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J Eat Disord. 2018 Oct 3;6:26. doi: 10.1186/s40337-018-0214-2. eCollection 2018.

Self-injurious behaviour in patients with anorexia nervosa: a quantitative study.

Author information

Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
2Inholland University of Applied Sciences, Amsterdam, The Netherlands.
Intensive Treatment Centre, Fivoor, The Hague, The Netherlands.
Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
5Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands.
6Department of Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.
Rivierduinen Eating disorders Ursula, Rivierduinen, Leiden, The Netherlands.
9Institute of Psychology, Leiden University, Leiden, the Netherlands.
10Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
11Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Clinical Psychology, Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.
13Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.
14Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
15Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Parnassia Psychiatric Institute, The Hague, The Netherlands.
GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands.



Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136).


A cross-sectional design using a self-report questionnaire. Mann-Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests.


Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts.


Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.


Anorexia nervosa; Feeding and eating disorders; Self-harm; Self-injurious behaviour

Conflict of interest statement

The study was approved by the research committee at Altrecht Eating Disorders Rintveld, Zeist, The Netherlands [protocol number 1140], in accordance both with the declaration of Helsinki and with the Dutch legislation regarding medical research in health care. All participants voluntarily agreed to participate in the study and gave their written informed consent. Written informed consent for participants aged younger than 18 years was also given by their parents.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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