The Scars of the Inner Critic: Perfectionism and Nonsuicidal Self‐Injury in Eating Disorders
Abstract
Nonsuicidal self‐injury (NSSI) is quite common in eating disorder (ED) patients and we wondered whether this combined self‐harming behaviour is related to perfectionism, a feature often found in ED patients. In addition, we examined associations between perfectionism and functions underlying NSSI and the possible mediating role of intrapersonal perfectionism in the association between perceived parental criticism and NSSI. In a sample of 95 ED patients, 38.9% reported at least one type of NSSI, and this subgroup reported significantly higher levels of parental criticism and evaluative concerns perfectionism (ECP) compared with ED patients without NSSI. ECP was positively related to the self‐punishment and cry‐for‐help functions of NSSI. Finally, ECP was found to mediate the association between parental criticism and NSSI symptoms. Directions for future research and practical implications are discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.
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Both low self-esteem and self-criticism have been linked to NSSI; poor self-esteem, along with weak coping strategies, appears to mediate the relationship between personality pathology and self-injury.
“Both low self-esteem [122, 123] and self-criticism [124–127] have been linked to NSSI; poor self-esteem, in particular, appears (along with weak coping strategies) to mediate the relationship between personality pathology and self-injury [128].”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [124]
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Comorbid posttraumatic stress disorder complicates eating disorder treatment: A nationwide study
Hübel, C., Johansson, T., Mundy, J., Lin, Y., Petersen, L. V., Isomaa, R., & Birgegård, A. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116563 · Cited by 4 · see citing works
“Having an ED predicts self-harm in young adulthood (Micali et al., 2015) and across individuals with EDs, up to 34 % of individuals engage in NSSI (Claes, Soenens, Vansteenkiste, and Vandereycken, 2012; Claes, Vandereycken, and Vertommen, 2001; Cucchi et al., 2016; Dohm et al., 2002; Jacobson and…”
Győri, D., Farkas, B. F., Komáromy, D., Horváth, L. O., Kollárovics, N., Garas, P., & Balázs, J. (2023) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe13110163 · Cited by 5 · see citing works
“Some results indicate a direct relationship between NSSI and perfectionism [36,38,39] and an indirect effect through rumination and negative affect [39].”
BackgroundResultInfluentialKennedy-Turner, J., Nemeth, Z., & Anderson, L. (2025) · Adolescent Research Review · doi:10.1007/s40894-025-00261-7 · Cited by 6 · see citing works
Vaca, D. J. G., Granero, R., Fernández‐Aranda, F., Mestre‐Bach, G., Martín‐Romera, V., Mallorquí‐Bagué, N., Mena-Moreno, T., Aymamí, N., del Pino‐Gutiérrez, A., Gómez‐Peña, M., et al. (2020) · Journal of Gambling Studies · doi:10.1007/s10899-020-09945-2 · Cited by 4 · see citing works
Functional Assessment of Non-suicidal Self-Injury and Eating Disorders
Andover, M. S., Holman, C. S., & Shashoua, M. Y. (2013) · Springer eBooks · doi:10.1007/978-3-642-40107-7_6 · Cited by 4 · see citing works
Nonsuicidal self-injury in eating disorders
Зинчук, М. С., Lavrishcheva, A. P., Menshikova, A. A., Voinova, N., Artemyeva, M. S., & Guekht, A. B. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212209170 · Cited by 3 · see citing works
Perceptual Dysfunction in Eating Disorders
Reilly, E. E., Brown, T. A., & Frank, G. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_470 · Cited by 3 · see citing works
Brocklesby, M. (2017) · doi:10.26686/wgtn.17065352.v1 · Cited by 2 · see citing works
“, 2012), and the limited research that has investigated perfectionism and the functions of NSSI (Claes et al., 2012), it is predicted that negative perfectionism will be associated with NSSI for self-punishment.”
BackgroundInfluentialFamily Therapy for Eating Disorders and Non-suicidal Self-Injury
Hughes, E. K., Allan, E., & Grange, D. L. (2013) · Springer eBooks · doi:10.1007/978-3-642-40107-7_9 · Cited by 2 · see citing works
Group-based intervention for eating disorders with non-suicidal-self-injury: a case series
Vieira, A., Rodrigues, T. F., Brandão, I., Timóteo, S., Nunes, P., & Gonçalves, S. (2021) · Clinical Psychologist · doi:10.1080/13284207.2021.1892454 · Cited by 2 · see citing works
An Integrated Cognitive-Emotional Perspective of NSSI
Tonta, K. E., Greene, D., Hasking, P. A., & Boyes, M. E. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.35 · Cited by 1 · see citing works
Deepening Couples Counseling Through Inner Critic Dialogue
Green, E. J., Elliott, K., & Myrick, A. C. (2013) · The Family Journal · doi:10.1177/1066480713513549 · Cited by 1 · see citing works
Janssen, W. F., & Hamza, C. A. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.873410 · Cited by 1 · see citing works
“Research has yet to examine how perfectionism is related to different functions for engaging in NSSI functions for engaging in NSSI, although in one study authors found that PC was correlated with self-punishment motivations (Claes et al., 2012).”
BackgroundInfluentialCastaneda, K. P., Reynolds, N., & Onwumere, J. (2022) · Health Sciences Review · doi:10.1016/j.hsr.2022.100023 · Cited by 2 · see citing works
Molenaar, C. Y. (2018) · Cited by 1 · see citing works
Jones, E. J., Howell, J. A., Tonta, K. E., Egan, S. J., Hasking, P. A., Boyes, M. E., McEvoy, P. M., & Mazzucchelli, T. G. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100342
“damage to one’s own body tissue in the absence of suicidal intent) [4, 5].”
(2015) · Clinical Psychology Science and Practice · doi:10.1037/h0101728.supp
Lester, R. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.64069-2
Understanding the Link Between Direct and Indirect Self-Injurious Behavior
Møhl, B., & Rubæk, L. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.61
Rasbi, H. A., Sumri, H. H. A., & Difai, Z. A. (2023) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba-142717
Unraveling Overcontrolled and Undercontrolled Nonsuicidal Self-Injury: A Grounded Theory
Ellison, S. E., Meyer, J. M., Whisenhunt, J. L., & Tyler, J. M. (2025) · The Professional Counselor · doi:10.15241/see.15.2.81
Ilieff, M. E. P., & Hamza, C. A. (2026) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2026.2673507
“Emotion regulation benefits of NSSI are particularly salient among individuals with negative self-views, perhaps because they also validate these views and gratify self-punishment desires (Claes et al., 2012).”
Gu, H., Xiao, Y., Ai, X., Fan, M., & Xia, T. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70173
- Authors
- Claes, L., Soenens, B., Vansteenkiste, M., & Vandereycken, W.
- Affiliations
- UCLouvain (BE)
- Ghent University (BE)
- Corresponding author
- Claes, Laurence
- Venue
- European Eating Disorders Review
- Publisher
- Wiley
- Published
- 2011-09-13
- Volume
- 20
- Issue
- 3
- Pages
- 196-202
- ISSN
- 1072-4133 (ISSN-L)
- 1099-0968
- OpenAlex
- W2124387308
- Cited by
- 77
- References
- 41
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 9 · 2022: 7 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 3 · 2015: 6 · 2014: 2 · 2013: 12 · 2012: 1
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Eating Disorders Review (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- non-suicidal self-injury, perfectionism, eating disorders, parental criticism, evaluative concerns perfectionism, self-punishment, mediating role, inner critic
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Female, Humans, Parent-Child Relations, Personality, Personality Inventory, Surveys and Questionnaires, Self Concept, Self-Injurious Behavior
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