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The Prevalence and Function of Self-Injurious Behavior in Eating Disorder Patients

Jun 21, 2023 | 0 comments

Jun 21, 2023 | Essays | 0 comments

Quantitative Article Critique


Smithuis, L., Kool-Goudzwaard, N., de Man-van Ginkel, J. M., van Os-Medendorp, H., Berends, T., Dingemans, A., Claes, L., van Elburg, A. A., … van Meijel, B. (2018). Self-injurious behavior in patients with anorexia nervosa: a quantitative study. Journal of Eating Disorders, 6, 26. https://doi:10.1186/s40337-018-0214-2 https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-018-0214-2

The article examined how many patients’ who are victims of eating disorders face difficulties in handling their emotions and have high self-injurious prevalence behavior. About different studies, it has been found that self-injurious and eating disorder behaviors help in regulating emotions and hence are used as a mechanism for coping for the patients. The researchers of the article aimed at determining self-injurious behavior prevalence, its characteristics, and its function of emotion regulation to patients suffering from anorexia nervosa or an eating disorder that the researchers did not specify.


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The researchers found that there was a 41 percent self-injurious behavior (SIB) prevalence from the earlier month (Smithuis et al, 2018). Furthermore, the researcher established that 55 percent of self-injuring victims were diagnosed with a secondary psychiatric diagnosis, while only 21 percent of the patients without the disorder had a secondary psychiatric diagnosis (Smithuis et al, 2018). As stated by the scholars, the results indicated that self-injurious behavior can be termed as a behavior that is emotion regulated.

Data analysis

In determining the SIB characteristics and SIB prevalence rates, the researchers calculated the frequencies for 136 patients which gave 42.5 percent only for those who completed the questionnaire (Smithuis et al, 2018). The scholars set the statistical level of significance for the overall tests at p < 0.05. The effect sizes for Wilcoxon and Mann-Whitney U-tests signed-rank tests were expressed by r, whereby r=.10 small effect; r=.30 medium effect; and r=.50 large effect. The researchers used SPSS version 24 in analyzing the statistics.

Reliability and Validity of Theoretical Integrations

The research examined how many patients’ who are victims of eating disorders face difficulties in handling their emotions and have high self-injurious prevalence behavior. The research further, aimed at determining self-injurious behavior prevalence, its characteristics, and its function of emotion regulation to patients suffering from anorexia nervosa or an eating disorder that the researchers did not specify.


About the SIB, the researchers stated that the results indicated a considerable increase in the feeling of relief and a substantial decrease in “expressing angry at self”, “feeling angry to other people”, and “feeling anxious.” According to the researchers, this indicated that SIB can be termed as emotion-regulated behavior, with victims being aware of the basis of the acts.

Interpretation of Findings

Emotions’ regulation difficulties are popular among people with an eating disorder. Using self-injurious behavior may happen as a strategy for coping with overwhelming emotions. Patients showing self-injurious behavior have undergone longer treatments for the eating disorder and have a high likelihood of developing secondary psychiatric identification that may show more severe pathology compared to patients who fail to self-injure.

Implications and Recommendation

Professionals should thoroughly examine the occurrence of SIB in patients with an eating disorder, show more concern to patients with comorbid and severe psychopathology and those having a long history of treatment. The examination should have a follow-up of functional analysis of the SIB and by effective inventions of therapy combined with the treatment of an eating disorder.

Global Issues

There is a high prevalence across the world of patients suffering from SIB and most of the patients experience a reduction in many negative emotions, for example, anger to themselves, which is then accompanied by much relief. Thus, worldwide, SIB is termed a behavioral emotion regulation for patients.


The study was clearly presented with approval from the research committee at Altrecht Eating Disorders and a declaration from the health care medical research. The participants had informed written consent. Besides, the authors of the research had declarations that they had no competing interests.

Research Credibility

The research was credible because the presented data were collected from patients who had signed consent and were victims of self-injurious behavior as well as patients who were not victims of the kind of behavior. Furthermore, the study was reliable because emotional state changes were tested before and after the patients showed the self-injurious behavior for comparison and to collect well-structured data. On top of this, in making the study credible, data was collected in the Netherlands at two specialized centers of treatment, handing Eating Disorder patients. Most importantly, the study involved many participants at different times and years. Additionally, the index diagnoses were examined by a multidisciplinary clinician’s team such as psychiatrists and psychologists, with the use of questions from two interviews that are semi-structurally standardized.

Summary Assessment

About the study, findings showed a high SIB prevalence in patients who were victims of an eating disorder not otherwise specified (EDNOS) or Anorexia Nervosa (AN). Patients performing SIB have shown to have a longer treatment history of an eating disorder, with half of the population having a diagnosis of comorbid that may show severe pathology. After the SIB act, many patients go through a reduction in many emotions, for example, anger to themselves accompanied by a huge relief. This is an indication that SIB may be considered as a behavioral emotional regulation function for the patients.

Qualitative Article Critique

Reference:  Hayden Heidari, & Marjan Marinade Hamooleh. (2016). Nursing Students’ Experiences Regarding Nursing Process: A Qualitative Study. Research and Development in Medical Education, Vol 5, Iss 2, Pp 101-104 (2016), (2), 101. https://doi.org/10.15171/rdme.2016.021 


According to the data obtained from the experience of students, three main experience categories were identified; those with performance decrease, those with decreased critical thinking, and those students with experience dissatisfaction.

Data Analysis

Considering the results, students do not get satisfaction with the current methods because measures of nursing are not accessed clearly. However, nursing education based on evidence will advance the needed skills for the process of nursing since it promotes activity. The research showed that current nursing does not raise creativity and critical thinking in itself.

Reliability and Validity of Theoretical Integrations

This research aimed at examining the reliability and validity of the qualitative study of the Saudi Arabia. The inclusion process of the DHH students‘ nursing experience regarding the process. It was aimed at proving whether students face many challenges during nursing procedures application.


Based on analysis of data regarding the three main categories of performance decrease, critical thinking decrease, and the dissatisfaction of survey by the American Association of Colleges of Pharmacy, in average a pharmacy student borrows an average of 0,000. Most student’s experience, a good number of the stated argued that using the process of nursing decrease the dependence sense as a result of monotony, leading to routineness consequently decrease in performance and motivation in nursing students. The students stated that the process of nursing involves bureaucracy as well as copying from books.

Interpretation of Findings

The nursing process framework cliché prevents students from critical thinking and resulted in copying everything from references. The findings established that the process of nursing involved just copying to do away with the tasks the students are assigned and the routineness decreases students’ innovation and creativity.

Implications and Recommendations

The nursing skill of critical thinking is fundamental in making correct decisions, resultantly, decreasing expenses, and increasing the quality of care. Most importantly, in giving education to students in nursing, methods should be put in place that result in deep and significant learning. Noteworthy, emphasis should be put on theoretical and practical education during nursing bachelor’s level to assist in implementing the process of nursing. Furthermore, the Ministry of Health authorities should give nurses the needed nursing process training. Finally, alternative methods in nursing education and care should be developed that meet students’ and nurses’ needs, which will be different from the present practices.

Global issues

The present complex system of care across the world is not meeting students’ and nurses’ needs therefore alternative nursing education and care methods are needed to promote the nursing process and the experience of students.


The study was clearly and precisely presented as well as the research being confidential, with participant’s names not being mentioned with high observations of moral considerations. Additionally, the authors of the research had no conflict of interest.

Research Credibility

The research was credible because the participants were nursing students who were studying nursing during their sixth semester selected for the sampling method. Furthermore, data saturation happened after the nine participants were interviewed.

Summary Assessment

The employment of the nursing process decreases the ability of critical thinking and increase the dissatisfaction of students. The assessment showed that professors and instructors must use alternative methods from the current ones in increasing nursing process critical thinking.


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