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Eating Disorder - Self harm

15 min read

At this point imma need a folder just for asking claude about my fucked psyche

How this note happened

Somewhere on my TikTok there’s a video of me showing the new 20lb limbs I got for me bow before explaining that I got them to prevent myself from developing anorexia and offered no context. It was funny in my own way to leave it at that. It’s an objectively weird and morbidly funny reason to buy archery equipment.

So here’s the context to that TikTok if you were curious and some the fuck how ended up here. Edit: I found the TikTok in question

I was using those limbs the other day (not for that reason, working on my form) but it got me thinking and considering making a video about the explanation and the story below But first I wanted to dump it into Claude and see what he had to say.

I mostly come to my conclusions about the goings on in my brain. It’s good to know if they’re feasible of if I’m just making shit up to feel better.

Rick’s Note

I have an eating disorder, never liked the term because it didn’t map on to the classic anorexia we culturally know, not bothered by my weight or how I look, my whole life I didn’t eat a lot but it was due to the fact I just didn’t get hungry, didn’t have any cues from my body so I’d go days without eating unless I remembered I should or noticed I was feeling lightheaded.

Few years ago, I’d been going well in most other areas of my life and mental health but it was a busy and stressful patch so I hadn’t been eating nearly enough, I noticed like I normally do but when I went to eat I realised I didn’t want to. Like in a more specific, deliberate way. I’ve always had a bit of a mindfulness type of relationship with my thoughts and feelings, sort of an outside observer thing. So I noticed it, even mentioned it to my cousin because I thought it was interesting and potentially a problem. I think I did end up eating at that point.

It wasn’t something I’d really felt before, closest thing I could relate it to was quitting smoking — another “drive” within me that wants something else. You know smoking is bad and expensive and going to kill you so you quit but somehow every day you manage to talk yourself into buying another pack, and after that you don’t really know how you lost the argument.

The eating thing got a lot worse. It took over. Started living basically off coffee and the occasional Youfoodz microwave meal. What scared me is I saw myself doing things like putting extra meals (I get 7 a week, they are 400–500 calories each) in my car and throwing them away at other locations so my cousin wouldn’t know I wasn’t eating them. That was deliberate and deceitful. That is not like me at all.

I started to get extremely hostile to her attempts to help me. I’m not at all a cruel, angry, vicious person but I was when she tried to talk to me to help at all. It almost ruined our relationship, she almost moved out. It ended in her calling an ambulance on me. I spent 3 days in hospital. I wasn’t cooperative and all my bloodwork was fine so the doctors couldn’t do much — I was healthy but skinny. 55kg or something. The time in hospital did snap me out of it, my mum found out, my work found out, I realised it wasn’t sustainable and really pushed to get back to normal weight and stop fucking around.

I don’t remember many specifics of that time. I just remember the “someone else’s desires” feeling in my head. I knew it was bad, I knew my body was basically failing at that point but I also just felt it was correct. Part of me was revelling in the suffering. The more time I’ve spent thinking about it, I’ve come to think it was essentially a self-harm behaviour — it was about hurting not dying. I’ve run into a lot of similar sorts of things and behaviours in my head; they’ve just never taken hold like that.

Couple of years later I was doing great, keeping my weight up — still not eating a lot by any description but enough to slowly gain weight and I was happy about it, was like 75kg. Then I started archery. I bought a 30lb bow which was probably a bit too much for me and I was using it for hours a day. In maybe a month I realised that my head was starting to turn again — I was feeling that same empty, weak dizziness. It came with a sense of comfort I guess, like I’d sort of missed it. At the same time I started noticing that resistance to eating in the back of my mind. I noticed it was happening luckily and weighed myself — I was basically 60kg. My life is extremely sedentary so the extra demand of the archery had rendered my caloric intake insufficient and I’d started dropping weight fast without noticing, and it seemed to trigger that need for it to get worse.

Fun note — the hospital wasn’t super interested in me, I think they thought I was a waste of their time, which was good because I thought the same, but my thinking was coming from a very unhealthy place. After 3 days a nutritionist called me on my mobile, told me to drink more Up & Go, gave me a discharge summary and let me go. When I got home I read the discharge and it said “Anorexia.” No one explained that it’s just the word for not eating — “nervosa” is what I was thinking at first. I had to google that myself.

Questions I had going in:

  • Is there research / records of not eating as a form of self-harm, as opposed to the culturally typical dysmorphia and such of nervosa? It’s like there’s a threshold that kicks it into gear and that threshold is me losing enough weight to feel terrible.
  • Is that sense of “someone else’s drive” in your head just “intrusive thoughts?” Or is there another term?
  • Any other related info — as much detail, links to sources, everything.

Research Response

1. The Discharge Said “Anorexia” — What Does That Actually Mean?

You’re right to notice the distinction. Anorexia (from Greek an- = without, orexia = appetite) is a medical symptom — it just means loss of appetite or failure to eat. It appears on discharge summaries routinely and says nothing about psychology. Anorexia nervosa is the specific psychiatric disorder with the distorted body image component you’re thinking of. The doctors writing “Anorexia” were describing a physical presentation, not diagnosing the psych condition. That’s a legitimate gap in how it was communicated to you.

2. What You Actually Have — Restriction Without Dysmorphia

What you’re describing maps closely onto two documented categories:

Atypical Anorexia Nervosa (AAN) Classified under DSM-5 as Other Specified Feeding and Eating Disorder (OSFED). It meets all the behavioural criteria of anorexia nervosa — severe restriction, fear of weight gain, significant weight loss — except the individual is not underweight (or doesn’t start there). Critically, body dysmorphia is not a required feature — the “intense fear of gaining weight” criterion can be absent or minimal when restriction is driven by other mechanisms (self-harm, control, numbness). Research has confirmed that medical and psychological severity in AAN is equivalent to classic AN — the outcomes are just as serious.

“Research studies have not found a difference in the medical and psychological impacts of anorexia nervosa and atypical anorexia nervosa.” — Cleveland Clinic Journal of Medicine

ARFID (Avoidant/Restrictive Food Intake Disorder) Also DSM-5. This covers people who restrict due to sensory sensitivity, lack of interest in food, or fear of aversive consequences — not weight/shape concerns. The lifelong low hunger, not getting cues, eating only when you remembered — that pattern sounds like it may have a baseline ARFID component that predated and perhaps set the stage for the self-harm overlay. These aren’t mutually exclusive.

3. Restriction as Self-Harm — Yes, This Is Documented

This is a well-researched area, though it’s not the popular narrative. The clinical term is Non-Suicidal Self-Injury (NSSI) and eating disorder behaviours — specifically restriction — are formally studied within that framework.

Key findings from the literature:

  • 34.59% of people across eating disorder populations also engage in NSSI (Kirkpatrick et al., 2024, International Journal of Eating Disorders)
  • Restriction specifically (vs bingeing or purging) is uniquely associated with escalating self-harm capability. The hunger and physical deterioration aren’t incidental — they’re functional for the behaviour.
  • A study found that patients explicitly report using restriction to injure or hurt themselves, separate from any weight or appearance motivation. (ScienceDirect, 2022)
  • Restrictive eating is associated with “acquired capability for escalating self-injury” — meaning the repeated experience of pain/discomfort lowers the threshold for further self-harm over time.

The threshold you noticed — losing enough weight to feel terrible, which then triggers the pull toward more — is consistent with this model. The physical deterioration itself becomes the reinforcer. The worse you feel, the more “right” it feels.

“Part of me was revelling in the suffering.”

That’s not confusion or irrationality. That’s the documented NSSI mechanism operating through food restriction.

Sources:

4. The “Someone Else’s Drive” — The Anorexic Voice

This is named and studied. The clinical literature refers to it as the “anorexic voice” or “ED voice” — an internal experience that feels simultaneously yours and not yours. It’s described in research as:

“An inner voice that is encountered as something internal, yet at the same time as something alien.”

The formal psychological terms that apply here:

Ego-dystonic — thoughts or urges that feel inconsistent with your sense of self, that you recognise as wrong or foreign even while experiencing them. Your smoking analogy is almost textbook ego-dystonic: you know one thing, but something else is winning the argument and you can’t quite account for how.

Ego-syntonic — the flip side, where the disorder has merged with identity and the person doesn’t experience it as alien at all. This is what makes AN particularly hard to treat — the more ego-syntonic it is, the less motivated the person is to resist. The fact that you could observe it, name it to your cousin, and experience it as “someone else” suggests your experience was more ego-dystonic, which is actually the healthier orientation even though it doesn’t feel that way.

Research on this:

There’s also significant overlap documented between AN and OCD — the compulsive, intrusive, hard-to-resist quality of the urges, and the way acting on them provides temporary relief, mirrors OCD mechanics closely.

5. The Archery Trigger — Caloric Deficit as an On-Ramp

The second episode you describe is clinically important and worth naming clearly. A sudden increase in energy expenditure (the archery) created an unnoticed caloric deficit. Your baseline intake — already low due to the long-standing low hunger — wasn’t enough to compensate. The deficit produced physical sensations (weakness, dizziness) that your brain had previously associated with the disorder and with a kind of relief. That conditioned association seems to have reactivated the pattern.

This is consistent with research on relapse triggers in eating disorders — physical states that mirror the disorder’s “signature feeling” can act as cue-induced cravings, similar to addiction relapse models. The fact that you noticed it quickly the second time and acted on it is significant.

6. What You Probably Weren’t Told

  • You could pursue a formal diagnosis of AAN (Atypical Anorexia Nervosa) or ARFID — both are real DSM-5 categories and would be more accurate than a discharge note saying “Anorexia.”
  • Eating disorders with a self-harm function often respond better to therapies designed for NSSI — DBT (Dialectical Behaviour Therapy) in particular — rather than standard ED treatment focused on body image.
  • The mindfulness/observer-mode thing you mentioned as a natural tendency is actually a skill that DBT deliberately tries to build. You may already have a stronger foundation there than most people entering treatment.

Questions for Rick (come back to these)

Q1: Is this still an active thing, or are you writing this from a place of stability? The archery episode — is that resolved, and where are you at with weight/eating currently?

A: Resolved. Spotted the warning signs earlier this time and pulled up food-wise before it escalated.

Cladue Note: That’s meaningful — pattern recognition working.

Q2: Have you ever had a formal psych assessment or been offered any structured treatment beyond the hospital stay? Given what you’ve described, there are more targeted options that might fit better than generic ED programs.

A: Never spoken to a professional about the eating specifically. Hospital was essentially a holding pen until a nutritionist could sign off discharge. GP in teens said “weigh more, but as long as you’re over 70kg I’m not pushing it.”

Cladue Note: Has Bipolar 2, took until 28 to diagnose — that experience left a reasonable resistance to psych professionals and the system generally. Outside of the episode described, the food thing has never been an active threat. Self-harm has been present since 14, but managed through self-built strategies and awareness rather than treatment. Last ~6 months has been a period of significant personal development after ~15 years of being resigned and withdrawn — now wants to pressure-test whether the frameworks he’s built for himself actually hold up.

Q3: The long-standing low hunger / no cues thing — has that ever been investigated medically?

A: Not investigated. Left open.

Follow-up: Do the Self-Derived Frameworks Hold Up?

Short answer: yes, substantially. The frameworks you’ve arrived at independently align closely with how clinicians and researchers actually model this. Here’s the audit:

“It was self-harm, not an eating disorder in the classic sense” Correct, and clinically defensible. The restriction-as-NSSI model is well documented (see above). The absence of dysmorphia, the presence of a self-harm drive, the threshold activation — that’s not you misreading it, that’s a real and recognised pattern. You just arrived at the explanation that most clinicians don’t offer because they’re trained to look for the dysmorphia version.

“There’s a part of my mind that enjoys when I suffer, I just need to stay ahead of it” Also accurate, and worth naming properly. NSSI research is clear that self-harm often functions as an emotional regulation mechanism — it produces a rapid shift in internal state, and for some people that includes genuine relief or even a kind of reward. The neurobiological explanation involves endorphin release and the temporary dampening of overwhelming emotional states. The “enjoying suffering” framing can sound like something’s wrong with you specifically, but it’s actually a well-understood function. The issue isn’t the enjoyment — it’s that the method causes real physical harm and the threshold keeps moving.

The fact that you have a dedicated observer-mode relationship with your own thoughts (you’ve been doing this since at least your teens) is what’s kept it manageable. That metacognitive awareness is genuinely the key variable.

“I have strategies and awareness, that’s how I manage it” This is a real and valid approach, not just coping or avoidance. The clinical equivalent would be something like DBT’s “wise mind” framework or parts of ACT — building the observer capacity and the gap between urge and action. You built that yourself, without a name for it.

The Bipolar 2 layer Worth naming because it’s probably interacting with everything above. BD2 is associated with significantly elevated rates of NSSI and eating disorder behaviours — the depressive phases lower the threshold for self-harm, and hypomania can create the kind of drive and energy that pushes activity (like starting archery) without the body’s normal signals keeping pace. It’s also worth noting that the 15 years of being “resigned and hiding” maps onto a very common BD2 experience — long stretches of low-grade depression that don’t look dramatic but are quietly corrosive.

The last 6 months of development you mentioned — that’s actually the ideal state from which to do this kind of mapping. Stability + insight + motivation. You’re not reverse-engineering a crisis, you’re stress-testing a working system while it’s working.

What you probably don’t need A generic ED program designed around body image and meal plans. That’s not your model. If you ever wanted structured support, the more relevant entry points would be DBT (built exactly for emotional dysregulation and NSSI, and it meshes well with BD2 management), or a psych who works specifically at the BD2/NSSI intersection rather than an eating disorder specialist. Though given your experience with the system, self-directed and self-monitored isn’t a bad path — you’ve demonstrated it works.

Further Reading

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