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Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study
  1. Anna Lavis1,
  2. Sheryllin McNeil2,
  3. Helen Bould3,4,
  4. Anthony Winston5,
  5. Kalen Reid6,
  6. Christina L Easter1,
  7. Rosina Pendrous1,
  8. Maria Michail7
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
  3. 3Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School & Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  4. 4Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
  5. 5Coventry and Warwickshire Partnership Trust, Coventry, UK
  6. 6Youth Advisory Group, Institute for Mental Health, University of Birmingham, Birmingham, UK
  7. 7Institute for Mental Health, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Anna Lavis; a.c.lavis{at}


Introduction Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16–25 diagnosed with an eating disorder. It will explore participants’ perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons’ Advisory Group, who will be key to study delivery and dissemination.

Methods and analysis This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16–25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants’ feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20–30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant’s data from both phases compared alongside comparative analysis of the datasets as a whole.

Ethics and dissemination The study gained ethical approval from the NHS HRA West Midlands–Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).

  • eating disorders
  • suicide & self-harm
  • child & adolescent psychiatry

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors AL, MM, KR, CLE, SM, HB and AW all designed the study. AL led on the writing of the protocol with input from RP. All authors contributed to and reviewed the draft prior to publication.

  • Funding This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR201108). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.