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Received: 27 September 2019 Revised: 16 April 2020 Accepted: 16 April 2020
DOI: 10.1002/eat.23284

ORIGINAL ARTICLE

Longitudinal relations of self-criticism with disordered eating

behaviors and nonsuicidal self-injury

Rachel L. Zelkowitz PhD1,2 | David A. Cole PhD1

1
Department of Psychology and Human
Development, Vanderbilt University, Nashville,
Tennessee
2
Women's Health Sciences Division, National
Center for PTSD, Veterans Affairs Boston
Healthcare System, Boston, Massachusetts
Correspondence
Rachel L. Zelkowitz, Women's Health Sciences
Division, National Center for PTSD, Veterans
Affairs Boston Healthcare System,
150 S. Huntington Avenue, Boston, MA
02130.
Email: rachel.zelkowitz@va.gov
Funding information
Patricia & Rodes Hart Foundation; National
Institute of Mental Health, Grant/Award
Number: F31MH108241-01A1; Department
of Veterans Affairs
Action Editor: Ruth Weissman
Abstract
Objective: Self-criticism has been proposed as a transdiagnostic predictor of disor-
dered eating and nonsuicidal self-injury (NSSI). First, this study explored cross-sectional
associations of multiple disordered eating behaviors, NSSI, and self-criticism. Second, it
tested longitudinal relations of self-criticism with disordered eating and NSSI, adjusting
for baseline levels of both behaviors.
Methods: In Sub-study 1, undergraduates (N = 251, 79.5% female, Mage = 19.1 years)
completed self-report measures of disordered eating, NSSI, and self-criticism at base-
line and after 8 weeks. In Sub-study 2, community-based young adults with histories
of disordered eating, NSSI, or both (N = 517, 88.8% female, Mage = 24.7 years) com-
pleted measures of disordered eating, NSSI, and self-criticism at baseline and after
4 weeks. All measures were completed online.
Results: In Sub-study 1, both disordered eating and NSSI showed significant cross-
sectional associations with self-criticism, and self-criticism was significantly related to
binge eating, fasting, and NSSI at follow-up. In Sub-study 2, both behaviors again
showed significant cross-sectional associations with self-criticism. Self-criticism
showed significant longitudinal relations with fasting, purging, and excessive exercise.
Longitudinal relations of self-criticism with NSSI varied across disordered eating
behaviors.
Discussion: NSSI showed cross-sectional associations with a range of disordered eat-
ing behaviors. Self-criticism reflects a common correlate of both disordered eating
and NSSI. Evidence supported transdiagnostic longitudinal impact of self-criticism
across multiple forms of disordered eating but provided more limited support for
impacts on NSSI.

KEYWORDS

comorbidity, eating disorders, risk factors, self-assessment, self-injurious behavior

1 | I N T RO DU CT I O N Both disordered eating and nonsuicidal self-injury (NSSI;

i.e., deliberate damage of body tissue absent intent to die;
Understanding self-harming behaviors among individuals with disor- Nock, 2009) are associated with substantial psychiatric and medical
dered eating is a key research priority (van der Kaap-Deeder, sequalae (Cipriano, Cella, & Cotrufo, 2017; Franklin et al., 2017;
Smets, & Boone, 2016; van Furth, van der Meer, & Cowan, 2016). Smith, Velkoff, Ribeiro, & Franklin, 2018; Treasure, Claudino, &

Int J Eat Disord. 2020;53:1097–1107. wileyonlinelibrary.com/journal/eat © 2020 Wiley Periodicals, Inc. 1097

1098
Zucker, 2010). We present two studies investigating the longitudi-
nal relations of self-criticism with disordered eating behaviors and
NSSI. Anticipating that relations may vary by behavior, we examined
binge eating, purging, restricting, and fasting separately.
Conceptual models of disordered eating and NSSI offer hypotheses
regarding processes that operate across both behaviors. Svirko and
Hawton (2007) proposed that self-criticism contributes to disordered eat-
ing and NSSI in the context of other risk factors (e.g., trauma, invalidating
environments, etc.). Claes and Muehlenkamp (2014) similarly theorized a
role for self-criticism (among other constructs) in these behaviors.
Evidence supports the cross-sectional association of self-criticism
to both disordered eating and NSSI (see Zelkowitz & Cole, 2018, for a
review). Such research has largely focused on eating disorder diagno-
ses, which encompass attitudes, cognitions, and behaviors, rather than
disordered eating behaviors. Furthermore, use of cross-sectional
studies has prevented examination of the temporal relations implied
by theoretical models of disordered eating and NSSI (Claes &
Muehlenkamp, 2014; Svirko & Hawton, 2007).
The literature on prospective relations of self-criticism to disordered
eating is limited. Perkins, Ortiz, and Smith (2019) observed associations
of self-criticism with disordered eating symptoms at baseline but not
two-month follow-up among adults seeking treatment for eating disor-
ders. Kupeli et al. (2013) similarly found associations of self-criticism and
disordered eating at baseline but not at 18-month follow-up among
community-based adults. However, findings on self-critical perfectionism,
a related construct, are more mixed. For example, Boone, Vansteenkiste,
Soenens, van der Kaap-Deeder, and Verstuyf (2014) found that self-
critical perfectionism correlated significantly with binge eating across
waves in a study among adolescents. Procopio, Holm-Denoma, Gordon,
and Joiner (2006) found significant bivariate correlations between
both perfectionism and self-esteem at baseline and bulimia nervosa
(BN) symptoms (i.e., attitudes and behaviors) at follow-up among a sam-
ple of adult women. The effect was nonsignificant after adjusting for
baseline symptoms, however. More recently, van der Kaap-Deeder
et al. (2016) did not find significant associations of self-critical perfection-
ism with changes in drive for thinness and body dissatisfaction among
patients in eating disorder treatment. Notably, the literature has focused
on composites of disordered eating behaviors and cognitions, potentially
masking the existence of behavior-specific relations.
Few longitudinal investigations have been conducted regarding
the impact of self-criticism on NSSI. You, Lin, and Leung (2014)
assessed self-criticism, NSSI, and other psychological variables among
adolescents. The authors found no significant relation of baseline self-
criticism to NSSI at 18-month follow-up after adjusting for baseline
NSSI and other variables. Daly and Willoughby (2019) also did not find
a significant relation of self-criticism with NSSI at one-year follow-up
among undergraduates. Longitudinal relations of self-criticism with
NSSI have been found after 1 and 2 months among people with NSSI
histories and clinical samples (Fox et al., 2018; Perkins et al., 2019).
This suggests that impacts of self-criticism on NSSI may occur over
shorter time frames.
Clearly, more work is needed to understand the relation of self-
criticism with both disordered eating and NSSI. The current study had
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ZELKOWITZ AND COLE
two main aims. First, we extended previous research by examining
cross-sectional associations of specific disordered eating behaviors
with NSSI and self-criticism. We specifically anticipated significant
associations of purging with NSSI, based on literature showing
increased NSSI among those with BN versus anorexia nervosa
(AN) and binge-eating disorder (Cucchi et al., 2016; Pollert,
Kauffman, & Veilleux, 2016). Second, we examined the longitudinal
relations of self-criticism with disordered eating behaviors and NSSI,
adjusting for baseline levels of each. We hypothesized that height-
ened self-criticism would be associated with increased engagement in
both disordered eating and NSSI even after adjusting for baseline
behaviors. We conducted these analyses among undergraduates (Sub-
study 1) and community-based adults with histories of disordered eat-
ing or NSSI (Sub-study 2).
2 | SUB-STUDY 1
2.1 | Sub-study 1 methods
2.1.1 | Participants
Participants included 251 students (79.5% female, 19.5% male, and
0.4% transgender) recruited from a mid-sized private university in
Tennessee, United States. Average age was 19.07 years (SD = 1.23).
Eighty percentage of participants completed follow-up assessments.
Participants with complete versus incomplete data did not differ sig-
nificantly on age, gender, baseline self-criticism (SC), recruitment
source, or baseline NSSI or disordered eating (DE) variables. We rec-
ruited through the psychology subject pool (82.9%) and campus
advertisements (16.7%). Recruitment method was unrelated to self-
criticism, NSSI, and disordered eating. The sample was 65.7% Cauca-
sian, 11.2% African American, 24.3% Asian or Asian American, 7.6%
Hispanic or Latino, and 1.6% another (participants could select more
than one option). Table 1 shows rates of disordered eating and NSSI
at waves 1 and 2.
2.1.2 | Procedure
Study descriptions noted that the goal was to understand “how peo-
ple think about themselves” and that it would include questions about
disordered eating and NSSI. Participants had to be between 18 and
25 and fluent in English. Participants completed survey measures
online at baseline and after 8 weeks. They chose course credit or
Amazon.com credit as compensation and were entered into a raffle
for an additional gift card for completing both waves. Participants
received university-based and national mental health resources after
completing each survey; those reporting elevated symptoms were
offered additional referrals to university counseling centers. The Insti-
tutional Review Board of the authors' institution approved the proce-
dures for both sub-studies (Protocol No. 130968), which conformed
to Common Rule standards.
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ZELKOWITZ AND COLE 1099

TABLE 1 Self-reported Wave 1 and

% of sample
2 disordered eating, NSSI among Behavior endorsing behaviora M SD Skewness
sub-study 1 participants
Wave 1
NSSIb 2.46 0.03 0.19 7.37
EDE-Q global — 1.56 1.34 0.98
Fasting 22.76 0.44 1.05 3.15
Binge eating 38.49 1.79 3.94 3.93
Purging 6.20 0.31 2.04 11.17
Exercise 29.46 2.16 5.03 3.06
Wave 2
NSSIb 3.98 0.06 0.35 6.05
EDE-Q global — 1.37 1.31 1.27
Fasting 18.50 0.25 0.68 4.73
Binge eating 32.65 1.36 3.07 3.93
Purging 5.61 0.26 1.69 9.50
Exercise 21.03 1.29 3.75 4.03

Note: Scraping the skin, cutting, and self-biting were the most commonly endorsed forms of NSSI in the
sample. Wave 1: Ns = 241–251. Wave 2: Ns = 195–201.
Abbreviations: EDE-Q, Eating Disorder Examination-Questionnaire; NSSI, nonsuicidal self-injury.
a
Based on number of individuals who reported engaging in behavior on at least 1 day in past month
(fasting and binge eating) or engaged in at least one episode of the behavior (NSSI, purging, and excessive
exercise).
b
Analyses based on binned data.

2.1.3 | Measures NSSI

Disordered eating
The Eating Disorder Examination-Questionnaire-6.0 (EDE-Q, Fairburn &
Beglin, 2008) is a widely used self-report measure of disordered eating
that has been shown to validly and reliably measure these symptoms in
a range of samples (Berg, Peterson, Frazier, & Crow, 2012). It assesses
disordered eating behaviors, cognitions and emotions from the past
28 days. Given our study aims, we focused on the behavior items.
Test–retest reliability estimates for these items ranged from moderate
to good in undergraduate samples over shorter time frames (Luce &
Crowther, 1999; Rø, Reas, & Lask, 2010; Rose, Vaewsorn, Rosselli-
Navarra, Wilson, & Weissman, 2013); test–retest reliability has been
shown to decrease across longer time frames (e.g., several months) and
in clinical samples (Bardone-Cone & Boyd, 2007; Reas, Grilo, &
Masheb, 2006). We focused on the fasting item (EDE-Q item 2) as clear
example of clinically relevant restriction behavior. We retained the orig-
inal scoring metric for the item (“0” to “6,” indicating no days of fasting
up to daily fasting). Purging reflected the sum of laxative misuse and
self-induced vomiting episodes. Participants self-reported the number
of times in the past month in which they engaged in compulsive exer-
cise. Binge eating was represented as days on which participants
reported eating an unusually large amount of food while experiencing
loss of control. As a supplementary analysis, we also used the global
EDE-Q score, which also includes cognitions and affect about caloric
restriction, eating, shape, and weight concerns. Internal consistency
was excellent at Waves 1 and 2 (Cronbach's α = .92 for both waves).
We used a self-report version of the Self-Injurious Thoughts and Behav-
ior Interview (SITBI, Nock, Holmberg, Photos, & Michel, 2007), a struc-
tured interview designed to assess the frequency and function of various
forms of self-injury (e.g., cutting, burning, and self-hitting). The NSSI
module asks about engagement in NSSI over the past month, past year,
and lifetime, and has shown both adequate test–retest reliability and
construct validity in a sample of older adolescents (Nock et al., 2007).
The online self-report version has been shown to reliably reflect
responses on the interview measure and has been used in previous stud-
ies of NSSI (Fox et al., 2018; Franklin, Lee, Puzia, & Prinstein, 2014). We
used the item assessing NSSI over the past month to be consistent with
the EDE-Q time frame. NSSI scores were both zero-inflated and skewed.
To reduce skew, we binned the data as follows: 0 = 0 episodes, 1 = 1–2
episodes, 2 = 3–4 episodes, and 3 = 5 or more episodes.
Self-criticism
We obtained three measures of self-criticism. The Depressive Experi-
ences Questionnaire (DEQ-SC; Blatt, D'Afflitti, & Quinlan, 1976) is a
66-item measure that measures depressive affect and cognitions
(as distinct from more normative negative affect). It uses 1 (strongly
disagree) to 7 (strongly agree) Likert scales. We used the DEQ-SC sub-
scale scoring by Bagby, Parker, Joffe, and Buis (1994), consisting of
the sum of nine construct-related items (e.g., “I often find that I don't
live up to my own standards or ideals”). Analyses of the full measure
have shown this scoring method to be psychometrically superior to
alternative versions for both clinical and undergraduate populations
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1100 ZELKOWITZ AND COLE

(Desmet et al., 2007). Coefficient alpha was .72 in this study. The
mean score was 35.60 (SD = 9.00).
The Self-Rating Scale (SRS; Hooley, Ho, Slater, & Lockshin, 2002)
is an eight-item measure of self-criticism that asks people to rate their
agreement with statements such as “others are justified in criticizing
me.” Items are rated on a 1 (strongly disagree) to 7 (strongly agree)
scale, then summed. The measure has shown good internal consis-
tency and test–retest reliability among community-based and clinical
samples (Fox et al., 2018; Perkins et al., 2019). In the present sample,
coefficient alpha was .88. Mean score was 24.55 (SD = 10.75).
The Forms of Self-Criticism/Self-Reassurance Scale (FSC, Gilbert,
Clarke, Hempel, Miles, & Irons, 2004) is a 24-item measure examining
both self-criticism and self-reassurance. Participants rate each state-
ment on a 0 (not at all like me) to 4 (extremely like me) scale. The mea-
sure has shown adequate reliability and validity in both undergraduate
and clinical samples (Gilbert et al., 2004; Kupeli et al., 2017). We
removed one item conceptually related to NSSI (i.e., “I become so
angry with myself that I want to hurt or injure myself”) and combined
the remaining self-criticism items from the “Inadequate Self” and
“Hated Self” subscales into a single score. Coefficient alpha was .88.
Mean score was 38.41 (SD = 12.41).
therefore, we used each participant's estimated factor scores as gen-
erated via the SPSS save factor score function in subsequent analyses.
Because of skewness of outcome variables, we conducted path analy-
sis via structural equation modeling using maximum likelihood estima-
tion with robust standard errors.
For Aim 1 (assessing correlations of disordered eating behaviors
with NSSI), we examined zero-order correlations of each eating variable
with self-criticism and NSSI using Pearson's r with robust standard error
estimates. For Aim 2, we tested models adjusting for Wave 1 levels of
each eating behavior and NSSI (Figure 1; each eating behavior was
assessed in a separate model). Significant path coefficients from self-
criticism to both disordered eating and NSSI would support
transdiagnostic effects of self-criticism. As a sensitivity analysis of the
relation of self-criticism with disordered eating symptoms more
broadly, we also examined the effect of self-criticism on the EDE-Q
Global score. Given the clearly directional nature of our hypotheses, we
used one-tailed tests with p < .05. We then used Benjamini and
Hochberg's (1995) procedure to control false discovery rate at α = .05
for the eight tests of the relation of self-criticism on NSSI and disor-
dered eating behaviors. Use of the MLR estimator in MPLUS enabled
us to retain cases with partial data. We prepared data in SPSS v. 26 and
used MPlus v. 7 (Muthén & Muthén, 1998–2012) for all other analyses.

2.1.4 | Data preparation and analytic approach

We used confirmatory factor analysis to assess whether the self-
criticism measures reflected a single latent factor. Results of this just-
identified model showed strong loadings on latent self-criticism
(DEQ-SC loading = 0.72; SRS loading = 0.81; FSC loading = 0.90);
F I G U R E 1 Heuristic of path diagram used to test Aim 2 in Studies
1 and 2. Each DE behavior (i.e., the composite, binge eating, purging,
restriction, and fasting) was tested in a separate model
2.2 | Sub-study 1 results
2.2.1 | Aim 1: To assess associations of disordered
eating behaviors with NSSI
We first compared the Wave 1 and Wave 2 covariance matrices of all
key variables. A model in which all Wave 1 estimates were con-
strained to their Wave 2 counterparts fit the data well, χ 2(21) = 22.89,
p > .35 indicating no significant differences. We therefore pooled the
correlations across waves (Table 2). Only fasting was significantly cor-
related with NSSI. The magnitude of this association was small but in
the expected direction (Cohen, 1988). The correlation of self-criticism
with NSSI was significant, in the expected direction and medium-
sized; the self-criticism-fasting correlation was also significant, in the
expected direction, and approaching medium-sized. Binge eating
showed a significant but small correlation with self-criticism in the
expected direction.

TABLE 2 Sub-study 1 pooled

Behavior 1 2 3 4 5 6
correlations of self-criticism with each
1. Self-criticism 1.00 nonsuicidal self-injury (NSSI) and
2. NSSI .30** 1.00 disordered eating, pearson's r with robust
3. Purge .01 .05 1.00 standard errors (Waves 1 and 2)

4. Fast .24** .10* .42** 1.00

5. Exercise .07 .03 −.06 .28** 1.00
6. Binge .10* −.04 .04 .04 .11* 1.00

*p < .05.
**p < .001 (one-tailed).
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ZELKOWITZ AND COLE 1101

TABLE 3 Study 1: Longitudinal relations of self-criticism with NSSI and disordered eating

Predictor b (SE) 95% CI β b (SE) 95% CI β

DV = wave 2 binge eating DV = wave 2 NSSI
W1 self-criticism 0.62 (0.23) a
[0.25, ∞] 0.18 0.10 (0.04)a [0.03, ∞] 0.27
W1 binge 0.35 (0.15) [0.10, ∞] 0.44 −0.003 (0.003) [−0.01, ∞] −0.03
W1 NSSI −1.30 (0.45) [−∞, −0.56] −0.08 0.49 (0.20) [0.16, ∞] 0.27
DV = wave 2 exercise DV = wave 2 NSSI
W1 self-criticism 0.18 (.25)ns [−0.23, ∞] 0.05 0.10 (0.04)a [0.03, ∞] 0.27
W1 exercise 0.39 (.12) [0.19, ∞] 0.53 0.00 (0.00) [−0.01, ∞] 0.002
W1 NSSI −0.63 (1.35) [−2.84, ∞] −0.03 0.49 (.20) [0.17, ∞] 0.27
DV = wave 2 purge DV = wave 2 NSSI
W1 self-criticism 0.05 (0.04)ns [−0.07, ∞] 0.02 0.11 (0.04)a [0.03, ∞] 0.28
W1 purge 1.212 (0.39) [0.57, ∞] 0.92 −0.03 (.01) [−0.05, ∞] −0.16
W1 NSSI −1.34 (0.84) [−2.72, ∞] −0.09 0.52 (0.21) [0.18, ∞] 0.28
DV = wave 2 fasting DV = wave 2 NSSI
W1 self-criticism 0.09 (.05)a [0.01, ∞] 0.12 0.10 (.05)a [0.03, ∞] 0.28
W1 fasting 0.31 (0.14) [0.08, ∞] 0.48 −0.01 (0.02) [−0.04, ∞] −0.02
W1 NSSI −0.17 (0.25) [−0.58, ∞] −0.05 0.50 (0.20) [0.18, ∞] 0.27

Note: Model ns range from 246 to 247. Each analysis controlled for baseline NSSI and the designated disordered eating behavior. Pattern of significant
results remained consistent when sample was restricted to women (model ns ranged from 198 to 199). Bold indicates values included in adjustment for
multiple comparisons.
Abbreviations: DV, dependent variable; NSSI, nonsuicidal self-injury.
a
Values significant at p < .05 (one-tailed) following Benjamini-Hochberg adjustment for multiple comparisons. Confidence intervals for one-tailed tests used
in these analyses are bound by lower estimates only.

2.2.2 | Aim 2: To assess longitudinal relations
of self-criticism with disordered eating and NSSI
Table 3 shows the relations of Wave 1 self-criticism with Wave 2 disordered
eating and NSSI. Results for each model are presented in a single table for
conciseness. For clarity, only p-values of results adjusted using Benjamini-
Hochberg's procedure are presented. Wave 1 self-criticism showed signifi-
cant longitudinal effects on binge eating and fasting after adjusting for these
behaviors and NSSI at baseline. The effect on NSSI was significant regard-
less of the eating behavior for which we adjusted. In the sensitivity analysis,
only the effect on NSSI was significant (Table S1). The pattern of results
remained the same when we restricted analyses to women.
3 | SUB-STUDY 2
This sub-study addressed the same aims as the first using community-
based adults who reported a lifetime history of either disordered eat-
ing, NSSI, or both behaviors.
3.1 | Sub-study 2 methods
3.1.1 | Participants
Participants were adults aged 18–30 (M = 24.65, SD = 3.58) recruited
from across the United States via Qualtrics Panels, a web-based
research volunteer management system. Volunteers completed sur-
veys in exchange for points redeemable for airline miles, gift cards,
and so forth. Participants were screened out for excessively
fast responding (<15 min) or for incorrect responses to validity indica-
tors (DeSimone & Harms, 2018; Wood, Harms, Lowman, &
DeSimone, 2017). Individuals were eligible if they reported a lifetime
history of NSSI, DE, or both behaviors. We attempted to recruit
roughly equal numbers of participants with each history (33.66%
NSSI, 30.37% disordered eating, 35.98% both). Most participants
were women (88.8%); 9.1% identified as men, 2.1% identified as
transgender or another gender. Participants self-reported race/ethnic-
ity: 72.53% Caucasian, 14.31% Hispanic or Latino, 12.19% African
American, 6.58% Asian or Asian American, 2.71% American Indian,
and 1.55% another (percentages do not sum to 100 as participants
could select more than one option).
At Wave 1, 307 individuals completed measures. Of these,
139 (45.28%) completed follow-up assessments. Because of the low
retention rate, we implemented data replenishment (Mazen, Tong, &
Taylor, 2019; Taylor, Tong, & Maxwell, 2019), a robust sample replen-
ishment method that can reduce the potentially biasing effects of
attrition. We recruited an additional 210 participants at Wave 2 to
replace those lost to attrition (giving us 349 participants at Wave
2, and a total N of 517, including replenishment participants). These
additional participants were attained from the same population and
screened for NSSI/disordered eating history to ensure that each
behavioral history pattern (i.e., NSSI only, disordered eating only, and
NSSI+ disordered eating) was equally represented at Waves 1 and
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1102 ZELKOWITZ AND COLE

2. On average, participants who did not complete Wave 2 assessments
were slightly younger, t(301.61) = 2.52 (p = .01) and less self-critical,
t(305) = 2.24 (p = .03) than those who completed follow-up assess-
ments. Those who completed both assessments did not differ from
replenishment participants on any study variables.
3.1.2 | Procedure
Participants completed questionnaires anonymously online and were
shown listings of national mental health resources after each survey.
Participants were prompted to complete Wave 2 4 weeks after com-
pleting Wave 1. Replenishment participants were recruited at this
time. All participants received credit redeemable for rewards as com-
pensation at each wave.
3.1.3 | Measures
We used the NSSI module of the SITBI, the behavior items of the
EDE-Q and all self-criticism measures. We again assessed the effect
of self-criticism on EDE-Q global score as a sensitivity analysis.
Table 4 shows descriptive statistics for the variables of interest for the
original participants at Waves 1 and 2 and the replenishment sample.
Wave 1 alpha coefficients were .86 for the SRS (Mean score = 35.04,
SD = 10.46), .89 for the FSC (M = 46.59, SD = 10.25), and .83 and .79
for the DEQ-SC (M = 41.29, SD = 10.32). For the EDE-Q global score,
internal consistency was .90 at Waves 1 and 2.
The range of NSSI episodes was greater in Study 2, so we added
additional bins to better capture the distribution. Bins were coded as
follows: 0 to 4 episodes were each coded as such, 5–10 episodes
were coded as “5” and greater than 10 episodes in the past month
received a code of “6.”
3.2 | Sub-study 2 results
3.2.1 | Aim 1: To assess associations of disordered
eating behaviors with NSSI
We again found no significant differences between the Wave 1 and
Wave 2 covariance matrices (χ 2(21) = 25.01, p > .25). Table 5 pre-
sents the pooled cross-sectional associations of each eating behav-
ior, NSSI, and self-criticism. Purging showed small but significant

TABLE 4 Sub-study 2: Descriptive

% of sample endorsing
statistics for NSSI and disordered eating
Behavior behaviora M SD Skewness
behaviors
Wave 1 (N = 307)
NSSIa 16.01 0.44 1.28 3.24
EDE-Q global — 2.73 1.37 −0.004
Fasting 56.68 1.19 1.50 1.43
Binge eating 65.80 3.97 5.67 2.32
Purging 29.97 2.50 6.28 3.52
Exercise 48.37 4.19 7.31 2.50
Wave 2 original participants (N = 139)
NSSIb 15.11 0.41 1.22 3.37
EDE-Q global — 2.52 1.45 0.08
Fasting 58.27 1.17 1.44 1.47
Binge eating 56.52 3.86 5.87 2.43
Purging 28.06 2.42 6.19 3.86
Exercise 35.97 2.68 5.73 2.96
Wave 2 replenishment participants (N = 210)
NSSIb 16.67 0.47 1.33 3.17
EDE-Q global — 2.53 1.43 0.08
Fasting 53.81 0.96 1.25 1.70
Binge eating 64.29 4.09 5.81 2.23
Purging 28.23 2.98 8.45 4.42
Exercise 42.11 3.68 7.01 2.70

Abbreviations: EDE-Q, Eating Disorder Examination-Questionnaire; NSSI, nonsuicidal self-injury.

a
Based on number of individuals who reported engaging in behavior on at least 1 day in past month
(fasting and binge eating) or engaged in at least one episode of the behavior (NSSI, purging, and excessive exercise).
b
Analyses conducted on binned data.
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ZELKOWITZ AND COLE 1103

TABLE 5 Sub-study 2: Pooled

Behavior 1 2 3 4 5 6
correlations of self-criticism, nonsuicidal
self-injury (NSSI), and disordered eating 1. Self-criticism 1.00
2. NSSI .19*** 1.00
3. Purge .19*** .20*** 1.00
4. Fast .25*** .05 .34*** 1.00
5. Exercise .09* .13** .47*** .32*** 1.00
6. Binge .21*** .07 .18*** .20*** .27*** 1.00

*p < .05.
**p < .01.
***p < .001 (one-tailed).

TABLE 6 Study 2: Longitudinal

Predictor B (SE) 95% CI β B (SE) 95% CI β
relations of self-criticism with NSSI and
disordered eating DV = wave 2 binge eating DV = wave 2 NSSI
W1 self-criticism 0.39 (0.48) ns [−0.40, ∞] 0.06 0.20 (0.10)a [0.04, ∞] 0.14
W1 binge 0.59 (0.11) [0.40, ∞] 0.57 0.01 (0.02) [−0.02, ∞] 0.03
W1 NSSI 0.59 (0.59) [−0.38, ∞] 0.13 0.21 (0.13) [0.004, ∞] 0.21
DV = wave 2 purge DV = wave 2 NSSI
W1 self-criticism 1.10 (0.45)a [0.37, ∞] 0.14 0.14 (.09)ns [−0.02, ∞] 0.10
W1 purge 0.85 (0.15) [0.61, ∞] 0.74 0.06 (0.02) [0.02, ∞] 0.31
W1 NSSI −0.07 (0.37) [−0.67, ∞] −0.01 0.12 (0.11) [−0.06, ∞] 0.12
DV = wave 2 exercise DV = wave 2 NSSI
W1 self-criticism 1.05 (0.47)a [0.28, ∞] 0.15 0.17 (0.10) ns [0.01, ∞] 0.12
W1 exercise 0.55 (0.12) [0.35, ∞] 0.62 0.02 (0.02) [−0.04, ∞] 0.19
W1 NSSI 0.31 (0.33) [−0.24, ∞] 0.06 0.19 (0.12) [−0.01, ∞] 0.13
DV = wave 2 fasting DV = wave 2 NSSI
W1 self-criticism 0.21 (0.09)a [0.06, ∞] 0.15 0.13 (0.11) ns [−0.04, ∞] 0.10
W1 fasting 0.34 (0.08) [0.21, ∞] 0.38 0.17 (0.10) [0.01, ∞] 0.20
W1 NSSI 0.02 (0.07) [−0.10, ∞] 0.02 0.21 (0.12) [0.01, ∞] 0.21

Note: Each model controls for baseline NSSI and disordered eating behavior (n = 517). Bold indicates
values included in adjustment for multiple comparisons.
Abbreviations: DV, dependent variable; NSSI, nonsuicidal self-injury.
a
Values significant at p < .05 following Benjamini-Hochberg adjustment for multiple comparisons.
Confidence intervals for one-tailed tests used in these analyses are bound by lower estimates only. Rela-
tion of baseline self-criticism to NSSI adjusting for binge eating was not significant when analyses were
restricted to women (n = 459) or those who completed both waves of the study (n = 139).

associations with NSSI. Self-criticism showed significant, small-
to-medium correlations with all disordered eating behaviors and
NSSI (Cohen, 1988).
3.2.2 | Aim 2: To assess longitudinal relations
of SC with disordered eating and NSSI
Table 6 shows longitudinal relations of Wave 1 self-criticism on each
Wave 2 eating behavior and NSSI, adjusting for baseline levels of both
behaviors. As in Study 1, eating behaviors changed across the analyses,
such that each model contained NSSI and one eating behavior
(Figure 1). After adjusting for baseline disordered eating and NSSI, self-
criticism showed significant longitudinal relations with purging, fasting,
and excessive exercise. The relation to NSSI at follow-up was
significant only when we adjusted for baseline NSSI and binge eating;
this relation was no longer significant when we limited analyses to
women or those who participated at both waves. Effects of self-
criticism on the EDE-Q global score and NSSI were not significant. See
Table S2.
4 | DI SCU SSION
Clinicians and researchers increasingly recognize substantial comorbid-
ity between disordered eating and NSSI and seek to explain
mechanisms of this relation. This work explored cross-sectional associa-
tions of specific disordered eating behaviors with NSSI, as well as
examining longitudinal relations of self-criticism with disordered eating
and NSSI in two samples. Three key findings emerged. First, we noted

1104
small but significant cross-sectional associations of various disordered
eating behaviors with NSSI in two studies, although the pattern of asso-
ciations varied across samples. Second, we observed significant cross-
sectional correlations of self-criticism with specific disordered eating
behaviors and NSSI. Third, we found partial support for self-criticism as
a transdiagnostic predictor of disordered eating and NSSI.
Few studies have examined the correlations between NSSI and spe-
cific disordered eating behaviors. Our first main finding was significant
cross-sectional associations of fasting and restriction with NSSI in the
undergraduate sample (Sub-study 1) and of purging with NSSI in the
sample of community-based adults with lifetime histories of either disor-
dered eating or NSSI (Sub-study 2). The Sub-study 2 finding was consis-
tent with our expectation that we would observe stronger associations
of NSSI with purging compared to other disordered eating behaviors
and the literature showing heightened lifetime NSSI prevalence among
those with BN versus AN (Cucchi et al., 2016). The current results
extend previous research by highlighting the association of NSSI with
past-month purging among community-based adults (who had a history
of either disordered eating, NSSI, or both). Significant associations of
NSSI with fasting and restriction in the undergraduate sample, although
unexpected, were consistent with findings by Wang, Pisetsky, Skutch,
Fruzzetti, and Haynos (2018). Taken together, these findings may indi-
cate differential associations of NSSI with various disordered eating
behaviors across different populations, although further research is nec-
essary to confirm this. Given that different eating behaviors correlated
with NSSI in across studies 1 and 2, we advocate studying and screening
for NSSI among people presenting with all forms of disordered eating.
Our second main finding was that of cross-sectional associations
of self-criticism with specific disordered eating behaviors and NSSI.
Significant associations of self-criticism across the full range of disor-
dered eating behaviors were somewhat unexpected, given previous
findings of differential associations of SC with diagnoses of BN versus
AN (Zelkowitz & Cole, 2018, although see Limburg, Watson, Hagger, &
Egan, 2017, for meta-analytic support for cross-sectional associations
of perfectionism with both AN and BN). Fairburn, Cooper, and
Shafran (2003) proposed that low self-esteem and extreme perfec-
tionism, both constructs closely related to SC, and function trans-
diagnostically across eating disorders. The current findings support
this model and suggest associations of SC with disordered eating
behaviors regardless of formal diagnosis.
Our third main finding was significant longitudinal relations of
self-criticism with disordered eating and NSSI in Sub-study 1 and
partial support for these relations in Sub-study 2. Our disordered
eating findings for the undergraduate sample were both consistent
with and extend previous studies of related constructs in this popu-
lation. For example, Kelly and Tasca (2016) found that increased
self-compassion protected against dietary restraint in a daily diary
study of undergraduates, after adjusting for self-esteem. Significant
cross-sectional associations of both self-criticism and perfectionism
with dieting and binge eating have been reported, as has initial evi-
dence for longitudinal relations of perfectionism with disordered eat-
ing (Bardone-Cone et al., 2007; MacKinnon et al., 2011; Sherry,
Stoeber, & Ramasubbu, 2016).
1098108x, 2020, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23284 by Consorci De Serveis Universitaris De Catalunya, Wiley Online Library on [18/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ZELKOWITZ AND COLE
Only the relation of self-criticism with fasting replicated in the
second sample. The nonsignificant relation of self-criticism with binge
eating at follow-up was unexpected, given past research on self-
critical perfectionism and binge eating (Boone et al., 2014). Identifying
factors that moderate the association of self-criticism and binge eat-
ing represents an important next step.
We observed significant longitudinal relations of self-criticism to
purging and excessive exercise in the second sample. Higher prevalence
of these behaviors in this sample may explain the discrepancy in the
findings across samples. Longitudinal relations of self-criticism with
fasting, purging, and exercise in Sub-study 2 are consistent with previ-
ous literature that has examined related constructs such as perfection-
ism and self-hatred on AN and BN symptoms more broadly (Halmi
et al., 2012; Kehayes, Smith, Sherry, Vidovic, & Saklofske, 2019;
Limburg et al., 2017; Nilsson, Sundbom, & Hägglöf, 2008; Shingleton
et al., 2013; Turner, Yiu, Claes, Muehlenkamp, & Chapman, 2016;
Tyrka, Waldron, Graber, & Brooks-Gunn, 2002). They contrast some-
what, however, with work by Perkins et al. (2019), that showed no sig-
nificant relation of self-criticism with follow-up disordered eating after
adjusting for baseline disordered eating symptoms and NSSI. This could
be because the subscales of use in that study emphasize DE-related
cognitions, and there may be little variance remaining to explain after
adjusting for these cognitions at baseline. Similarly, we found no signifi-
cant relation of self-criticism with the EDE-Q global scale in either of
our samples.
Our NSSI findings for Sub-study 1 are commensurate with Fox
et al.'s (2018) results of a significant relation of self-criticism with NSSI
over 4 weeks and those of Perkins et al.'s (2019) that identified a sig-
nificant relation of self-criticism with NSSI after 2 months. Our find-
ings diverge from Daly and Willoughby's (2019) report of a
nonsignificant longitudinal relation of self-criticism with NSSI among
undergraduates; however, the authors evaluated the relation over a
one-year lag, suggesting that it may be time-limited.
Support for a longitudinal relation of self-criticism to NSSI was
less robust in Sub-study 2. Self-criticism showed a significant pro-
spective relation with NSSI only when we adjusted for baseline binge
eating. High levels of comorbid disordered eating behaviors in this
sample may explain the discrepancy; self-criticism may lead to height-
ened risk of NSSI behaviors via engagement in increased disordered
eating among those who engage in both types of behavior. Examining
such mediational models is an important direction for future
research.
Understanding such pathways is central to etiological theories
of their comorbidity (Claes & Muehlenkamp, 2014; Svirko &
Hawton, 2007). To our knowledge, this is the first prospective exami-
nation of the relation of self-criticism to both disordered eating and
NSSI among nonclinical samples adjusting for prior levels of both
behaviors. The results echo other findings that point to common func-
tions and motivations across these behaviors (Fox et al., 2019;
Muehlenkamp, Takakuni, Brausch, & Peyerl, 2019; Wang et al., 2018).
Hooley and Franklin (2018) theorized that self-criticism may
erode the self-regard that typically protects against self-injury; our
results suggest that this process may be relevant to disordered eating

ZELKOWITZ AND COLE
as well. This effect may be particularly germane for fasting, given the
replication of this finding across samples. Recent efforts to under-
stand harm-related intentions for disordered eating behaviors suggest
that people engaging in extreme restriction may intend to cause long-
term harm, even death (Fox et al., 2018). Initial evidence suggests that
self-criticism may relate differentially to NSSI depending on the func-
tion of the behavior (Itzhaky, Shahar, Stein, & Fennig, 2016). Further
exploration of how self-criticism relates to disordered eating behav-
iors and NSSI across differing behavioral functions represents an
important next step for the field. For example, self-criticism may rep-
resent a primary treatment target among individuals who engage in
these behaviors for self-punishment.
Strengths of the present work include use of multiple samples
with common measures to facilitate cross-study comparisons, assess-
ment of discrete DE behaviors, and comprehensive assessment of
self-criticism. Study limitations also exist. One limitation was reliance
on self-reported disordered eating and NSSI. Future research would
benefit from combining self-report and clinical interviews about NSSI
and disordered eating. A second limitation concerned the change in
intervals between waves for the two sub-studies. Although guided by
pragmatic considerations, this does prevent direct comparisons of
findings from samples 1 and 2. The relation of self-criticism to
changes in NSSI and disordered eating almost certainly vary as a func-
tion of time lag. For a fuller picture of the dynamic relation of self-
criticism to disordered eating and NSSI behaviors, multi-wave studies
would be useful.
Retention of participants in Sub-study 2 was much lower than in
Sub-study 1. We attempted to address this through the use of the
replenishment strategy but sensitivity analyses suggest this may have
impacted our findings for NSSI. Additionally, both samples also
included relatively few participants who identified as men, precluding
gender comparisons. This is an important area for future research,
given support for gender differences in the constructs of interest
(Daly & Willoughby, 2019; Forbush, Heatherton, & Keel, 2007).
Understanding causes of direct and indirect self-harm and their
comorbidity is crucial to enhancing prevention and treatment efforts.
The present work highlights associations of the full range of disor-
dered eating behaviors with NSSI. Findings suggest that self-criticism
may act transdiagnostically on both sets of problem behaviors and
thus represents an important target for intervention.
ACKNOWLEDGMENTS
This material is the result of work supported with resources and the
use of facilities at the VA Boston Healthcare System. The views
expressed in this article are those of the authors and do not necessar-
ily reflect the position or policy of the Department of Veterans Affairs
or the United States Government. R. L. Z. was supported in part from
the National Institute of Mental Health National Research Service
Award F31MH108241-01A1. D. A. C. was supported in part by a gift
from the Patricia & Rodes Hart Foundation. We gratefully acknowl-
edge Rachel Anand, Andrew C. Porter, Anna Skubel, and Elizabeth
Weiss for assistance with data collection.
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1105
CONFLIC T OF INT ER E ST
The authors declare that they have no conflicts of interest.
DATA AVAILABILITY STAT EMEN T
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
OR CID
Rachel L. Zelkowitz https://orcid.org/0000-0002-3083-4669
RE FE RE NCE S
Bagby, R. M., Parker, J. D. A., Joffe, R. T., & Buis, T. (1994). Reconstruction
and validation of the depressive experiences questionnaire. Assess-
ment, 1(1), 59–68. https://doi.org/10.1177/1073191194001001009
Bardone-Cone, A. M., & Boyd, C. A. (2007). Psychometric properties of
eating disorder instruments in Black and White young women: Internal
consistency, temporal stability, and validity. Psychological Assessment,
19(3), 356–362. https://doi.org/10.1037/1040-3590.19.3.356
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M.,
Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and
eating disorders: Current status and future directions. Clinical Psychol-
ogy Review, 27(3), 384–405. https://doi.org/10.1016/j.cpr.2006.
12.005
Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012). Psychometric
evaluation of the eating disorder examination and eating disorder
examination-questionnaire: Asystematic review of the literature: Psy-
chometrics of the EDE and EDE-Q. International Journal of Eating
Disorders, 45(3), 428–438. https://doi.org/10.1002/eat.20931
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate:
A practical and powerful approach to multiple testing. Journal of the
Royal Statistical Society: Series B (Methodological), 57(1), 289–300.
https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
Blatt, S. J., D'Afflitti, J. P., & Quinlan, D. M. (1976). Experiences of depres-
sion in normal young adults. Journal of Abnormal Psychology, 85(4),
383–389. https://doi.org/10.1037/0021-843X.85.4.383
Boone, L., Vansteenkiste, M., Soenens, B., van der Kaap-Deeder, J., &
Verstuyf, J. (2014). Self-critical perfectionism and binge eating symp-
toms: A longitudinal test of the intervening role of psychological need
frustration. Journal of Counseling Psychology, 61, 363–373. https://doi.
org/10.1037/a0036418
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A sys-
tematic review. Frontiers in Psychology, 8, 1–14. https://doi.org/10.
3389/fpsyg.2017.01946
Claes, L., & Muehlenkamp, J. J. (Eds.). (2014). Non-suicidal self-injury in eat-
ing disorders: Advancements in etiology and treatment. Berlin, Germany:
Springer-Verlag Retrieved from www.springer.com/us/book/
9783642401060
Cohen, J. (1988). Statistical power analysis for the behavioral sciences
(2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.
Cucchi, A., Ryan, D., Konstantakopoulos, G., Stroumpa, S., Kaçar, A. Ş.,
Renshaw, S., … Kravariti, E. (2016). Lifetime prevalence of non-suicidal
self-injury in patients with eating disorders: A systematic review and
meta-analysis. Psychological Medicine, 46(7), 1345–1358. https://doi.
org/10.1017/S0033291716000027
Daly, O., & Willoughby, T. (2019). A longitudinal study investigating
bidirectionality among nonsuicidal self-injury, self-criticism, and paren-
tal criticism. Psychiatry Research, 271, 678–683. https://doi.org/10.
1016/j.psychres.2018.12.056
DeSimone, J. A., & Harms, P. D. (2018). Dirty data: The effects of screen-
ing respondents who provide low-quality data in survey research. Jour-
nal of Business Psychology, 33(5), 559–577. https://doi.org/10.1007/
s10869-017-9514-9

1106
Desmet, M., Vanheule, S., Groenvynck, H., Verhaeghe, P., Vogel, J., &
Bogaerts, S. (2007). The depressive experiences questionnaire: An
inquiry into the different scoring procedures. European Journal of Psy-
chological Assessment, 23(2), 89–98. https://doi.org/10.1027/1015-
5759.23.2.89
Fairburn, C. G., & Beglin, S. J. (2008, 2008). The eating disorder
examination-questionnaire 6.0. Appendix. In Cognitive behavior therapy
and eating disorders. New York, NY: Guilford Press.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour ther-
apy for eating disorders: A “transdiagnostic” theory and treatment.
Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.
1016/s0005-7967(02)00088-8
Forbush, K., Heatherton, T. F., & Keel, P. K. (2007). Relationships between
perfectionism and specific disordered eating behaviors. The Interna-
tional Journal of Eating Disorders, 40(1), 37–41. https://doi.org/10.
1002/eat.20310
Fox, K. R., Wang, S. B., Boccagno, C., Haynos, A. F., Kleiman, E., &
Hooley, J. M. (2019). Comparing self-harming intentions underlying
eating disordered behaviors and NSSI: Evidence that distinctions are
less clear than assumed. The International Journal of Eating Disorders,
52(5), 564–575. https://doi.org/10.1002/eat.23041
Fox, K. R., Ribeiro, J. D., Kleiman, E. M., Hooley, J. M., Nock, M. K., &
Franklin, J. C. (2018). Affect toward the self and self-injury stimuli
as potential risk factors for nonsuicidal self-injury. Psychiatry
Research, 260, 279–285. https://doi.org/10.1016/j.psychres.2017.
11.083
Franklin, J. C., Lee, K. M., Puzia, M. E., & Prinstein, M. J. (2014). Recent and
frequent nonsuicidal self-injury is associated with diminished implicit
and explicit aversion toward self-cutting stimuli. Clinical Psychological
Science, 2(3), 306–318. https://doi.org/10.1177/2167702613503140
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M.,
Huang, X., … Nock, M. K. (2017). Risk factors for suicidal thoughts and
behaviors: A meta-analysis of 50 years of research. Psychological Bulle-
tin, 143(2), 187–232. https://doi.org/10.1037/bul0000084
van Furth, E. F., van der Meer, A., & Cowan, K. (2016). Top 10 research
priorities for eating disorders. The Lancet Psychiatry, 3(8), 706–707.
https://doi.org/10.1016/S2215-0366(16)30147-X
Gilbert, P., Clarke, M., Hempel, S., Miles, J. N. V., & Irons, C. (2004). Criti-
cizing and reassuring oneself: An exploration of forms, styles and rea-
sons in female students. The British Journal of Clinical Psychology,
43(Pt 1), 31–50. https://doi.org/10.1348/014466504772812959
Halmi, K. A., Bellace, D., Berthod, S., Ghosh, S., Berrettini, W.,
Brandt, H. A., … Strober, M. (2012). An examination of early childhood
perfectionism across anorexia nervosa subtypes. The International
Journal of Eating Disorders, 45(6), 800–807. https://doi.org/10.1002/
eat.22019
Hooley, J. M., & Franklin, J. C. (2018). Why do people hurt themselves? A
new conceptual model of nonsuicidal self-injury. Clinical Psychological
Science, 6(3), 428–451. https://doi.org/10.1177/2167702617745641
Hooley, J. M., Ho, D. T., Slater, J. A., & Lockshin, A. (2002). Pain insensitivity
and self-harming behavior. Paper presented at the annual meeting of
the Society for Research in Psychopathology.
Itzhaky, L., Shahar, G., Stein, D., & Fennig, S. (2016). In eating-disordered
inpatient adolescents, self-criticism predicts nonsuicidal self-injury.
Suicide & Life-Threatening Behavior, 46(4), 385–397. https://doi.org/
10.1111/sltb.12223
Kehayes, I.-L., Smith, M., Sherry, S., Vidovic, V., & Saklofske, D. (2019). Are
perfectionism dimensions risk factors for bulimic symptoms? A meta-
analysis of longitudinal studies. Personality and Individual Differences,
138, 117–125. https://doi.org/10.1016/j.paid.2018.09.022
Kelly, A. C., & Tasca, G. A. (2016). Within-persons predictors of change
during eating disorders treatment: An examination of self-compassion,
self-criticism, shame, and eating disorder symptoms. The International
1098108x, 2020, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23284 by Consorci De Serveis Universitaris De Catalunya, Wiley Online Library on [18/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ZELKOWITZ AND COLE
Journal of Eating Disorders, 49(7), 716–722. https://doi.org/10.1002/
eat.22527
Kupeli, N., Chilcot, J., Schmidt, U. H., Campbell, I. C., & Troop, N. A. (2013).
A confirmatory factor analysis and validation of the forms of self-
criticism/reassurance scale: CFA of FSCRS. British Journal of Clinical
Psychology, 52(1), 12–25. https://doi.org/10.1111/j.2044-8260.2012.
02042.x
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relation-
ship between perfectionism and psychopathology: A meta-analysis.
Journal of Clinical Psychology, 73(10), 1301–1326. https://doi.org/10.
1002/jclp.22435
Luce, K. H., & Crowther, J. H. (1999). The reliability of the eating disorder
examination-self-report questionnaire version (EDE-Q). The Interna-
tional Journal of Eating Disorders, 25(3), 349–351.
Mackinnon, S. P., Sherry, S. B., Graham, A. R., Stewart, S. H., Sherry, D. L.,
Allen, S. L., … McGrath, D. S. (2011). Reformulating and testing the
perfectionism model of binge eating among undergraduate women: A
short-term, three-wave longitudinal study. Journal of Counseling Psy-
chology, 58(4), 630–646. https://doi.org/10.1037/a0025068
Mazen, J. A. M., Tong, X., & Taylor, L. K. (2019). Evaluation of supplemen-
tal samples in longitudinal research with non-normal missing data.
Behavior Research Methods, 51(3), 1321–1335. https://doi.org/10.
3758/s13428-018-1070-3
Muehlenkamp, J. J., Takakuni, S., Brausch, A. M., & Peyerl, N. (2019).
Behavioral functions underlying NSSI and eating disorder behaviors.
Journal of Clinical Psychology, 75(7), 1219–1232. https://doi.org/10.
1002/jclp.22745
Muthén, L. K., & Muthén, B. O. (1998–2012). Mplus User's Guide (7th ed.).
Los Angeles, CA: Muthén & Muthén.
Nock, M. K. (2009). Why do people hurt themselves? New insights into
the nature and functions of self-injury. Current Directions in Psychologi-
cal Science, 18(2), 78–83. https://doi.org/10.1111/j.1467-8721.2009.
01613.x
Nilsson, K., Sundbom, E., & Hägglöf, B. (2008). A longitudinal study of per-
fectionism in adolescent onset anorexia nervosa-restricting type.
European Eating Disorders Review: The Journal of the Eating Disorders
Association, 16(5), 386–394. https://doi.org/10.1002/erv.850
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-
injurious thoughts and behaviors interview: Development, reliability,
and validity in an adolescent sample. Psychological Assessment, 19(3),
309–317. https://doi.org/10.1037/1040-3590.19.3.309
Perkins, N. M., Ortiz, S. N., & Smith, A. R. (2019). Self-criticism longitudi-
nally predicts nonsuicidal self-injury in eating disorders. Eating Disor-
ders, 28(2), 151–170. https://doi.org/10.1080/10640266.2019.
1695450
Pollert, G. A., Kauffman, A. A., & Veilleux, J. C. (2016). Symptoms of psy-
chopathology within groups of eating-disordered, restrained eating,
and unrestrained eating individuals: Symptoms of psychopathology.
Journal of Clinical Psychology, 72(6), 621–632. https://doi.org/10.
1002/jclp.22283
Procopio, C. A., Holm-Denoma, J. M., Gordon, K. H., & Joiner, T. E. (2006).
Two–three-year stability and interrelations of bulimotypic indicators
and depressive and anxious symptoms in middle-aged women. Interna-
tional Journal of Eating Disorders, 39(4), 312–319. https://doi.org/10.
1002/eat.20242
Reas, D. L., Grilo, C. M., & Masheb, R. M. (2006). Reliability of the eating
disorder examination-questionnaire in patients with binge eating dis-
order. Behaviour Research and Therapy, 44(1), 43–51. https://doi.org/
10.1016/j.brat.2005.01.004
Rø, Ø., Reas, D. L., & Lask, B. (2010). Norms for the eating disorder exami-
nation questionnaire among female university students in Norway.
Nordic Journal of Psychiatry, 64(6), 428–432. https://doi.org/10.3109/
08039481003797235

ZELKOWITZ AND COLE
Rose, J. S., Vaewsorn, A., Rosselli-Navarra, F., Wilson, G. T., &
Weissman, R. S. (2013). Test-retest reliability of the eating disorder
examination-questionnaire (EDE-Q) in a college sample. Journal of Eat-
ing Disorders, 1(1), 42. https://doi.org/10.1186/2050-2974-1-42
Sherry, S. B., Stoeber, J., & Ramasubbu, C. (2016). Perfectionism explains
variance in self-defeating behaviors beyond self-criticism: Evidence
from a cross-national sample. Personality and Individual Differences, 95,
196–199. https://doi.org/10.1016/j.paid.2016.02.059
Shingleton, R. M., Eddy, K. T., Keshaviah, A., Franko, D. L., Swanson, S. A.,
Yu, J. S., … Herzog, D. B. (2013). Binge/purge thoughts in nonsuicidal
self-injurious adolescents: An ecological momentary analysis. The Inter-
national Journal of Eating Disorders, 46(7), 684–689. https://doi.org/
10.1002/eat.22142
Smith, A. R., Velkoff, E. A., Ribeiro, J. D., & Franklin, J. (2018). Are eating
disorders and related symptoms risk factors for suicidal thoughts and
behaviors? A meta-analysis. Suicide and Life-Threatening Behavior, 49,
221–239. https://doi.org/10.1111/sltb.12427
Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disor-
ders: The extent and nature of the association. Suicide and Life-
Threatening Behavior, 37(4), 409–421. https://doi.org/10.1521/suli.
2007.37.4.409
Taylor, L. K., Tong, X., & Maxwell, S. E. (2019). Evaluating supplemental
samples in longitudinal research: Replacement and refreshment
approaches. Multivariate Behavioral Research, 55(2), 277–299. https://
doi.org/10.1080/00273171.2019.1628694
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. Lancet
(London, England), 375(9714), 583–593. https://doi.org/10.1016/
S0140-6736(09)61748-7
Turner, B. J., Yiu, A., Claes, L., Muehlenkamp, J. J., & Chapman, A. L. (2016).
Occurrence and co-occurrence of nonsuicidal self-injury and disordered
eating in a daily diary study: Which behavior, when? Psychiatry Research,
246, 39–47. https://doi.org/10.1016/j.psychres.2016.09.012
Tyrka, A. R., Waldron, I., Graber, J. A., & Brooks-Gunn, J. (2002). Prospec-
tive predictors of the onset of anorexic and bulimic syndromes. Inter-
national Journal of Eating Disorders, 32(3), 282–290. https://doi.org/
10.1002/eat.10094
1098108x, 2020, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23284 by Consorci De Serveis Universitaris De Catalunya, Wiley Online Library on [18/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1107
van der Kaap-Deeder, J., Smets, J., & Boone, L. (2016). The impeding role
of self-critical perfectionism on therapeutic alliance during treatment
and eating disorder symptoms at follow-up in patients with an eating
disorder. Psychologica Belgica, 56(2), 100–110. https://doi.org/10.
5334/pb.297
Wang, S. B., Pisetsky, E. M., Skutch, J. M., Fruzzetti, A. E., & Haynos, A. F.
(2018). Restrictive eating and nonsuicidal self-injury in a nonclinical
sample: Co-occurrence and associations with emotion dysregulation
and interpersonal problems. Comprehensive Psychiatry, 82, 128–132.
https://doi.org/10.1016/j.comppsych.2018.02.005
Wood, D., Harms, P. D., Lowman, G. H., & DeSimone, J. A. (2017). Response
speed and response consistency as mutually validating indicators of
data quality in online samples. Social Psychological and Personality Sci-
ence, 8(4), 454–464. https://doi.org/10.1177/1948550617703168
You, J., Lin, M.-P., & Leung, F. (2014). A longitudinal moderated mediation
model of nonsuicidal self-injury among adolescents. Journal of Abnor-
mal Child Psychology, 43, 381–390. https://doi.org/10.1007/s10802-
014-9901-x
Zelkowitz, R. L., & Cole, D. A. (2018). Self-criticism as a transdiagnostic
process in nonsuicidal self-injury and disordered eating: Systematic
review and meta-analysis. Suicide and Life-Threatening Behavior, 49(1),
310–327. https://doi.org/10.1111/sltb.12436
SUPPORTING INF ORMATION
Additional supporting information may be found online in the
Supporting Information section at the end of this article.
How to cite this article: Zelkowitz RL, Cole DA. Longitudinal
relations of self-criticism with disordered eating behaviors and
nonsuicidal self-injury. Int J Eat Disord. 2020;53:1097–1107.
https://doi.org/10.1002/eat.23284