12-Step Model for Co-Occurring Self-Harm & Eating Disorders

Woman Dealing With a negative body image

Contributor: Camille Williams, MA, LCPC, Eating Disorder Specialist at Timberline Knolls Residential Treatment Center

The 12-Step Model was originally designed for alcoholics and has expanded into many other addictive behaviors including gambling, codependency, emotions, and eating disorders (ED).

ED recovery has several 12-step options including Overeaters Anonymous, Anorexics, and Bulimics Anonymous, and Eating Disorders Anonymous, which offer books and materials.

Although there are no specific 12-step materials for self-harm (SH) currently the steps and principles can still be applied and help someone in recovery.

Addictions often arise out of a need to cope through behaviors that become excessive, unhealthy, and ineffective. The needs of an addict are very valid and may include a need to numb, control, escape, feel, or protect.

Addictions and Shame

Shame is often a part of the addictive cycle and can manifest in more than one way. An addict may begin using an unhealthy coping skill as a need for punishment, which arises from the feelings of shame.

Continuously engaging in behaviors that have negative consequences may result in even more shame and amplify the need for punishment. This cycle continues to build on itself leading the individual to increase frequency and intensity of behaviors as well as perpetually escalating the feelings of shame.

Shame and punishment are two common underlying constructs in the recovery process for an individual who is struggling with co-occurring ED and SH. It may begin as ED behaviors and then switch to SH behaviors, known as cross-addiction or they may happen simultaneously, which is called co-occurring.

Eating Disorders and Self-harm

ED and SH share many similarities with alcohol or drug addiction and may also co-occur. Turner (2002) recognizes, “self-injurers produce their own internal opioids through a subconscious physiological process, to which they can become addicted” (p. 32).

Woman Reading Book on eating disordersThe 12-step model is an approach that can be used for any addiction. Conceptualizing ED and SH behaviors as addictions allow for the application of 12-step programs.

This perspective may help an addict let go of shame and self-blame and begin to explore their addiction as a disease that needs to be treated.

It also provides an opportunity for community support through others who are in their own recovery process. Community support invites honesty, which is another beneficial way of letting go of shame through sharing addiction secrets to others rather than being alone in struggles.

Additionally, the 12-step model may provide an outline and structure to recovery work and invite a more significant commitment.

It can start with applying Step 1 from Eating Disorders Anonymous (EDA): “We admitted we were powerless over our eating disorders – that our lives had become unmanageable.” Notice, this can be applied to SH by changing “eating disorders” to “self-harm behaviors.”

Applying Step 1

Some people in recovery struggle with the word “powerless” because it can feel very out of control, and when addressed honestly, the addictive behaviors have become out of control. In the recovery process and in applying step 1 it can begin by recognizing powerlessness over thoughts, feelings, urges, and cravings related to ED, SH, or any other addictive behavior.

woman reading a notebook

Through recurrent behaviors to manage thoughts, feelings, urges, and cravings those experiences have intensified as have behaviors. In an addiction it begins to feel like the behavior(s) is the only way to cope, because it has been the only behavior(s) used.

In recovery, an addict begins to explore, with support, new ways to respond to thoughts, feelings, urges, and cravings.

Also in step 1, by noticing ways, life has become unmanageable, less functional, less happy, and less meaningful an addict may discover motivation to restore life even if it requires challenging recovery work.

EDA has a 12-step workbook and many other materials online at http://www.4eda.org/. 12-step programs provide step work, readings, stories, sponsors, support groups, and much more.

And even though materials are not currently available for SH, it is just as effective to utilize other addiction material and replace the behavior.

There are many different approaches to 12-step work in recovery that can address and meet recovery goals. Finally, as it is commonly said in 12-step programs, take what you need and leave the rest.

About the Author: Camille Williams, MA, NCC, LCPC

As the Eating Disorder Program Coordinator, Camille supports the development of curriculum, supervises the eating disorder specialist, and provides group therapy. She also educates and trains all staff on campus and advocates for eating disorder awareness through publications.

Camille started at Timberline Knolls as a Behavioral Health Specialist. She then transitioned into the Eating Disorder Specialist (EDS) role. In this position for nearly five years, she developed her skills and competence in working with the eating disorder population.

Camille received a Bachelor of Arts degree in both psychology and sociology from Augustana College in Rock Island, IL. She then went on to earn a Master of Arts in Clinical Professional Psychology from Roosevelt University, IL.

Camille is a member of the International Association of Eating Disorder Professionals (IAEDP).


[1] Turner, V.J. (2002). Secret scars: Uncovering and understanding the addiction of self-injury. Hazelden Center City, MN: Hazelden Foundation.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on April 3, 2024.
Reviewed By: Jacquelyn Ekern, MS, LPC on April 3, 2024.
Published on EatingDisorderHope.com