behaviours more likely.
However, recovery from both is very much possible.
For more information on self-harm you can visit www.lifesigns.org.uk/siad/