Understanding the Link Between Self-Harm & Eating Disorders

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Contributor: Staff at Timberline Knolls Residential Treatment Center

The COVID-19 pandemic has led to an increase in mental health concerns and substance abuse, and we’ve only scratched the surface on some of the long-term fallout of those conditions.

It has also led to a surge of new cases and relapses for eating disorders. In the first 12 months of the pandemic, there were 125 eating disorder-related hospitalizations among patients ages 10-23 at Michigan Medicine, the medical center at the University of Michigan [1]. That’s more than double the average admissions (56) during the same time frame between 2017 and 2019.

There has been an especially stark upswing for adolescent girls. One analysis of electronic medical records data from about 80 U.S. hospitals found a 30% increase in hospitalizations for girls ages 12-18 compared with predictions based on pre-pandemic trends (male admissions did not increase) [2].

These are concerning tendencies, as is the increase in attempted suicides among adolescent girls. At the worst point in the winter of 2020, young women were attempting suicide at more than four times the rate of young males. Emergency department visits for suspected suicide attempts among U.S. girls ages 12-17 rose 51% during the pandemic from the same period in 2019, according to the Centers for Disease Control and Prevention (CDC) [3].

There is not necessarily a link between the rise in eating disorders and the increase in suicide attempts during the pandemic, though the National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that there are 10,200 deaths in the U.S. each year that are the direct result of an eating disorder. Along with that, 26% of people who have eating disorders attempt suicide [4].

But a person who has an eating disorder doesn’t necessarily have to resort to suicidal behaviors to have long-term physical and mental consequences.

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How Self-Harm & Eating Disorders Are Connected

For years, researchers have connected eating disorders and self-harming behaviors, the latter of which is formally known as nonsuicidal self-injury (NSSI).

Examples of NSSI can include cutting, burning, banging, or punching yourself; embedding objects under your skin; or a number of other behaviors that are intended to be painful without ending your own life.

Both eating disorders and NSSI can affect how a person feels, and those who struggle with these disorders often use them as a way to express or suppress their emotions. But that’s not a sustainable coping mechanism.

According to one study done at Cornell University, symptoms of both self-harm and eating disorders occur together in about 25%-50% of individuals who engage in one or the other. The rate of overlap (which can be upward of 65%) is higher among individuals who have been diagnosed with a mental illness [5].

As is the case with the increase in hospitalizations for young women who have eating disorders and the uptick in suicide attempts among that same demographic, adolescent girls are at greater risk for having an eating disorder that co-occurs with NSSI.

Pink Flowers in the Field

Gender and age aside, some other common overlapping factors that put a person at risk for both include:

  • Trouble coping with negative emotions
  • Lack of healthy family relationships
  • Dissociative tendencies
  • Impulsivity
  • Depression
  • History of trauma or abuse
  • Negative attitudes toward their body

How to Help a Person Who Struggles with Self-Harm & an Eating Disorder

As with any mental health concern, the best way to respond to someone in your life who has an eating disorder and is engaging in self-harming behaviors is to provide support.

These behaviors are generally the sign of underlying distress in a person’s life rather than an effort at manipulation or attention-seeking. Some ideas for how to provide help include:

  • Profess that you care about them. This is the most basic of approaches, but it’s also one of the most effective. By letting the person who’s struggling know that you’re there for them, you’re also letting them know that you’re not passing judgment. You’ll do whatever it takes to help get them to a better place.
  • Identify coping skills. Eating disorders and NSSI are often outlets to cope with other concerns. By helping a person redirect their negative events and feelings into positive avenues, such as going outside, listening to music, or doing something creative, you’re introducing alternatives that can mitigate these damaging behaviors.
  • Tread carefully. Don’t diminish either the eating disorder or self-harming behaviors. Both need to be specifically addressed in order for a person to move toward recovery. Also, try to avoid offering advice, which is easy to interpret as criticism. Validate what someone communicates about how they feel even if you can’t understand what they’re going through.
  • Seek out treatment options. Eating disorders and self-harming behaviors are serious concerns that may require professional treatment. Look for local therapeutic resources and have a list of professional experts who can provide comprehensive, evidence-based care.

More than a quarter of people who have an eating disorder attempt suicide, and NSSI, while not a suicidal behavior itself, is a strong predictor of later suicide attempts [6].

Eating disorders and self-harming behaviors are treatable, and with the right amount of support, a person can return to living a healthy, productive life.


[1] Mostafavi, B. (2021, July 7). Study: Hospitalizations for eating disorders spike among adolescents during COVID. Michigan Health Lab. Retrieved from: https://labblog.uofmhealth.org/rounds/study-hospitalizations-for-eating-disorders-spike-among-adolescents-during-covid.

[2] Little, D., Teriakidis, A., Lindgren, E., Allen, S., Barkley, E., & Rubin-Miller, L. (2021, April 29). Increase in adolescent hospitalizations related to eating disorders. Epic Health Research Network. Retrieved from: https://ehrn.org/articles/increase-in-adolescent-hospitalizations-related-to-eating-disorders.

[3] Yard, E., Radhakrishan, L., Ballesteros, M., Sheppard, M., Gates, A., Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J., Ehlman, D., Holland, K., Idaikkadar, N., Ivey-Stephenson, A., Martinez, P., Law, R., & Stone, D. (2021, June 18). Emergency department visits for suspected suicide attempts among persons aged 12-25 years before and during the COVID-19 pandemic —United States, January 2019-May 2021. The Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm?s_cid=mm7024e1_w.

[4] Eating Disorder Statistics. (n.d.). The National Association of Anorexia Nervosa and Associated Disorders. Retrieved from: https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/.

[5] Ernhout, C., Babington, P., & Childs, M. (n.d.). What’s the relationship? Non-suicidal self-injury and eating disorders. Cornell Research Program on Self-Injury and Recovery. Retrieved from: http://www.selfinjury.bctr.cornell.edu/perch/resources/whats-the-relationship-nssi-and-ed-1.pdf.

[6] Whitlock, J., Muehlenkamp, J., Eckenrode, J., Baral Abrams, G., Barreira, P., & Kress, V. (2012, Dec. 4). Nonsuicidal self-injury as a gateway to suicide in young adults. Journal of Adolescent Health. 52(4): 486-492. Retrieved from: https://www.jahonline.org/article/S1054-139X(12)00405-3/fulltext.

About Timberline Knolls

Timberline Knolls BannerAt Timberline Knolls Residential Treatment Center, located outside of Chicago, Illinois, we provide specialized care for women and girls who are living with mental health disorders. Our private facility offers female-only treatment programs for eating disorders, addiction, and a range of mental health conditions. We work closely with each person to develop treatment goals to maximize strengths while focusing on individual needs. Our treatment team understands that each woman has unique needs and that she must play a role in her journey to wellness.

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 a 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 August 11, 2021. Published on EatingDisorderHope.com
Reviewed & Approved on August 11, 2021 by Jacquelyn Ekern, MS, LPC