TOPLINE:

Self-harm and suicidal ideation at the age of 21 years strongly predicted disordered eating at the age of 26 years in young adults, with self-harm showing a high predictive strength. The relationship appeared stronger in this direction than the reverse, suggesting that self-injurious behaviours may precede disordered eating as manifestations of psychological distress.

METHODOLOGY:

• Researchers conducted a longitudinal study on two large UK-based cohorts: the TEDS and the COPING study.
• The analysis included 5196 participants from the TEDS cohort (67% women; 95% European ethnic origin), comprising 807 monozygotic twin pairs, 1201 dizygotic twin pairs, and 1180 unpaired twins assessed at ages of 16, 21, and 26 years.
• From the COPING cohort, 490 individuals (53% women; 81% European ethnic origin) with complete data for at least one of the timepoints were included.
• The researchers employed structural equation modelling to conduct analyses investigating temporal associations between disordered eating, self-harm, and suicidal ideation.
• Symptoms of disordered eating, self-harm, and suicidal ideation were assessed multiple times across the study periods.

TAKEAWAY:

• Self-harm at the age of 21 years emerged as a strong predictor of disordered eating at the age of 26 years (beta coefficient [β], 0.35; 95% CI, 0.27-0.43), and suicidal ideation at the age of 21 years showed a strong correlation with disordered eating at the age of 26 years (β, 0.32; 95% CI, 0.24-0.40).
• Symptoms of disordered eating, self-harm, and suicidal ideation peaked around the age of 21 years and declined by the age of 26 years in the TEDS cohort, demonstrating limited continuity across adolescence and young adulthood.
• The observed directional relationship suggested that self-harm and suicidal ideation may be early manifestations of underlying psychological distress, later evolving into symptoms of disordered eating as alternative coping mechanisms.
• The COPING cohort showed greater temporal stability in symptoms of disordered eating, particularly restrictive behaviours, with stronger associations noted between self-harm and suicidal ideation than those observed in the younger TEDS cohort, with minimal cross-domain effects.

IN PRACTICE:

"Intervening at the stage of self-harm may not only reduce the immediate risk of suicide but also prevent the later onset or escalation of disordered eating," the authors wrote.

"Because self-harm is a well-documented precursor to suicide in the general population, identifying and treating self-injurious behaviours early, and addressing deficits in emotional regulation and maladaptive coping strategies, could help break the cycle of distress and maladaptive coping before it leads to more severe psychopathology," they added.

SOURCE:

This study was led by Agnieszka Musial, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England. It was published online on November 10, 2025, in The British Journal of Psychiatry.

LIMITATIONS:

The COPING sample had limited statistical power. The estimation of multiple paths may have introduced type 1 error. Non-linear relationships, particularly in the COPING cohort, suggested that simple linear models may not have fully captured the temporal dynamics between symptoms. The short timeframe between COPING measurements limited the ability to detect sustained changes. This study did not examine the role of co-occurring personality disorders in mediating the relationship between symptoms of disordered eating and suicidality.

DISCLOSURES:

This study was supported by the Rosetrees-Stoneygate Fellowship and MQ Transforming Mental Health. Two authors reported receiving funding and grants from the National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, and Mental Health and the Developing Mind initiative. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.