Something lots of people talk to us about is self-harm either alongside the eating disorder or when recovering from an eating disorder. When you hear about self-harm for the first time, or your loved one expresses these thoughts, feelings or behaviors it can bring about intense emotions such as fear, worry, confusion and anger. This are all normal responses and it will bring up different emotions for different people.

Hi, my name is Sarah, and I am part of the telehealth team here at EDV.

Before we get started, I want to acknowledge that this article is going to cover a big topic, self-harm and eating disorders. Before reading on take some time to check in with yourself and see whether you’re up for this conversation right now or whether it might be best to wait until you are in a better physical or emotional place.

So what is self-harm?

Self-harm is any act that causes physical harm to yourself.  This could take many different forms and is a short-term way of someone managing intense emotional distress.

There are many reasons why someone might self-harm. These include someone wanting to feel something when they feel numb, feeling so much emotional distress that physical pain is a way of releasing this or helping it to feel ‘real’.  Having thoughts of self-harm does not necessarily mean you want to end your life or experience thoughts of suicide, although people can experience both.

What about self-harm and eating disorders?

Many people who experience an eating disorder also experience self-harm. In some ways this makes sense, as the behaviors of an eating disorder could also be considered a form of self-harm. Eating disorder behaviors cause physical harm to our bodies, although it may not be as visible as other forms of self-harm, and eating disorder behaviors are also a way of managing intense emotional pain or distress. The difference sometimes is the intentionality. Self-harm is an intentional act of physical harm whereas the eating disorder isn’t always about intentionally causing harm.

If we think about the relationship between self-harm and eating disorders it is really understandable that if a person is trying to challenge the eating disorder behaviors, or this way of managing intense feelings, then other ways might come up, like self-harm, that might be a different way of managing the same intense thoughts or feelings. It is important for loved ones to have an awareness as of any other possible self-harm during the initial period of treatment and/or challenging of the eating disorder too.

It is also really understandable that they might come up at the same time or one after the other. For example, a person might experience an eating disorder behavior, like a binge or purge, and then afterwards feel intense feelings of shame or guilt which can lead to thoughts or urges to self-harm.

What can I do to support my loved one to manage when they are experiencing thoughts of self-harm?

• The first thing to do, which is really hard, is to take a moment so you can remain calm yourself. If you are feeling emotional, it can unintentionally lead to feelings of being a burden, not good enough or blamed for your loved one.
• Try to understand what it is for your loved one. Ask them questions in a non-blaming way like: “I am feeling worried about you and want to support you, can you help me understand what this is for you or when it happens.” They might not always be ready or know straight away and that is ok too, you can try again another day or time.
• It is always ok to ask your loved one directly about any self-harm thoughts or behaviors in a curious, respectful way. This will not increase the behavior and instead bring it out into the open.
• Let them know that you love them no matter what. We can often forget to do this and it is really important that it is said and heard.
• Ask your loved one what is helpful when they have these thoughts/feelings. They might not know and it might be about giving a few things a try. Self-harm thoughts/urges often come on like a wave and then subside, lasting different lengths of time for different people. Often just sitting with them, not asking questions, doing anything or fixing it but just being there can be really helpful.  There are also lots of distractions they might be able to use to help last through the wave and different things will work for different people. Lifeline describe some of the different ways to manage in the moment here. 
• If there is a treating team involved, have a chat to them about your concerns and if there is anything that would be helpful from their perspective.
• Finally make sure you look after yourself too. It is really important modelling for your loved one and you are less likely to be able to support them in an ongoing way if you are not looking after yourself.

If this has brought up any concerns for you then please reach out for the appropriate support.  It might be a call with a support person or treating team, you might like to book in for a telehealth counselling appointment here to chat more or if you are needing more immediate support please contact Lifeline here or call them on 13 11 14.  If you are in immediate danger call 000 or go to your local emergency department.