Eating Disorders:

A study by Favazza and Conterio (1989) states that episodic and repetitive self-mutilation are frequently seen in conjunction with, or as a replacement for, eating disorders. In a study of 290 self-mutilating women, they found that 22% of the subjects suffered from only bulimia nervosa, 15% from anorexia nervosa and 13% from both disorders, for a total of 50%.
Among these subjects, the average age when the eating disorder first became evident was 16 years. Adolescence is also when superficial self-mutilation is usually first displayed.

One woman in Jennifer Harris's 2000 study was quoted as saying, "When I started to emerge from my anorexia, I needed some other way of dealing with the pain and hurt, so I started cutting instead. It is a way of gaining temporary relief. As the blood flows down the sink, so does the anger and the anguish." Some women use purging as a form of self-mutilation. Their purging is a literal form of self-mutilation from the inside out, as it lacerates organs and causes internal injuries and bleeding. They attack their bodies internally to find the same relief that cutters or burners do in attacking their bodies externally.

The link between superficial self-mutilation and eating disorders can create serious complication in treatment. According to Steven Levenkron, author of Cutting: Understanding and Overcoming Self-Mutilation, self-mutilating behavior is frequently "at the top of the pyramid of psychological problems that an individual may suffer from, the tip of the iceberg." This means that self-mutilation may develop from another problem, frequently anorexia or bulimia. In this case, as the patient in therapy begins to limit or stop their self-mutilating behavior, they will begin to lose weight or resume previously halted use of laxatives or drugs. According to Levenkron, treating such a patient, requires a uniquely strong therapist-patient relationship. Complete trust of the therapist is intrinsic to ensuring that the patient does not resume self-mutilating behaviors when they are again consumed by other destructive behaviors that neither they, nor the therapist can predict. Such psychotherapy is "no less than an undertaking to change one's mental and emotional personality organization."