Self-injurious behaviour in anorexia nervosa: a phenomenological study

Abstract

Aims To get insight into the lived experiences of self-injurious behaviour in patients with anorexia nervosa. This may contribute to more patient-centred care and finally to better treatment outcomes. Background Little is know about the lived experiences of the participants under study. The existing literature is scarce and does not focus on anorexia nervosa explicitly. It is estimated that the self-injury rate is 45% in the population of eating disordered patients. Patients with anorexia nervosa have stressed the importance of a good therapeutic relationship, which may come under strain when misunderstandings in the communication occur because of a lack of understanding regarding the self-injurious behaviour. Methods A phenomenological research design was used. Ten patients were included. The main research question was: what are the lived experiences of patients with anorexia nervosa who injure themselves? Data were collected between May 2011 and August 2011 using a semi-structured topic guide with five sub-questions related to the main research question. Results Self-injury serves to cope with overwhelming feelings as well as a method of punishing oneself. Self-injury is used to suppress the overpowering feelings that can occur when participants are pressured to change their anorectic eating habits. Self-injury can also occur in interactions with others, to suppress feelings of guilt and shame. Patients tend to punish themselves to suppress feelings of self-hatred. Conclusion The interviews indicate that the participants experienced self-injury as necessary, functional and autonomous behaviour to control overwhelming emotions and to better cope with the fear and anxiety that occur during treatment. Relevance to clinical practice Five aspects may be helpful to improve nursing care for this patient group: (1) noticing the self-injury by assessment or observation; (2) communicating about the self-injury free from judgements and assumptions; (3) analysing the motives and reasons behind it; (4) agreements to decrease the self-injury in dialogue with the patient; (5) exploration of alternative interventions such that self-injury is needed less.