Self-Harm in Eating Disorders: Identifying Contextual Patterns using an Ecological Momentary Assessment Study

Introduction: Eating disorders (EDs) and self-harm are highly co-morbid; however, little is known about the contextual factors that underlie self-harm in people with EDs. Method: Participants aged 16+ were recruited from three specialist outpatient ED services in England to a registered smartphone app-based ecological momentary assessment study, receiving six semi-random prompts for 14 days. Questions were on the frequency, processes, contexts, and functions of self-harm thoughts and behaviours. Results: Fifty-one participants consented and 43 began using the app. Of these, 78% reported ≥1 self-harm thought, 35% reported ≥1 suicidal thought, and 42% reported ≥1 act of self-harm. No suicide attempts were reported. Of the 1569 EMA responses, 269 (17%) described self-harm thoughts and 50 (3%) self-harm behaviours. When self-harm thoughts occurred, participants commonly considered cutting, were alone, were experiencing worry, and reported a “moderate” urge to self-harm. When self-harming, participants commonly reported cutting, feeling self-hatred, and thinking about self-harm for “1-30 minutes” beforehand. Conclusion: This study is novel in providing information on both the contexts within which self-harm thoughts and behaviours manifest and the temporal patterns they take in people with an ED. Findings point to the need for appropriate co-designed self-harm safety planning for people attending outpatient ED services.