Overview and aims:
Self-harm and eating disorders are often comorbid in clinical samples but how frequently self-harm and disordered eating co-occur in the general population is less clear. This is important to study at a population level as not everyone with self-harm or disordered eating seeks or receives help from clinical services.
Research suggests emotional dysregulation (the inability to be aware of, accept, regulate, and modify emotional reactions and subsequent behaviours) is associated self-harm and eating disorders. Emotional dysregulation may be a common precursor to both self-harm and disordered eating but few studies have investigated the prospective associations. Furthermore, the mechanisms underlying the potential prospective associations of emotional dysregulation with disordered eating and self-harm are unknown. Identifying mechanisms along this pathway has the potential to identify early modifiable targets and facilitate development of interventions to prevent both self-harm and disordered eating.
The aims of this project were to:
- Examine the co-occurrence of self-harm and disordered eating across adolescence and young adulthood in a UK population-based cohort.
- Investigate:
- the association between emotional dysregulation in childhood and disordered eating and self-harm in adolescence in a UK population-based cohort, and
- the extent to which social cognition, emotion recognition of others’ faces, and being bullied mediated these associations.
Sample:
What did we do?
For the first aim, we examined the prevalence of males and females reporting self-harm or disordered eating at 16 years and 24 years. Then we examined the proportion of individuals with disordered eating also reporting self-harm (compared to those without disordered eating); and the proportion of individuals self-harming who also reported disordered eating (compared to those not self-harming).
For the second aim, we investigated whether emotional dysregulation at 7 years old was associated with self-harm and disordered eating at 16 years old. We then used a mediation model to assess the extent that social cognition (7 years), emotion recognition (8 years), and being bullied (11 years) mediated the associations from emotional dysregulation to self-harm and disordered eating.
What did we find?
We found that self-harm and disordered eating behaviours were common, and commonly co-occurred in young people. At age 16, 32.7% of females and 7.6% of males reported some form of disordered eating in the past year, and 15.3% of females and 5.4% of males reported self-harm in the past year. The prevalence of disordered eating was notably high among females who reported self-harm, affecting nearly two-thirds of young women across late adolescence and early adulthood. Furthermore, two-in-five 24-year-old males who self-harmed also reported disordered eating.
We found that children with higher emotional dysregulation were more likely to report both disordered eating and self-harm during adolescence. Mediating pathways appeared to differ by sex (females had two dominant indirect effects via social cognition and bullying to both self-harm and disordered eating, whereas males had these same two dominant pathways for disordered eating, but only one dominant indirect effect – social cognition – for self-harm). Pathways also differed by outcome, with stronger indirect effects found for disordered eating than self-harm. These results suggest that emotional dysregulation, social cognition, and bullying, may be useful targets to prevent both disordered eating and self-harm.
Project team:
- University of Bristol, UK: Helen Bould (PI); Naomi Warne; Jon Heron; Becky Mars; David Gunnell; Paul Moran; Lucy Biddle; Gemma Hammerton; Marcus Munafò; Ian Penton-Voak; Andy Skinner
- University of Oxford, UK: Anne Stewart
- University College London, UK: Francesca Solmi
Funders/Supporters
This study was funded by an MRC/MRF grant awarded to Dr Helen Bould (PI)
Publications and other outputs:
Warne, N., Heron, J., Mars, B., Moran, P., Stewart, A., Munafò, M., Biddle, L., Skinner, A., Gunnell, D., Bould, H. (2021) Comorbidity of self-harm and disordered eating in young people: Evidence from a UK population-based cohort. Journal of Affective Disorders, 282, 386-390. https://doi.org/10.1016/j.jad.2020.12.053
Animation describing findings on the co-occurrence of self-harm and disordered eating
Warne, N., Heron, J., Mars, B., Solmi, F., Biddle, B., Gunnell, D., Hammerton, G., Moran, P., Munafò, M., Penton-Voak, I., Skinner, A., Stewart, A., Bould, H. (2022) Emotional dysregulation in childhood and self-harm and disordered eating in adolescence: Prospective associations and mediating pathways, Journal of Child Psychology and Psychiatry, 64(5), 797-806, https://doi.org/10.1111/jcpp.13738
Podcast for The Association for Child and Adolescent Mental Health on the paper
Contact for further details: helen.bould@bristol.ac.uk