Fighting Bulimia and Eating Disorders

Drunkorexia

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A new buzz word in the world of eating disorders is drunkorexia. This is not an official medical term; instead, it’s media shorthand for anorexia or bulimia combined with alcohol abuse. Typically, it is used to describe a young college-age woman who starves herself throughout the day to avoid calories, then goes out at night and drinks to excess.

The name is somewhat of a misnomer because it implies that alcohol abuse is strongly tied to anorexia, not bulimia. However, this is not the case. A woman with anorexia tends to avoid alcohol consumption altogether, due to its high caloric content. Another reason for avoidance is that someone with anorexia is afraid the alcohol will make her lose control, which will then cause her to eat. On occasion, a woman with anorexia may intentionally have a drink in order to counteract anxiety. This anxiety often revolves around thoughts of eating, especially in the company of others. Instead of alcohol, those with anorexia are far more likely to turn to drugs such as cocaine and methamphetamine, which provide energy and suppress appetite. Other drugs of choice include nicotine and caffeine; similarly, these substances are used for energy and to stave off hunger.

A woman with bulimia is much more likely to fall into the category of drunkorexia. In fact, alcohol may figure prominently in her binge-purge cycle. In addition to eating huge quantities of food, she imbibes excessively. Not only does she experience the mood altering effects of alcohol, but the large amount of liquid helps her in the purge process. After purging, it is not unusual for her to drink even more, in order to sustain feelings of intoxication. In a minority of cases, alcohol may be the only calories she consumes in a day. This is not beneficial to her body, since alcohol consists of “empty” calories, meaning there is little, if any, nutritive value. She may maintain a desired weight in this manner, but will also suffer malnutrition in the process.

Either way, when substance abuse occurs among those with anorexia or bulimia, it exacerbates a situation that is already extremely dangerous, and can be, deadly.

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Pregorexia

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There are many things a mother-to-be can do to maximize the possibility of having a problem-free pregnancy, a healthy baby and positive birth experience. Regular, moderate exercise is one of them. When an expectant mother exercises, her heart rate increases, as does her baby’s. It’s as if the baby inside her body is also getting a mini work-out. Throughout her pregnancy, she receives all the health benefits of any exercise regimen, including increased energy, muscle tone and strength, and better, more restful sleep. At the conclusion of her pregnancy, a woman who remains active will enjoy an easier labor and delivery. Her newborn will also experience trickle-down health benefits from the mother’s activity, such as a higher IQ. What’s more, by remaining active, it will be easier to shed any residual pregnancy pounds. When exercise is moderate, and done under a doctor’s supervision and care, it is extremely positive for all involved.

Unfortunately, with society’s obsession with remaining thin, some women have taken exercise to an extreme, even while pregnant. The media term for this is “pregorexia.” This is when a pregnant woman consistently exercises to an unhealthy degree; when in fact, she is far more concerned with weight than health. This is highly individualized; in other words, what is considered excessive for one woman does not hold true across the board. However, if a woman is routinely exercising to the point of exhaustion, this should be considered a red flag. To make matters worse, this inordinate focus on weight gain often extends to her diet, as well. She may take in far fewer calories than her body requires, possibly causing risk to her unborn baby, in the form of lower birth weight, birth defects and growth retardation. However, by restricting calories, she is even more likely to cause harm to herself. You see, the first priority where a pregnancy is concerned, is the baby. For example, if calcium appears to be in short supply, the growing baby will get what’s available, while the mother goes without. By cutting back, or eliminating calcium-rich products altogether, the mother may experience osteoporosis far earlier than she should.

What is causing pregorexia? A couple of factors. First, as mentioned, America is utterly obsessed with thinness, witness the fact that ten million women and girls currently have eating disorders. Now, add to that, our fascination with celebrities, mostly actresses and models, many of whom seem to be having babies lately. And the truth is, these beautiful people, go right on looking amazing during their pregnancies. It only gets worse after they deliver; within about an hour of having a baby, these women look splendid – back in their tight pre-baby clothes. Of course, few expectant or new mothers gazing at the photos of these new moms in glossy magazines keep in mind that the pictures are probably altered to make the celebrity appear far better – and thinner — than she really is.

So … women throughout America say to themselves: if they can do it, so can I. But the problem is, they can’t, simply because they live real lives. Normal, everyday women have jobs, families, other children; they have to drop the little one off at kindergarten, take another to the dentist, they have to pick up dry cleaning and make sure homework is done. Even if it is a first pregnancy, normal women in today’s society have a lot of responsibilities, undoubtedly including a job. What’s more, average women do not have full-time nannies for other children, daily personal trainers or live-in chefs. In short, average women do not have unlimited amounts of money to spend on their personal appearance, pregnancy or no. Therefore, trying to fashion themselves after celebrities is not only unrealistic it is unfair. These women are setting themselves up to fail and ultimately feel badly about themselves.

If you are pregnant … rejoice! Eat well, remain fit, gain a healthy amount of weight and see your primary care physician regularly. Do not compare yourselves to others, especially those you see in magazines. Instead, focus on the blessing of the healthy baby that is soon to be a wonderful addition to your life.

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Anorexia Tests

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Anorexia nervosa is a disease; however, unlike many other conditions such as leukemia, HIV, or kidney disease, there is no blood test available to detect its presence in the human body. One diagnostic tool often used by physicians and dieticians is the SCOFF screen, which asks the following questions:

1. Do you make yourself sick because you feel uncomfortably full?

2. Do you worry you have lost control over how much you eat?

3. Have you recently lost more than 15 pounds in a three-month period?

4. Do you believe yourself to be fat when others say you are too thin?

5. Would you say that food dominates your life?

A “yes” answer to two or more of these questions indicates an eating disorder may be present.

Keeping the above in mind, there is much that can be done to discover whether or not a family member has anorexia. Observation is the first line of defense for any parent. If an adolescent is losing a great deal of weight, or a young child is failing to gain weight at an expected rate, something is probably wrong, especially if she has body image issues or possesses a genuine fear of gaining weight. Other observable signs along the mental-health line are anxiety, depression, or inability to concentrate. At the very least, these children should be seen by the family doctor or a primary care provider. If other medical conditions are ruled out, anorexia should be considered. Remember, children as young as six are currently being diagnosed with eating disorders.

It is important to detect changes in diet and eating habits. This extends to breakfast, snacks, and most importantly, dinner. Most parents already know how key it is for a family to share dinner together, simply as a bonding or catching-up time with one another. Dinnertime is also an opportunity to watch a child eat. When we say eat, we mean the food needs to actually be consumed. A common anorexia behavior is the ability to not eat, while all the time making others think the opposite. A standard technique is to slip food to the family pet, or hide it in a napkin, to be thrown away later. Often, food is pushed around on the plate, to make it appear as though there is less of it at the end of the meal.

If anorexia is suspected, communication is a good place to start. Talk with the young child or adolescent about general subjects such as school, sports, or friends. These conversations may lead to related topics that may elicit more insight regarding feelings and emotions. Do not expect the child to admit to having an eating disorder, because the truth is, they rarely do. This is not a privacy issue, it is the secrecy and deception that is part of the disease. In some cases, the child may be forthcoming and agree to change her behaviors regarding food, get back on the right track and take better care of her health; but again, probably not.

Professional treatment is often required with anorexia. Many people find a good outpatient therapist and are able to engage in counseling while still at home. However, if real change isn’t seen in a reasonable amount of time, inpatient treatment is recommended. Since 1990, Remuda Programs for Eating Disorders has treated nearly 8,000 women and girls. Remuda offers three distinct programs for children, adolescent girls, and adults. Remuda has an unparalleled recovery rate of 95% over one, five, and ten years.

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Orthorexia

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Eating healthy foods is certainly beneficial, especially these days when fast food and junk food are the norm for so many individuals and families. However, it is possible to overdo a good thing, even in this arena. Some people have succumbed to an eating disorder sometimes referred to as orthorexia. This is when an individual is completely obsessed with healthy foods; indeed, orthorexia nervosa is considered by some authorities to be a medical condition in which the sufferer systematically avoids specific foods in the belief that they are harmful.

As with any obsessive behavior, the problem stems from a complete preoccupation with one thing to the exclusion of everything else. Those with orthorexia spend shocking amounts of time on ensuring what they consider to be a healthy diet.

Orthorexics are consumed by a need to eliminate “bad” foods from their diets. This desire to be as healthy as possible starts innocently enough. They may initially cut out “white” products: sugar, bleached flour, rice. But they don’t stop there, and perhaps all processed foods are the next to go. The problem is, anyone looking hard enough, can and will find fault with every food. Slowly, the list of “good” foods becomes more and more limited. In turn, someone with orthorexia must spend inordinate amounts of time researching food products, then planning and preparing their own meals. Indeed, this focus becomes so time and labor intensive that it starts cutting into the time normally spent at work, leisure pursuits, and time traditionally reserved for friends and family. This obsession with dietary rules and restrictions truly takes over their lives.

If you think you might be heading in this direction, consider the following questions:

1. Are you obsessed with maintaining a healthy weight?
2. Does food preparation and planning occupy a disproportionate amount of your time?
3. Do you feel isolated from your friends and family by your dietary requirements?
4. Have friends or loved ones suggested that your interest in healthy eating has become an obsession?

Answering “yes” to any or all of the above questions should be considered a red flag. You might want to consult a health professional, such as a dietitian or primary care provider for help and guidance. Food, like all things, should simply be an aspect of life, not the exclusive focus of any life.

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Eating Disorders In Boys: What Parents Should Know

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It seems that the answer to the following question should be so obvious: Who gets eating disorders? Women and girls, right? Actually … yes, but… More and more, boys are at risk for these disorders as well. Today, anorexia, bulimia, and especially, binge-eating disorder are on the rise in the male population.

What most parents want to know, regardless of gender, is “Why?” To a large degree, the cultural pressure that has been placed on girls for decades to be perfect in achievement and appearance has now been extended to boys. With females, perfection usually translates to “thin,” whereas with boys, thin is joined by lean, muscular, and possessing a masculine physique, as the key set of issues. This insidious message is far more pervasive than a parent might think.

Take male action figures – a multi-million dollar industry in the US. In essence, action toys are to boys what Barbie is to girls. Studies reveal that over recent decades, these action figures have transformed into completely unrealistic shapes. Either they resemble the physiques of advanced bodybuilders, or they display a body that is not even humanly obtainable, especially in the area of the chest and shoulders. Only through extreme steroid abuse could any “real” person even come vaguely close to replicating these distorted figures. Yet, just as some little girls want to grow up and look like Barbie, some little boys want to become big and strong, just like the toys they play with everyday.

Anorexia is diagnosed in boys as young as eight, with an average age of onset between 12 and 14. Often the eating disorder is driven by an obsession with fitness. Either the boy is involved in sports, and sees weight loss as beneficial to performance, or he is not engaged in sports, but wants to be, and views weight loss as the key. Either way, he eats less and less, while increasing his level of daily exercise. Initially, this behavior often appears positive to parents – their son is taking care of his body, getting in shape. The problem is that anorexia is an addictive behavior. As difficult as it is for a parent to imagine, starvation can become an addiction—one that is extremely hard to break.

Body image and appearance are not the only motivating factors for boys with anorexia. As with their female counterparts, extreme weight loss in boys can be a way to exert control in a chaotic world, shift the focus of the family, or serve as a mask for their troubled emotional state.

Interestingly, boys are highly influenced by health-related concerns. Whereas a girl may engage in an eating disorder because her mother is overweight and she does not want to follow in her footsteps, a boy is more likely to do so because his father is ill. Say a father is obese and has diabetes. The fact that the father is fat doesn’t necessarily trouble the boy; but the fact that he is sick does. The boy may say to himself, “that will never happen to me,” then embark on a habit of dietary restricting.

Bulimia and binge-eating disorder, or BED, usually manifest in boys when they are well into their teens. With the former, they engage in compensatory behavior such as vomiting or extreme exercise; with the latter, they do not. With both, enormous quantities of food are consumed at one time, usually two to three times a week. This type of inordinate food consumption is in no way related to physiological hunger; instead, it is tied to emotions. Food is used as a distraction, or a method to cope with unpleasant emotions such as anxiety, depression, loneliness, or anger. Boys, in effect, find solace or comfort in food.

So … what is a parent to do? Perhaps the most important thing to do is simply observe your son. As a boy ages, he should grow. Weight gain, along with increased height, are natural and normal. If he suddenly becomes overly finicky about what he will or won’t eat and starts losing weight, you should be concerned. This is particularly true if he is simultaneously increasing his activity level and becoming compulsive about the need to exercise. In the case of bulimia or BED, other behavioral changes, especially regarding food, should be noted. And though a standard perception of teenage boys is that they always eat you out of house and home, this is different. If a boy is eating in secret, eating a large amount of food in a seemingly uncontrolled fashion, even stealing food, something is probably amiss. If a boy is involved in these types of behaviors, it’s time to take a closer look at how he is doing in school, his grades, his friendships, his mood and general attitude.

In short, it is important for parents to know that eating disorders can occur in sons, as well as daughters. But it is equally important to know that help and healing are available.

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Tips for Healthy Eating

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What is healthy eating? Our culture’s diet craze is now a multi-billion-dollar-a-year industry that leaves the public reeling with facts and myths to sort through. As an antidote to this confusion, following is a list of tips for healthy eating. * Listen to your body. Eat when you’re hungry, stop when you’re full.

* Balance: Balance means that most of the time you eat because you’re hungry and use food as fuel for your body. But it also means that sometimes you eat simply when the food appeals to you or when it is appropriate in a social setting (e.g., popcorn at the movies), allowing yourself to eat for enjoyment. Such balance provides both physical satisfaction and decreases the likelihood of overeating certain foods due to a feeling of deprivation or denial. There are both physiological and psychological factors in our food/eating choices. With balance, we honor both.

* Variety: Choose foods from a variety of sources. The USDA Food Guide Pyramid provides a structure for determining the number of servings from each food group that will provide the best variety. Eat different foods every day.

* Moderation: Portion size is key. Most restaurants aim to please by offering great value through large portions. Just because you are given a large portion doesn’t mean you have to eat it all! Take some home for later. Consult the Food Guide Pyramid for examples of serving sizes until you can gauge an appropriate serving size for yourself by listening to your body.

* Drink plenty of water. Eight 8 ounce glasses of water is a good daily average.

* Aim for 3 meals and 1 to 3 snacks a day. The idea that snacking between meals is bad is a thing of the past. By eating every 2 to 4 hours, you prevent your body from getting overly hungry—which could set you up to overeat later. Plus, the body uses the fuel from food very efficiently when you’re eating smaller amounts more frequently throughout the day. This means that your metabolism is revved up and running at full speed, which reduces the likelihood of calories being stored as fat.

* Avoid radical and fad diets. Fad diets and yo-yo weight patterns only make your body work harder to maintain homeostasis. Weight fluctuations may increase your body’s “set-point”—the weight at which your body wants to stay. Bottom line: eat normally, exercise moderately, and let your body weigh what it wants.

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Eating Disorders: An Introduction

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A 7 year-old in Denver cries every night because she thinks she has the fattest thighs in her class. Hundreds of Esquire’s readers report that they would rather get run over by a truck than be overweight. The media drown us with images of inhumanly thin women whose bodies have been stretched using computer graphics programs or created from the heads, thighs, and breasts of several women combined into one. Is it any wonder that eating disorders affect 7 million women and 1 million men in the US?

What Are Eating Disorders? Eating disorders include anorexia and bulimia nervosa and binge-eating disorder. People with anorexia starve themselves to dangerously thin levels, at least 15% below their appropriate weight. People with bulimia binge uncontrollably on large amounts of food—sometimes thousands of calories at a time—and then purge the calories out of their bodies through vomiting, starving, excessive exercise, laxatives, or other methods. People with binge-eating disorder eat uncontrollably, but they do not purge the calories.

Eating disorders are serious illnesses. The malnourishment of both anorexia and bulimia affects the body rapidly and can lead to hypoglycemia, pancreatitis, enlargement of the heart, heart attacks, congestive heart failure, permanent brain shrinkage with loss of memory and IQ, infertility, and osteoporosis. It is not uncommon for a teenage girl with anorexia to have the bones of an 80 year-old woman. The condition is not reversible. Ultimately, approximately 6% of people with anorexia and1% with bulimia will die from their eating disorder.

How Common Are They? Estimates indicate that 1/3 of American women and 15% of men will have an eating disorder or related problem at some time in their lives. 50 years ago, eating disorders were practically unheard of. So what happened?

What Causes Them? Research suggests a strong genetic component to eating disorders. People who are genetically prone to perfectionism and low self-esteem may be most at risk. But since the human genome has barely changed in the past 50 years, genes cannot explain the recent increase in eating disorders. Something in our modern environment has triggered our ancient genes. Most authorities believe that media influences form a significant part of this modern-day trigger. Media images have equated thinness with beauty, peer acceptance, sexual and financial success, self-esteem, morality, and health. The cultural pressures for young people to obtain and maintain super-thin bodies are extreme.

In this environment, thinness readily becomes a way of dealing with many emotional issues. The imagined antidote to the common problems of young people—such as low self-esteem, feelings of victimization or disempowerment, or an uncertain identity—is the perfect body. Unfortunately, the “solution” fails to correct the problem, and brings more problems of its own.

How Can They Be Treated? Because eating disorders are multi-faceted illnesses, treatment should occur by a team of providers, including a primary care physician, counselor, and dietitian. Sometimes a psychiatrist is needed. A thorough assessment helps to determine which of the following issues require attention:

1. Physiology: Biochemistry can be off balance due to genetics, starvation, or other factors. Proper nutrition is the first line of treatment. Medications may be needed to treat related conditions (e.g., hormone replacement therapy or anti-depressants).

2. Emotions: Many people with eating disorders use their disorder to regulate intense negative feelings such as anger, shame, and self-hatred. Emotion regulation skills, such as those in Dialectical Behavior Therapy, are excellent treatment tools.

3. Distorted Thoughts: Most people with eating disorders view their bodies inaccurately, placing inordinate value on appearance. Cognitive restructuring is essential to deal with their dysfunctional beliefs and thoughts.

4. Motivation: Work with eating disorder patients should be tailored to their motivational level, so that they are actively choosing treatment. Motivational Interviewing may be needed to assess motivation and to help patients actively embrace recovery.

5. Skills: Eating disorders are unhealthy, irrational ways of obtaining rational goals. One must validate the underlying needs that eating disorders serve—such as the needs for love and acceptance—while helping patients to understand that they have chosen destructive methods to meet these legitimate goals. Providers can teach new skills and tools through which patients may meet their needs more effectively.

6. Social Context: Because the environment can be unfriendly and difficult, patients must learn to deal with the environment more assertively and to protect themselves in healthier ways. Because some patients have been deeply wounded by others, it is important to begin the forgiveness process. Marital or family therapy may be needed to change the systemic relationship patterns that sustain eating disorders.

7. Spirituality: Patients must learn to take responsibility for their lives rather than continue in the victim role. It makes no sense to blame anyone for the eating disorder; it does make sense to emphasize personal responsibility for recovery. Also needed is a transformation from a worldview in which self-worth comes from appearance or achievement to one that values people as unique individuals. A person’s faith often helps in this spiritual transformation.

Is Treatment Effective? Outcome studies suggest that treatment promotes adequate recovery in 75% of patients with eating disorders. Some treatment programs report even higher recovery rates. Recovery expectations have increased in the past 20 years, as the field learns more and improves its treatment methods. Overall, there is much hope for people with eating disorders.

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Diabetes and Eating Disorders

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Today, millions of women and girls throughout the United States are starving themselves, exercising to an excessive degree, or spending huge amounts of money to take part in the latest diet craze. All this with one goal in mind: to be thin. However, another group of people, equally driven by the desire to shed pounds, have discovered a different way. Some individuals with Type I diabetes have found they can have a skinny body without cutting back on calories, running a single mile, or spending a dime. By reducing their insulin intake, this goal can be achieved without the efforts of dieting and exercise. This practice is commonly referred to as diabulimia.

But though a waif-like body may result, the price is huge and the price is often permanent, frequently paid in the form of disability or death.

By definition, diabetes is very taxing on a person’s body, especially the eyes, nerves, and kidneys. In fact, the leading cause of blindness in the US is diabetes. Yet, with good medical care, healthy diet and reasonable exercise, Type I diabetics can live long and healthy lives… unless an eating disorder is added to the equation. Unfortunately, far too many adolescents in particular use insulin manipulation as a form of weight control. Whereas a young woman with bulimia might purge through vomiting or excessive exercise, a diabetic purges by under dosing insulin, which causes sugar to be eliminated from her body via urine.

The combination of the two isn’t just unhealthy, it is often lethal. When anorexia is present, the mortality rate for these young women escalates to 35%. Perhaps even worse than the heightened death rate is the escalation of medical complications such as vision loss and kidney failure. What a diabetic woman might expect to experience in 15 to 20, even 30, years, she is accelerating to five to seven years. This means if a Type I diabetic begins insulin manipulation at the age of 17, she could be totally blind, suffering from extreme nerve pain, or on a kidney-transplant list by her mid 20s. To say nothing of the fact that her ability to have children may be permanently compromised. No wonder this is considered by the health profession to be the worst possible combination, Type I diabetes plus an eating disorder.

What can be done? A lot. If you or someone you know is manipulating insulin as a method of weight control, professional help must be sought immediately. Damage does not have to be permanent, but rarely can a good outcome be accomplished without medical intervention. If you are a parent of a diabetic child and you think this behavior may be occurring, you must take action. Do not expect your daughter to be honest when questioned. Deception is part of eating disorders. Rather, take note of such things as her insulin. Does she seem to be using less, or have you seemingly had to purchase fewer bottles lately? Check her blood sugar yourself, and if possible, examine the sugar log on her glucometer. Get to her physician for a Hemoglobin A1C —- often this number will be very revealing in terms of possible long-term under dosing. Remember, the earlier you get help, the greater the possibility for a positive outcome.

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Pregnancy and Eating Disorders

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It is hard to imagine two medical conditions that are seemingly more diametrically opposed: eating disorders and pregnancy. While one condition is concerned with bringing a new life into the world, the other is focused on the damage or outright destruction of a current life. Though seemingly at odds, this situation does occur.

Because anorexia centers on starvation, the woman’s body usually shuts down the reproductive function. Indeed, one of the primary physical indicators of anorexia is amenorrhea, which is the discontinuation of the menstrual cycle. This is why many women going to fertility clinics right now are either actively anorexic, or have been previously involved in the behavior. Unfortunately, the doctors do not always ask questions about weight, eating habits or exercise history. Ovulation can be induced and pregnancy can occur. With these women, the odds aren’t good. There is a higher miscarriage rate than in the general population, 38% vs. 16%. If the pregnancy continues, often there is poor fetal growth, especially in the third trimester. The baby’s health can certainly be compromised, as can the mother’s. When it comes to reproduction, the female body provides for the baby first. This means that any available nutrition will go to the child, causing the mother’s body to suffer even greater depletion.

For those women who have actually recovered from anorexia, pregnancy can trigger relapse. This can be do to weight gain, the out-of-control nature of the changes that are occurring, or insensitive remarks made by those around her regarding her growing body.

Different from anorexia, bulimia focuses on consuming huge quantities of food, then purging the food from the system, usually by vomiting. These women often use diet products, laxatives and diuretics to an excessive degree. Unlike anorexia, it is difficult to tell exactly who suffers from this disorder by simply looking; this is because these women maintain an average, or even above average, weight. This is important because, despite the fact that menstrual periods may be irregular, they can achieve pregnancy at any time. A full 75% of pregnancies occurring in women with bulimia are unplanned and the rate of early miscarriage is two-and-a-half times higher than with healthy women. A woman could easily still be abusing substances far into a pregnancy without even knowing she was carrying a child. Fortunately, studies show that those with bulimia do tend to binge and purge less often when pregnant and abuse substances less frequently.

Certain obstetrical complications are common to both disorders. Pre-term delivery is 70% higher in eating-disordered mothers and their babies are at twice the risk of having a low birth rate. In addition, there is a heightened risk of still births, breech presentation, and congenital malformation. The baby’s health immediately after birth, as indicated by the APGAR scores, is not as positive as babies born to healthy women.

Once no longer pregnant, the incident of postpartum depression is significant: 60% for those with bulimia; 40% for those with anorexia. Compared to the general population where this condition is experience by only 13-18% of women, these numbers are very high.

The truth is if a woman continues to practice eating-disordered behaviors throughout a pregnancy, it can be very harmful to both her and her child. However, if she can eat well and gain normal weight, the heightened risk of pregnancy complications or birth defects will be negated.

In fact, if she can concentrate on the health of her developing infant and the subsequent desire to be the best mother she can be for her new baby, a woman may discover a new commitment to recovery.

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Self-Injury and Eating Disorders

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Self-injury, particularly cutting on oneself, is becoming more prevalent in the US, especially in those with eating disorders.

Self-injury is when individuals cause physical harm to themselves on a repetitive basis, without suicidal intent. In terms of a psychiatric diagnosis, it falls under the realm of an impulse control disorder. Although cutting is perhaps the most common form of self-injury, self-injury takes a variety of other forms, including head banging, skin picking, biting, repetitious rubbing or scratching, hitting, or burning with anything from a cigarette lighter to a curling iron. Typically, the injury is caused on the arms or legs, even though other body parts can be targeted.

Certainly, the most commonly posed question is “why?” As with most psychiatric illnesses, the behaviors involved with the disorder are mystifying to those who see them happening and often to those who engage in them as well.

Although eating disorders and impulse control disorder are completely separate from one another, they often manifest together. In fact, at Remuda Programs for Eating Disorders, a full 50% of our patients engage in self-injury. The “why” usually falls into one of a few categories. Self-Punishment

The need to punish oneself is usually connected to feelings of great shame and inadequacy. The person feels that she doesn’t do things well enough. The focus is sometimes the eating disorder itself. She feels she hasn’t displayed enough discipline and should be “better” at being bulimic or anorexic. This shame leads to anger at oneself, which leads to a need for self-punishment, often expressed through self-harm. Diversion/Distraction

If an individual also suffers with Post Traumatic Stress Syndrome, she might find herself thinking about or remembering things that were highly traumatic. In order to return to the here and now and reground in the present, she may self-injure. The pain will distract her from thoughts or emotions that are deemed even more painful. Relaxation

Strange as this may seem, self-injury can have a relaxing quality for the person; this is physiological in nature. The brain releases chemicals to combat the pain caused by the self-injury. These chemicals are soothing in nature. The person’s tension and stress level are reduced.

In trying to understand self-injury or endeavoring to deal with a person who engages in the behavior, it is important to remember that a person self-injures because it works. Cutting, burning, or biting actually serves a true purpose, a real function in their life. They usually do not do it for attention, or because it is the “in” thing to do – they do it because it helps them feel better. Often, it provides release, allows the person to feel calm and less anxious. And because it works, there is an addictive quality to it. The behavior can be eliminated, but it must be replaced with a different, healthier, behavior.

Self injury can be an extremely complex issue; therefore, professional help is definitely recommended.

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