On international Self Injury Awareness Day, Alison Hudson, manager of Care UK’s self harm services at Newcombe Lodge and Bisley Lodge in Stroud, looks at the similarities and differences between self harm and eating disorders.
Self harm and eating disorders are, in many ways, two sides of the same coin. They’re both forms of self injury, but one is visible while the other is turned inwards. The two are closely interlinked, a fact that’s illustrated in the way our Stroud self harm service at Newcombe Lodge and Bisley Lodge grew out of our nearby eating disorder services at Althea Park House and Ashleigh House.
Today, at the Newcombe Lodge and Bisley Lodge service we find that anything from 25-50% of the people we care for have a diagnosed eating disorder and also self harm. A number of others will have ‘disordered eating’ but no diagnosed eating disorder.
How do the two issues differ?
Background and causes:
Some of the differences are that the young people who come to us who self harm and have an eating disorder often come from a hospital setting and are likely to have been in the system longer than those whose main diagnosis is self harm. Those with eating disorders are more likely to be perfectionists and their disorder may be triggered by a range of stresses. With self harm the background issue is predominantly abuse and neglect, and the reasons why they self harm will be shame-based. Self harm becomes their way of coping and reflects their self-worth.
Young people who self harm tend to be louder and more expressive. They’re chaotic and want everyone to know they’re not okay. Although they may hide their cuts in the community, here they want them to be visible. They’re proof of how sad they’re feeling. Those who self harm are less likely to attend therapy – in fact it might take months to get them into the therapy room as it’s easier for them not to face their experiences.
A young person with an eating disorder is generally quieter and more introverted. Their eating disorder makes them more secretive. Their more perfectionistic tendencies will mean they’ll be more compliant with schooling and therapy than those who only self harm. However, there’s nothing to show that their recovery will be faster or more comprehensive as a result.
Why does a person ‘choose’ one type of self injury over another?
Self harm is often a result of ‘nurture’ – it’s a learned method of self injury. A person may have seen a parent do it, they may have heard about it (or been in a secure unit where they saw it happening). They may have injured themselves as child and got a good response compared to how they were treated the rest of time when they needed attention. Over time they may even adapt their self harming if their family becomes ‘used to’ this behaviour, or if typical objects used for self harming are taken away from them.
In contrast, eating disorders are increasingly being seen as a result of ‘nature’, of a genetic disorder of the brain that you’re born with, rather than something you adopt as a learned experience. Our own Medical Director, Bryan Lask, is one of the leading names in research into this area. Find out more.
Why are girls more likely to self harm than boys?
Boys tend to find other self injurious ways to cope, including using drugs, alcohol, or violent behaviour. As a result, they’re more likely to end up in the justice system than in one of our services – but we do treat boys and young men from time to time. And that doesn’t mean girls haven’t tried different substances, but they may have seen loved ones abusing drugs and alcohol and chosen to avoid those methods.
Do you treat self harm and eating disorders differently?
The short answer is yes, we do.
The difference comes down to the level of tolerance we can show for the two different behaviours. You can’t allow a person with an eating disorder to continue starving themselves as this may have fatal consequences. You have to start them eating again.
However, and this does surprise some people initially, we do allow a young person to self injure in a controlled way (what we call ‘safe tolerance’). This is simply because if we were to stop them hurting themselves they would only get more creative in doing so, with potentially far more dangerous consequences. Experience, and psychology, has taught us that if they have a tiny item somewhere safe in their room that they know they could use if they needed to, the need isn’t so strong and they feel more in control, so they’re less likely to self harm.
The challenges of treating both issues
There are challenges with treating someone who has an eating disorder and self harms in a predominantly self harm-oriented service.
If someone self harms and has an eating disorder they don’t necessarily eat with the other young people in the service who often question why the person with the eating disorder is getting special treatment. Obviously the subject of eating is much more fraught for an ED sufferer than for someone who ‘only’ self harms and they’ll need in-depth support and attention at meal times from a member of staff.
Struggle between conditions:
If a person who has both issues gets their self harm under control, their eating disorder can become very bad. Luckily, we have staff here at Newcombe and Bisley Lodges who are experienced in working with young people with eating disorders, just as there are staff in our eating disorder services who are experienced in working with people who self harm.
However, the benefit of keeping someone who self harms and has an eating disorder here in our predominantly self harm-oriented service is that they’re less likely to feel the need to ‘compete’ with other ED sufferers than they might in an eating disorder-based unit.
If you’d like to know more about our self harm services please click here.