Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed

Kathryn R. Fox, Shirley B. Wang, Chelsea Boccagno, Ann F. Haynos, Evan Kleiman, Jill M. Hooley

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective: Eating disordered (ED) behaviors (i.e., binge eating, compensatory behaviors, restrictive eating) and nonsuicidal self-injury (NSSI; intentional and nonsuicidal self-harm) are highly comorbid and share several similarities, including consequent pain and physical damage. However, whereas NSSI is considered direct self-harm, ED behaviors are considered indirect self-harm. These distinctions stem from theoretical understanding that NSSI is enacted to cause physical harm in the moment, whereas ED behaviors are enacted for other reasons, with consequent physical harm occurring downstream of the behaviors. We sought to build on these theoretically informed classifications by assessing a range of self-harming intentions across NSSI and ED behaviors. Method: Study recruitment was conducted via online forums. After screening for inclusion criteria, 151 adults reported on their intent to and knowledge of causing physical harm in the short- and long-term and suicide and death related cognitions and intentions when engaging in NSSI and specific ED behaviors. Results: Participants reported engaging in ED and NSSI behaviors with intent to hurt themselves physically in the moment and long-term, alongside thoughts of suicide, and with some hope and knowledge of dying sooner due to these behaviors. Distinctions across behaviors also emerged. Participants reported greater intent to cause physical harm in the moment via NSSI and in the long-run via restrictive eating. NSSI and restrictive eating were associated with stronger endorsement of most suicide and death-related intentions than binge eating or compensatory behaviors. Conclusions: Findings shed light on classification of self-harming behaviors, casting doubt that firm boundaries differentiate direct and indirectly self-harming behaviors.

Original languageEnglish (US)
Pages (from-to)564-575
Number of pages12
JournalInternational Journal of Eating Disorders
Issue number5
StatePublished - May 2019

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health


  • binge eating
  • direct self-harm
  • eating disorder
  • indirect selfharm
  • nonsuicidal self-injury
  • purging
  • restrictive eating
  • suicide


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