Self-harm in individuals who experience binge eating disorder: A systematic review and meta-analysis

Abstract

Background: Binge Eating Disorder (BED) and self-harm often co-occur and cause great distress. BED is often poorly understood and under-represented in research, despite high prevalence. It is unclear how self-harm in BED populations compares to rates of self-harm in other eating disorder populations or control groups. A systematic review and meta-analysis were undertaken with the aim of investigating how often self-harm occurs along with BED compared to other eating disorders and control groups. Method: The protocol for this review was pre-registered (PROSPERO reference: CRD42023466201). Online databases, PsycINFO, MEDLINE and Web of Science, were searched using key terms relating to BED and self-harm, for publications dating up to February 2025. Inclusion criteria were studies that measured BED and self-harm. Titles, abstracts and full texts were screened by independent screeners. Sixteen studies were identified. Meta-analyses were completed to determine the odds of self-harm in BED groups compared to other eating disorders and non-clinical control groups. Risk of bias and publication bias were assessed. Results: There was no difference in rate of self-harm between people experiencing BED compared to those experiencing Anorexia Nervosa (Odds Ratio [OR] = 0.7, 95% Confidence Interval [CI] = 0.4–1.2) or Other Specified Feeding and Eating Disorders (OR = 0.7, 95% CI = 0.4-1.0). Self-harm was 1.6 times more likely in BED groups compared to non-clinical controls (OR = 1.6, 95% CI = 1.0-2.5), and almost half as likely compared to Bulimia Nervosa groups (OR = 0.6, 95% CI = 0.4–0.8). Conclusions: BED is associated with a higher prevalence of self-harm compared to non-clinical populations and should be approached similarly to other eating disorders in this regard. Increased awareness of the potential for self-harm in BED groups is vital to ensure interventions for eating disorders integrate self-harm prevention. Further research is required in non-western communities and across sexes and gender identities.