Dual-Diagnosis: Anorexia and the Prevalence of Self-Harm


Liv was 12 the first time she shoved away from the dinner table, declaring, “I’m too fat!” Her mother was shocked that such a young girl could have those feelings, and her father didn’t take her seriously. No one could have known that Liv had been nurturing such fears for over a year, and that in fact, little by little, she’d been reducing her intake of food.

These days, she was eating next to nothing: less than 300 calories per day. She’d perfected the art of moving food around on her plate until it looked as though she’d eaten something. And everyone thought that her increasingly thinning figure was the product of a growth spurt or the changes brought on by puberty, but Liv’s refusal to eat had interrupted both of these. She wasn’t just not growing, she was shrinking — though you couldn’t have convinced her of that fact.

The once carefree, curious girl had been replaced by an anxious perfectionist who was never happy. She fretted and worried and was consumed by fears of gaining weight, of losing control. She grew deeply depressed. The once bubbly child became a homebody, refusing to return the calls of friends or even to leave the house. She obsessed over images of frail bodies on Tumblr and YouTube, idealizing their wasting away while punishing herself for not measuring up.

And something else: She began to cut. Liv was first introduced to cutting on these very websites, among the young women who shared her anorexia. They confessed that self-injury behaviors gave them a sense of relief — replacing a controllable, external sensation for an internal, seemingly unmanageable pain. She followed their lead. But when her mother walked in on her one evening and saw the jagged scabs Liv had previously hidden, she didn’t understand. She was angry and ashamed of her daughter. She let those feelings be known, which only compounded the situation.

Liv had secrets she’d never told, and she needed to tell them. But she needed to trust before she could tell. She would not be able to stop abusing her body until she could stop blaming her body, and she would not be able to stop doing that until she trusted someone enough to help show her how.

Self-Harm and Eating Disorders Often Coincide

Both eating disorders and self-harming behaviors — such as cutting, scratching, burning, picking, intentionally self-poisoning and head banging — affect a large number of young women and a growing number of young men. It can be argued that an eating disorder is itself a kind of self-injury, which may be one reason these behaviors pair so frequently together. Young people who experience eating disorders and those who self-harm tend to exhibit many of the same traits, such as perfectionism, anxiety, depression, low self-esteem, and frequently a history of abuse or trauma. Often, but not always, these young women and men come from troubled families.

An estimated 25 percent of people with an eating disorder will also exhibit self-harming behaviors. These two problems are said to co-occur or to exist as a dual diagnosis for these individuals, but for others, it is common for an eating disorder to replace self-harming behavior or vice versa. In other words, a person may make a concerted effort to give up cutting, but may unconsciously replace it with bingeing and purging behavior or anorexia.

Help Dealing with the Emotions Behind the Self-Destruction

Both behaviors serve as unconscious ways for the individual to cope with, deny or release intense or uncomfortable emotions, such as fear, anger, shame, guilt or sadness. To put an end to the self-destructive cycle, a pattern which can become highly compulsive and addictive, the individual needs to begin to address her feelings consciously and directly. This can be very hard to do at first, especially if family problems or an abusive history have not been dealt with. Help confronting painful emotions is vital for the recovery of any young person struggling with eating disorders and self-harming behaviors.

If you know a young person you suspect is struggling with restricted eating or another type of eating disorder, and who may be inflicting a pattern of direct self-harm, it’s important not to confront her with anger. This will likely only add fuel to her behavior, and you can be certain she already feels anger toward herself. Instead, let her know of your concern and of the danger her eating disorder poses. Calmly and consistently insist she seek help. Offer to go with her.

By: Julie Jordan Avritt

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