Anorexic Cutters: The Diagnosis Doctors Aren't Catching

As the rest of medical science zooms by, technologically advancing itself through non-invasive laser beam surgeries and MRI-reading iPads, doctors still harness (believe it or not) the ability to perform a basic physical exam. You can see a cirrhotic liver worsening by the yellowing of someone’s eyes and feel a lung consolidation through distinct vibrations on their back. That’s why it’s hard to imagine that with so much of medicine relying on keen observation skills, problems like starvation, physical wasting and burns or cuts on the skin could be so easily missed.

This week, researchers from Stanford’s Lucile Packard Children’s Hospital have proven this inconsistency true. In a study of over 1,400 teenagers with eating disorders, researchers found that almost 40 percent of teens surveyed admitted to inflicting self harm. Even more shocking is the fact that doctors missed almost 50 percent of these double-injury cases.

"We ask 97 percent of children 12 years and up if they smoke cigarettes; we need to get that good with screening for self-injurious behavior," said the study's lead author, Dr. Rebecka Peebles in the press release.

The study included teens ages 10 to 21 who were enrolled in the hospital’s eating disorder program. Although both boys and girls were included, the majority of participants were white females. This is also the profile of teens that doctors most frequently screened, suggesting that perhaps there’s an entire subgroup of less obvious-appearing teens who are flying under the diagnostic radar.

The most commonly reported injuries included cutting and burning, but other similar studies have shown severe scratching, hitting, and banging are also common methods of harm. And although this study highlighted non-suicidal self harm as a potential complication, a recent study in the American Journal of Psychiatry found that people with eating disorders also have an increased risk of suicide.

The reasons for these self destructive behaviors are not that well understood, and this is perhaps part of the reason why more physicians are not screening for it. If a bruise, burn, or cut isn’t staring you right in the eye, it might be easy to forget and instead focus solely on the eating disorder. But as the pathophysiology of these disorders becomes clearer, doctors are realizing that self injury is likely a temporary alleviation of emotional pain and a self expression of anger or disgust. According to a recent article in the Journal of Clinical Psychology, it can also be a non-verbal cry for help or a diversion exercise in avoiding actual suicidal thoughts.

Whatever the motivation, it’s clear that teens with eating disorders are an especially at-risk group for developing self-harming behaviors, including suicide. As the study points out, acknowledging this association and developing screening tools to diagnose even the least obvious teens is the next step in lowering the already alarming number of teens who intentionally hurt themselves.

Photo Credit: Charlotte Astrid