Eating Disorder Symptoms and Suicidal Ideation: The Moderating Role of Disgust: Eating Disorder Symptoms, Disgust, and Suicide

Prevalence of suicide attempt, suicide ideation and self-harm at diagnosis in adolescents with eating disorders

BACKGROUND

Data concerning the suicide prevalence of eating disorder (ED) subtypes and predictive factors are lacking in youth. This study aimed to examine suicide attempts (SA), suicide ideation (SI) and self-harm (SH) upon diagnosis in adolescents with EDs.

METHODS

The prevalence of SA, SI and SH in ED subtypes was evaluated by retrospectively assessing the Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety (HEEADSSS) instrument of adolescents diagnosed with an ED. Clinical predictors of SI in anorexia nervosa (AN) and atypical AN (AAN) were assessed.

RESULTS

Among all participants (398), 41 (10.3%) reported SA, 126 (31.7%) SI and 60 (15.1%) SH. While SA did not differ statistically between ED subgroups (p = .123), they were two times more prevalent in the bulimia nervosa (BN) group (17.5%) than in the AN group (8.5%). In the BN group, SI was 2.3 times more prevalent than in the AN group (p = .001). The AN and ARFID groups exhibited substantially less SH (p = .036). Having a higher body mass index (BMI) was the only significant predictor of SI.

CONCLUSIONS

This study demonstrates that adolescents with EDs are at an increased risk for suicidality, highlighting the need for close screening, particularly in those with BN, AN-BP and AN with a higher BMI.

Testing the longitudinal relationship between muscle dysmorphia symptoms and suicidality: A network analysis investigation

Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.

Subjective disgust and facial electromyography responses towards unedited and morphed overweight self-pictures in women with varying levels of eating disorder symptomatology

Individuals with an eating disorder (ED) often report to be disgusted by their body. Body-related self-disgust could play an important role in the development and maintenance of EDs. We investigated if women with relatively high ED symptom scores indeed respond with disgust upon exposure to their body as indexed by facial electromyography (fEMG) of the m. levator labii superioris and self-report. Given that one's self-disgust may increase/decrease depending on the relative distance of the own body to the thin ideal, we also assessed women's disgust for overweight- and thin-morphs of their body. Female undergraduate students (N = 104) were photographed and presented with their (morphed) body pictures, next to disgust-relevant and overweight body control pictures. Higher levels of ED symptoms were associated with stronger self-reported disgust to unedited body-pictures and overweight-morphs. Disgust to thin-morphs was unrelated to ED symptoms. Participants generally showed heightened facial disgust towards overweight morphs, yet the strength of facial disgust was unrelated to ED symptoms. Thus, the findings provide evidence for the involvement of heightened body-related self-disgust in ED symptomatology, albeit only on the basis of self-report.

Longitudinal relationships between muscle dysmorphia symptoms and suicidal ideation

INTRODUCTION

Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship.

METHODS

Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6 weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model.

RESULTS

Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance.

CONCLUSIONS

Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms.

'The last thing you feel is the self-disgust'. The role of self-directed disgust in men who have attempted suicide: A grounded theory study

OBJECTIVE

Globally, suicide affects more men than women. Emotional pain underpins many theoretical accounts of suicidality, yet little is known about the role of disgust in suicide. Self-directed disgust, whereby aspects of the self-serve as an object of disgust, has been hypothesised to factor in suicide. This research aimed to explore the processes which link self-disgust to attempted suicide in males.

METHOD

Nine men who had attempted suicide completed semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

RESULTS

Three concepts emerged out of the analysis: (1) self-disgust; (2) worthlessness; and (3) the endured emotional distress of 'the abyss'" - these concepts interweaved, leading the men to experience hopelessness, disconnection and an inability to cope, leading ultimately to their suicide attempt. Throughout this journey, various disgust-related processes worsened men's distress and increased their suicidal risk. Historic adversities prevailed across the data, as did the men's difficulties in understanding their emotions.

CONCLUSION

Self-disgust was an important emotion in the men's experiences of suicide and shaped their views of themselves and their lives. The distancing and repellent properties of self-disgust, in addition to the fear of having their 'disgustingness' exposed, increased suicidal risk. Self-disgust appeared more pervasive in the suicidality of men with a history of multiple childhood adversities. The limitations of this research are discussed as implications for clinical practice and directions for future research.

Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology

OBJECTIVE

The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics.

METHOD

Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale.

RESULTS

AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups.

DISCUSSION

Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.

Self-disgust and urge to be thin in eating disorders: how can self-compassion help?

PURPOSE

This study aimed to examine the moderator role of self-compassion in the relationship between self-disgust and drive for thinness, controlling for external shame, in eating disorder patients and in a community sample.

METHODS

Sixty-two female participants with an eating disorder diagnose and 119 female participants from the community, were asked to fill instruments that assess self-disgust, self-compassion, drive for thinness, and external shame.

RESULTS

We found a moderator effect of self-compassion on the association between self-disgust and drive for thinness in the clinical sample when adjusting for shame. The association between self-disgust and drive for thinness was buffered among those who reported medium and lower levels of self-compassion. Replicating the findings in the community sample we found no moderator effect of self-compassion.

CONCLUSION

These results provide evidence that people with eating disorders who perceive the self as highly disgusting may benefit from promoting a self-compassionate response to diminish drive for thinness.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety

In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety.

The Differences Between Individuals Engaging in Nonsuicidal Self-Injury and Suicide Attempt Are Complex (vs. Complicated or Simple)

BACKGROUND

Why do some people engage in nonsuicidal self-injury (NSSI) while others attempt suicide? One way to advance knowledge about this question is to shed light on the differences between people who engage in NSSI and people who attempt suicide. These groups could differ in three broad ways. First, these two groups may differ in a simple way, such that one or a small set of factors is both necessary and sufficient to accurately distinguish the two groups. Second, they might differ in a complicated way, meaning that a specific set of a large number of factors is both necessary and sufficient to accurately classify them. Third, they might differ in a complex way, with no necessary factor combinations and potentially no sufficient factor combinations. In this scenario, at the group level, complicated algorithms would either be insufficient (i.e., no complicated algorithm produces good accuracy) or unnecessary (i.e., many complicated algorithms produce good accuracy) to distinguish between groups. This study directly tested these three possibilities in a sample of people with a history of NSSI and/or suicide attempt.

METHOD

A total of 954 participants who have either engaged in NSSI and/or suicide attempt in their lifetime were recruited from online forums. Participants completed a series of measures on factors commonly associated with NSSI and suicide attempt. To test for simple differences, univariate logistic regressions were conducted. One theoretically informed multiple logistic regression model with suicidal desire, capability for suicide, and their interaction term was considered as well. To examine complicated and complex differences, multiple logistic regression and machine learning analyses were conducted.

RESULTS

No simple algorithm (i.e., single factor or small set of factors) accurately distinguished between groups. Complicated algorithms constructed with cross-validation methods produced fair accuracy; complicated algorithms constructed with bootstrap optimism methods produced good accuracy, but multiple different algorithms with this method produced similar results.

CONCLUSIONS

Findings were consistent with complex differences between people who engage in NSSI and suicide attempts. Specific complicated algorithms were either insufficient (cross-validation results) or unnecessary (bootstrap optimism results) to distinguish between these groups with high accuracy.

Factor Structure, Reliability, and Validity of the Japanese Version of the Disgust Propensity and Sensitivity Scale-Revised

The Disgust Propensity and Sensitivity Scale-Revised is one of the most widely used measures of individual differences for the emotion of disgust. It consists of 2 subscales: disgust propensity and disgust sensitivity. This study examined the factor structure, reliability, and validity of the Japanese version of the revised Disgust Propensity and Sensitivity Scale. Japanese participants (N = 1067) completed the scale as well as the Padua Inventory, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Positive and Negative Affective Schedule. The participants were divided into 3 samples: Sample 1 (n = 481, mean age = 23.05, 186 males and 295 females); Sample 2 (n = 492, mean age = 20.27, 243 males and 249 females); and Sample 3 (n = 94, mean age = 22.68, 35 males and 58 females). We combined Samples 1 and 2 (n = 973, mean age = 21.66, 429 males and 544 females), and then created 2 subsamples to ensure the mutual independence of the samples used for two different factor analyses: subsample 1 (n = 486, mean age = 21.86, 199 male and 287 female) for exploratory factor analysis and subsample 2 (n = 487, mean age = 21.40, 230 male and 257 female) for confirmatory factor analysis. We examined test-retest reliability using Sample 3, and construct validity using Samples 1, 2, and the combined sample. Exploratory and confirmatory factor analyses revealed that the item-factor structure of the Japanese Disgust Propensity and Sensitivity Scale-Revised was identical to the English version. Moreover, the scale showed good internal consistency, test-retest reliability, and construct validity for empirical support as provided by correlational analyses. Results revealed adequate psychometric properties of the scale. This study provided the first examples of empirical support for the DPSS-R-J.

Can the Phenomenology of a Suicidal Crisis Be Usefully Understood As a Suite of Antipredator Defensive Reactions?

When perceiving a dangerous predation threat, mammalian and other species activate antipredator defensive reactions. These include the seemingly paradoxical-but compatible-activation of overarousal (e.g., agitation, insomnia) and "shutdown" (e.g., mutism, withdrawal) states. Acute suicidal crises, too, are characterized by the co-occurrence of overarousal and shutdown behaviors. In the minutes, hours, and days prior to one's death by suicide, it is not uncommon for one to be simultaneously agitated and socially withdrawn, states that resemble antipredator defensive reactions. In this article, we present empirical, clinical, and philosophical grist for our conjecture that antipredator defensive reactions may serve as a useful way to understand the phenomenology of a serious suicidal crisis, and we reflect on the implications that soon-to-be suicide decedents are simultaneously killer and victim.