How Do Obsessive-Compulsive Symptoms Differ in Eating Disorder Patients With and Without Self-Harm?

What you need to know

• Patients with anorexia nervosa binge-eating/purging type and bulimia nervosa engage in self-harm more frequently than those with restrictive anorexia nervosa.
• Eating disorder patients who engage in self-harm show higher levels of obsessive-compulsive symptoms across all domains compared to those who do not self-harm.
• The presence of self-harm in eating disorder patients may indicate more severe obsessive-compulsive symptoms, requiring targeted treatment approaches.

Background on eating disorders, obsessive-compulsive symptoms, and self-harm

Eating disorders, obsessive-compulsive symptoms, and self-harm behaviors are often interconnected mental health issues. Eating disorders involve abnormal eating habits and extreme concern with body weight or shape. The main types are:

• Anorexia nervosa, restrictive type (AN-R): Severely limiting food intake
• Anorexia nervosa, binge-eating/purging type (AN-BP): Periods of food restriction alternating with binge eating and purging
• Bulimia nervosa (BN): Recurring episodes of binge eating followed by compensatory behaviors like vomiting

Obsessive-compulsive symptoms involve intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety. Common themes include contamination fears, checking behaviors, and need for symmetry/order.

Non-suicidal self-injury (NSSI) refers to deliberately harming one’s body without suicidal intent, such as cutting or burning oneself. It often serves as a way to cope with emotional pain or distress.

These conditions frequently co-occur and may share underlying factors related to difficulty regulating emotions and behaviors. Understanding their complex relationships can inform more effective treatments.

How the study was conducted

The researchers examined 429 female inpatients receiving treatment for eating disorders at a specialized clinic. Participants completed questionnaires assessing:

• Eating disorder diagnosis and symptoms
• Presence of recent (past month) and lifetime self-harm behaviors
• Obsessive-compulsive symptoms across five domains:
  1. Impulses (fear of losing control)
  2. Washing (contamination concerns)
  3. Checking behaviors
  4. Rumination (excessive worrying)
  5. Precision (need for exactness)

The study compared obsessive-compulsive symptoms between:

• Different eating disorder subtypes (AN-R, AN-BP, BN)
• Those with and without recent/lifetime self-harm

This allowed the researchers to examine how eating disorder type and presence of self-harm related to severity of obsessive-compulsive symptoms.

Key findings on self-harm prevalence

Self-harm was common among the eating disorder patients in this study:

• 31.9% engaged in self-harm in the past month
• 56.4% had a lifetime history of self-harm

Self-harm rates differed significantly between eating disorder subtypes:

• AN-BP and BN patients had higher rates of both recent and lifetime self-harm compared to AN-R patients
• For example, 40.5% of AN-BP and 41.1% of BN patients engaged in recent self-harm, compared to only 18.3% of AN-R patients

This aligns with previous research showing higher impulsivity in AN-BP and BN compared to the more restrictive AN-R subtype. The binge-eating and purging behaviors in AN-BP and BN may reflect broader difficulties with impulse control that also manifest as self-harm.

Obsessive-compulsive symptoms in different eating disorder subtypes

When comparing obsessive-compulsive symptoms across eating disorder subtypes, the main difference was in the “Impulses” domain:

• AN-BP patients scored significantly higher on Impulses compared to both AN-R and BN patients
• This domain reflects fears about losing control over one’s behavior

The eating disorder subtypes did not differ significantly on the other obsessive-compulsive symptom domains (Washing, Checking, Rumination, and Precision).

These findings suggest that fears about behavioral control may be especially pronounced in AN-BP. This could relate to the alternating restriction and binge-eating/purging cycles characteristic of this subtype.

Obsessive-compulsive symptoms in those with and without self-harm

The most striking findings related to differences between eating disorder patients who did versus did not engage in self-harm:

• Patients with both recent and lifetime self-harm scored significantly higher on all five obsessive-compulsive symptom domains compared to those without self-harm
• This held true even after controlling for age and body mass index

These results indicate that the presence of self-harm behaviors in eating disorder patients is associated with more severe obsessive-compulsive symptoms across the board. This suggests that self-harm may be a marker of greater overall symptom severity and complexity in eating disorders.

Implications for understanding and treating eating disorders

The study findings have several important implications:

1. Screening for self-harm is crucial in eating disorder patients, as it may indicate more severe obsessive-compulsive symptoms requiring targeted intervention.

2. The high rates of self-harm in AN-BP and BN highlight the need to address impulse control and emotion regulation in these subtypes.

3. The broad elevation of obsessive-compulsive symptoms in those with self-harm suggests these patients may benefit from more intensive or specialized treatment approaches.

4. Transdiagnostic treatments that can address eating disorder symptoms, self-harm, and obsessive-compulsive symptoms may be particularly valuable for these complex cases.

5. The interconnections between these symptoms underscore the importance of comprehensive assessment and individualized treatment planning in eating disorders.

Limitations and future directions

Some limitations of this study include:

• The sample was limited to female inpatients, so findings may not generalize to males or outpatients
• All data was collected through self-report questionnaires
• Only impulsive forms of self-harm were assessed

Future research could:

• Include male participants and outpatient samples
• Use multiple assessment methods beyond self-report
• Compare compulsive versus impulsive forms of self-harm
• Examine how these symptom relationships change over the course of treatment

Conclusions

• Self-harm behaviors are common in eating disorders, especially anorexia nervosa binge-eating/purging type and bulimia nervosa.
• The presence of self-harm in eating disorder patients is associated with more severe obsessive-compulsive symptoms across multiple domains.
• Comprehensive assessment of self-harm and obsessive-compulsive symptoms is important for treatment planning in eating disorders.
• Integrated treatments addressing eating disorder symptoms, self-harm, and obsessive-compulsive symptoms may be beneficial for these complex cases.