Eating Disorders and Self Injury 

By Dena Cabrera, Psy.D. Remuda Ranch, Programs 
for Eating and Anxiety Disorders

=At Remuda Ranch, we have treated eating disorders for more than 20 years. In addition to anorexia or bulimia, the vast majority of patients usually struggle with anxiety or depression. However, during the past five years, we have experienced an alarming increase in self-harm among our patients. Approximately 40 to 50 percent of our women and girls have either reported a history of self-injury or are presently engaging in these behaviors. This includes everything from scratching and biting, to head banging and burning. Far and away, the most common form of self injury is cutting. This can be done with knives, razors, glass, or in the case of desert dwellers, cactus needles.

Naturally, the question remains: "why?" Why would anyone intentionally injure and inflict pain on their own body? Although this type of behavior is unfathomable to most people, it makes complete sense to the woman or girl practicing it. Not unlike the eating disorder, self-harm serves a very real purpose in the individual’s life, usually as a coping mechanism. In effect, cutting becomes an immediate, unhealthy response to an uncomfortable situation or unpleasant emotion.

The reasons for cutting are many and varied; they can fall into one or more of the following categories:

Diversion: the act of self-harm can produce a trance-like state. This allows the individual to avoid unpleasant feelings, emotions or suicidal thoughts.

Attention: Most of those who harm their bodies do it in areas that will not be seen: the inside of the thighs or upper arms, the lower abdomen, even the breasts. However, if the result of the action is highly visible, then it is probably a bid for attention or cry for help.

Stimulation: sometimes people cause pain to reassure themselves that they are "still here." They need to feel their own bodies in order to reground themselves in reality.

Emotional Release: the cutting behavior allows an outlet for feelings of guilt, shame, weakness, or anger.

Relaxation: a person can actually find the cutting behavior to be stress-reducing and soothing. She can feel pleasure from the warmth of the blood and the sensation of pain.

Social Motives: many of those who have anorexia perceive themselves as strong because they have "conquered" the need for food. Similarly, cutters may view their action as one of great strength and believe it makes them appear powerful.

Alteration: for a variety of reasons, a woman or girl may want to cause her body to be unattractive to others through scarring.

Self-harm is not confined to the eating disorder population. Cutting is on the rise throughout our country, especially in teenage girls. This behavior is in no way taboo. It has become acceptable in our society and such practices are not uncommon in our schools. Recently, certain celebrities have openly discussed their history with cutting, further legitimizing the behavior.

As in the eating disorder population, cutting is a method of emotion regulation and used as a way to cope with painful thoughts or feelings. Adolescent girls are under a tremendous amount of pressure today, especially in the area of appearance. They feel they must have a certain "look" to be popular in school or even successful in life. Add to that pressure the normal angst of adolescence, stress over grades, or problems at home, and she is a pressure cooker of emotion. If this adolescent has never developed healthy coping strategies, she may consider cutting herself to achieve some relief. The problem is: it works. While engaging in the behavior, her attention is diverted from all of her problems; she is completely focused on the experience; and in some strange way, she feels powerful and in control. The additional problem is that cutting is often an addictive behavior because the relief is only temporary. People who cut come to believe that they cannot cope without it.

Self-harm is often the result of trauma, especially sexual. If a young girl experienced something traumatic such as divorce in the family, she may incorrectly conclude that the fault was hers. She may believe she is "bad" and needs to be punished; she deserves the pain that cutting inflicts. In the case of sexual abuse, she may think that her own body was the cause of the rape or molestation, so it must be punished. Or, fearing that such an assault might happen again, she mutilates her body to ensure its unattractiveness.

Whether an adolescent cuts herself to get attention, or to reduce anxiety, this is a very serious problem. Dealing with it effectively is not as easy as eliminating sharp objects from the home; professional help is required. This person needs to learn life-management skills, which will not only help her identify emotions, but discover how to cope with them appropriately. If you are a teacher, school counselor, or parent and know someone who is intentionally hurting herself, please get help immediately.