Self-injurious behavior in anorexia nervosa

J Nerv Ment Dis. 2000 Aug;188(8):537-42. doi: 10.1097/00005053-200008000-00010.


Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / diagnosis*
  • Anorexia Nervosa / epidemiology
  • Anorexia Nervosa / therapy
  • Attitude to Health
  • Bulimia / diagnosis
  • Bulimia / epidemiology
  • Bulimia / psychology
  • Cathartics / adverse effects
  • Child
  • Child Abuse, Sexual / psychology
  • Child Abuse, Sexual / statistics & numerical data
  • Cognitive Behavioral Therapy
  • Comorbidity
  • Compulsive Behavior / diagnosis
  • Compulsive Behavior / epidemiology
  • Diuretics / adverse effects
  • Female
  • Humans
  • Impulsive Behavior / diagnosis
  • Impulsive Behavior / epidemiology
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Dropouts
  • Personality Inventory / statistics & numerical data
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Self-Injurious Behavior / diagnosis*
  • Self-Injurious Behavior / epidemiology
  • Self-Injurious Behavior / therapy
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Vomiting / diagnosis
  • Vomiting / psychology


  • Cathartics
  • Diuretics