NSSI and Eating Disorders

Jessica Garisch & YWS Team

© Youth Wellbeing Study

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

Models of Eating Disorder

Eating Disorder: Basic model

The Experiential Avoidance Model (EAM) (Chapman, Gratz & Brown 2006)

Integrated theoretical model of the development and maintenance of NSSI (Nock, 2010)

Physical effects: Anorexia

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

• Questions? Comments?• Thanks for listening