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Sesso G, Mazzullo C, Valente E, Ditaranto F, Fantozzi P, Belmonti V, Berloffa S, Placini F, Tancredi R, Masi G, Milone A. Non-Suicidal Self-Injury in Eating and Feeding Disorder Patients: Characteristics and Clinical Implications in a Group of Referred Female Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:947. [PMID: 39201882 PMCID: PMC11353179 DOI: 10.3390/children11080947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and Feeding or Eating Disorders (FEDs) often coexist during adolescence with reciprocal influences on their clinical picture. The present study aimed to identify differences and similarities in the clinical presentation of young patients with both conditions compared to those with the two non-comorbid disorders. METHODS We consecutively recruited forty-five female patients aged between 11 and 18 at our third-level hospital and subdivided them into three groups (NSSI: n = 15; FED: n = 15; NSSI + FED: n = 15). Patients underwent a full clinical assessment. RESULTS Based on our results, the NSSI + FED group was characterized by higher rates of binging/purging behaviors, greater prevalence of Cyclothymic Disorder, and a more severe clinical presentation compared to the non-comorbid groups. Moreover, higher levels of suicidal ideation were found in the NSSI + FED group. Pharmacological treatment patterns also differed, with SSRI being prescribed more frequently to NSSI + FED patients while mood stabilizers were prescribed more frequently to NSSI ones. A Principal Component Analysis identified four main dimensions: "Body Image" impairment was more pronounced in NSSI + FED patients, indicating negative attitudes towards their own body; "Metacognition" deficits were higher in NSSI than FED. CONCLUSIONS The present study underscores distinctive clinical features in patients with comorbid NSSI and FED, emphasizing the urgent need for tailored intervention strategies focusing on specific symptom domains.
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Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies, Piazza San Francesco, 55100 Lucca, Italy
| | - Cristina Mazzullo
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Elena Valente
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Francesca Ditaranto
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Pamela Fantozzi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Vittorio Belmonti
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Stefano Berloffa
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Francesca Placini
- Clinica di Neuropsichiatria dell’Infanzia e dell’Adolescenza, Ospedale Pediatrico-Microcitemico, Via Jenner s.n.c., 09121 Cagliari, Italy
| | - Raffaella Tancredi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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3
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Conway-Jones R, James A, Goldacre MJ, Seminog OO. Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021. Int J Eat Disord 2024; 57:162-172. [PMID: 37949682 DOI: 10.1002/eat.24091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population. METHOD A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. RESULTS We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH. DISCUSSION Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. PUBLIC SIGNIFICANCE This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.
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Affiliation(s)
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M J Goldacre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - O O Seminog
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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4
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Washburn JJ, Soto D, Osorio CA, Slesinger NC. Eating disorder behaviors as a form of non-suicidal self-injury. Psychiatry Res 2023; 319:115002. [PMID: 36549098 DOI: 10.1016/j.psychres.2022.115002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Nonsuicidal Self-Injury (NSSI), the purposeful harming of one's body tissue without suicidal intent. NSSI frequently co-occurs with other self-destructive forms of psychopathology, such as eating disorders (ED); however, it remains unclear if ED behaviors are used as a form of NSSI. This exploratory study examined the occurrence of Self-Injurious Disordered Eating Symptoms (SIDES), as well as differences in clinical correlates and treatment outcomes between NSSI patients with and without SIDES. Participants included 1,327 patients admitted for partial hospitalization or intensive outpatient treatment for NSSI (87.4% female; 75.3% Non-Hispanic White). Data were collected at admission and discharge as part of routine clinical outcome assessment. Results indicate that 29.5% of the sample engaged in SIDES, while most were not diagnosed with an ED. Patients that engaged in SIDES reported greater clinical severity at baseline, including greater general psychopathology, lower quality of life, and worse functional impairment, as well as more clinically severe NSSI (e.g., greater number of methods, higher urge to self-injure, greater intrapersonal functions). No differences in treatment outcomes were found. These findings suggest that some NSSI patients perceive ED behaviors as a form of NSSI and that SIDES may be a marker for a more severe clinical presentation.
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Affiliation(s)
- Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Danya Soto
- Department of Educational Psychology, School of Education, University of Wisconsin - Madison, Madison, WI, United States
| | - Christina A Osorio
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Noël C Slesinger
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
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5
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Bresin K, Mekawi Y. Different Ways to Drown Out the Pain: A Meta-Analysis of the Association Between Nonsuicidal Self-Injury and Alcohol Use. Arch Suicide Res 2022; 26:348-369. [PMID: 32780651 DOI: 10.1080/13811118.2020.1802378] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature. METHOD To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI. RESULTS Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems. CONCLUSIONS These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed.HighlightsThere are several reasons to think that NSSI and alcohol use are linked.No reviews or meta-analyses have been conducted.We found a significant and small effect linking greater NSSI with greater alcohol use.
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6
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Cliffe C, Seyedsalehi A, Vardavoulia K, Bittar A, Velupillai S, Shetty H, Schmidt U, Dutta R. Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: a retrospective cohort study. BMJ Open 2021; 11:e053808. [PMID: 34972768 PMCID: PMC8720985 DOI: 10.1136/bmjopen-2021-053808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality. DESIGN AND SETTING This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust. PARTICIPANTS All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included. INTERVENTION AND MEASURES Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study. RESULTS The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a 'near perfect' and 'strong' agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001). CONCLUSION A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.
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Affiliation(s)
- Charlotte Cliffe
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Aida Seyedsalehi
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Katerina Vardavoulia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - André Bittar
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ulrike Schmidt
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Rina Dutta
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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7
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Vieira AI, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Group-based intervention for eating disorders with non-suicidal-self-injury: a case series. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Gonçalves
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
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8
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Ahn J, Lee JH, Jung YC. Identifying Predictors of Non-Suicidal Self-Injuries in Individuals with Eating Disorders. Yonsei Med J 2021; 62:159-163. [PMID: 33527795 PMCID: PMC7859680 DOI: 10.3349/ymj.2021.62.2.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/30/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Nearly one third of all patients with an eating disorder (ED) present with non-suicidal self-injury (NSSI). Although it is necessary to pay attention clinically to NSSI in ED patients due to an increased suicidal risk, there are limited data on potential predictors of NSSI in ED. We conducted this study to uncover predictors of NSSI in ED. MATERIALS AND METHODS A total of 1355 ED patients who visited an ED clinic was evaluated through structured interviews by psychiatrists. The demographic and clinical characteristics of ED patients with NSSI (NSSI group) and ED patients without NSSI (non-NSSI group) were analyzed to identify potential predictors of NSSI in ED. RESULTS Among all ED individuals, 242 (17.9%) reported a history of NSSI. Compared to the non-NSSI group, the NSSI group reported more severe eating symptomatology, more comorbid psychiatric disease, and more suicidal risk. Comorbid alcohol use disorder, depressive disorder, purging behavior, history of suicide attempt, and rumination symptoms were uncovered as predictors of NSSI in ED. CONCLUSION The findings of the study are meaningful in that they highlight predictors of NSSI in ED in a large clinical sample. Understanding risk factors of NSSI and offering appropriate interventions are important to preventing suicidality in ED.
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Affiliation(s)
- Jaeun Ahn
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Young Chul Jung
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
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9
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Gyori D, Balazs J. Nonsuicidal Self-Injury and Perfectionism: A Systematic Review. Front Psychiatry 2021; 12:691147. [PMID: 34305684 PMCID: PMC8293614 DOI: 10.3389/fpsyt.2021.691147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nonsuicidal self-injury (NSSI) and perfectionism mean a huge concern related to mental health and psychopathology. Recently, there has been a growing interest in research on the exploration of the association of perfectionism and NSSI, but till today there is no systematic review has been prepared in this topic. Aims: Therefore, we performed a systematic literature review of published studies that investigated the association between NSSI and perfectionism. Methods: The systematic search was made on PubMed, OVID Medline, PsychInfo, Scopus, and Web of Science. The search terms were ("nonsuicidal self-injury" OR "nonsuicidal self-injury" OR NSSI OR "self-injury" OR "self-injurious behavior" OR SIB OR "self-harm" OR "deliberate self-harm" OR DSH) AND (perfectionism). The inclusion criteria were as follows: written in English; reported empirical data; used validated self-report measures; investigated the association of nonsuicidal self-injury and perfectionism. There were no restrictions on participants regarding age, gender, race or ethnicity. Exclusion criteria: not written in English; was a review/meta-analysis; measured suicide behavior; measured self-injury irrespective of motivation or suicidal intent; was not about the association between nonsuicidal self-injury and perfectionism. Results: After the screening process, 15 studies were included in our systematic review. The majority of studies (12) were published in the last 10 years. Nine (60%) recruited participants from community samples, four (26.7%) from clinical populations, and two (13.3%) both from community and clinical participants. Fourteen (93.3%) of the studies were cross-sectional studies, and one study contained a longitudinal investigation. The majority of studies included only or mainly female participants (62.3-87.2%) and two studies contained a balanced male-female ratio population. Fourteen (93.3%) studies from the 15 studies found a significant positive association between NSSI and perfectionism. Limitations: The heterogeneity of used instruments makes it difficult to compare the results of involved studies. Only two studies investigated populations with balanced gender ratios. Only two studies examined both clinical and community populations. Clinical investigations enrolled mainly eating-disordered (ED) patients. Conclusions: The results of the current systematic review highlight the role of perfectionism in NSSI engagement. This systematic review may help the development of effective prevention initiatives and treatment strategies.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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10
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Dzombak JW, Haynos AF, Rienecke RD, Van Huysse JL. Brief report: Differences in nonsuicidal self-injury according to binge eating and purging status in an adolescent sample seeking eating disorder treatment. Eat Behav 2020; 37:101389. [PMID: 32388487 PMCID: PMC9340432 DOI: 10.1016/j.eatbeh.2020.101389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) is elevated in adults with eating disorders (EDs), with a particularly increased incidence among individuals who engage in binge eating and/or purging (B/P) behaviors. Despite substantially elevated prevalence of NSSI in adolescence in general, NSSI in child and adolescent ED samples is understudied. There is some evidence for elevated prevalence of NSSI between B/P and restriction-only groups; however, this finding is not consistently reported and research in this area has excluded certain diagnostic groups (e.g., other specified feeding or eating disorder). Our aim was to identify the rates at which a transdiagnostic sample of adolescent patients with EDs (n = 155) report lifetime or past-month NSSI, and whether these rates differ between individuals who engaged in recent B/P behaviors vs. restriction only. Lifetime NSSI was present in 40.6% of the sample, and 23.2% of participants reported engaging in NSSI in the month prior to treatment. Individuals who reported recent B/P behaviors were more likely to report past-month (p = .005, OR = 5.57) and lifetime (p = .004, OR = 4.39) NSSI compared to individuals who did not report B/P behaviors. These results suggest an increase in risk for NSSI in child and adolescent patients in ED treatment who endorse B/P behaviors compared to patients who endorse restriction only. Research is needed to clarify the etiologic factors that may explain this association and the longitudinal changes in NSSI throughout the course of EDs.
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Affiliation(s)
- Jesse W.P. Dzombak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Renee D. Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Eating Recovery Center/Insight Behavioral Health Centers, Chicago, IL, United States of America,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States of America
| | - Jessica L. Van Huysse
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Corresponding author at: Department of Psychiatry, University of Michigan, C.S. Mott Children’s Hospital, 5th Floor Reception B, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States of America. (J.L. Van Huysse)
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11
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Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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12
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Nitkowski D, Wünsch-Leiteritz W, Braks K, Hristova S, Petermann F. Indirekte und direkte nichtsuizidale Selbstverletzungen bei Mädchen und jungen Frauen mit Essstörungen. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Zusammenfassung. Nichtsuizidales selbstverletzendes Verhalten (NSSV) tritt häufig bei Essstörungen auf. Die Befundlage zum Zusammenhang zwischen einem restriktiv-asketischen beziehungsweise bulimischen Essverhalten und NSSV ist jedoch nicht konsistent. Es wird geprüft, ob borderlinespezifische Gedanken die Beziehung zwischen asketischen beziehungsweise bulimischen Essverhalten auf der einen Seite und NSSV auf der anderen Seite mediieren. Eine Stichprobe von 74 Mädchen und jungen Frauen im Alter von 14 bis 21 Jahren ( M = 17.49; SD = 1.85), die eine Anorexie oder eine Bulimie aufweisen, bearbeiteten Fragebögen zu NSSV, borderlinespezifischen Gedanken sowie zu asketischen und bulimischen Verhaltensweisen. Borderline-Gedanken mediierten den Zusammenhang zwischen asketischem Verhalten auf der einen Seite und der Anzahl an bisher genutzten NSSV-Methoden und NSSI zur psychischen Regulation auf der anderen Seite. Bei Bulimie fand sich hingegen keine Mediation. Ein asketisches Verhalten ist bei Mädchen und jungen Frauen mit einer Essstörung über Borderline-Gedankenmuster mit der Anzahl an NSSV-Methoden und der Nutzung von NSSV zur psychischen Regulation verbunden. Ein primär durch Essattacken gekennzeichnetes Verhalten weist keinen Zusammenhang mit NSSV auf. Die verschiedenen Arten von gestörtem Essverhalten sollten separat auf einen Zusammenhang mit NSSV untersucht werden.
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Affiliation(s)
- Dennis Nitkowski
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Wally Wünsch-Leiteritz
- Klinik Lüneburger Heide, Kompetenzzentrum für die Behandlung von Essstörungen und ADHS, Bad Bevensen
| | - Karsten Braks
- Klinik am Korso, Fachzentrum für gestörtes Essverhalten, Bad Oeynhausen
| | - Stella Hristova
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
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Ospina Gutiérrez ML, Ulloa Rodriguez MF, Ruiz Moreno LM. [Non-suicidal self-injuries in adolescents: Prevention and detection in primary care]. Semergen 2019; 45:546-551. [PMID: 31053424 DOI: 10.1016/j.semerg.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/13/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
Abstract
Non-suicidal self-injuries (NSSI) are self-harm behaviours without a suicidal objective, and have a prevalence of 17-18% in adolescents. It is characterised by self-inflicted injuries, mainly in the extremities and abdomen. The psychopathology is subject to the presence of emotional deregulation, in which it seeks the masking of emotional pain with physical pain. A literature review was conducted using research in databases, including key words in English and Spanish. It was found that the identification of NSSI risk factors in adolescents helps in its prevention and identification, and as such it was proposed to classify the NSSI risk factors, as well as the tools for their identification in primary care. It was concluded that the management of NSSI corresponds to the child and adolescent psychiatrist, but primary care physicians have a fundamental role in its detection and prevention.
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Carlson L, Steward T, Agüera Z, Mestre-Bach G, Magaña P, Granero R, Jiménez-Murcia S, Claes L, Gearhardt AN, Menchón JM, Fernández-Aranda F. Associations of food addiction and nonsuicidal self-injury among women with an eating disorder: A common strategy for regulating emotions? EUROPEAN EATING DISORDERS REVIEW 2018; 26:629-637. [PMID: 30318670 DOI: 10.1002/erv.2646] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We examined the association between lifetime nonsuicidal self-injury (NSSI), emotion regulation, and food addiction (FA) in women (n = 220) with eating disorders (ED) compared with (n = 121) healthy controls (HC). METHOD Participants were assessed via face-to-face interviews for ED diagnosis and lifetime NSSI. FA was assessed with Yale Food Addiction Scale 2.0 and emotion regulation using the Difficulty in Emotion Regulation Scale (DERS). RESULTS The prevalence of FA was significantly higher among women with an ED when compared with HC (75.9% vs. 4.1%, p < 0.001). Similarly, subjects presenting FA showed a high prevalence of lifetime NSSI, in both ED and HC (40.7% and 60.0%, respectively). Our predictive model revealed FA and DERS total scores as indicators of the presence of lifetime NSSI independent of group assignment, ED diagnosis, and age. CONCLUSIONS These findings suggest a shared aetiology between ED, NSSI, and FA, explained possibly in part by emotion-regulation deficits.
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Affiliation(s)
- Lily Carlson
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain
| | - Pablo Magaña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Law, Pompeu Fabra University, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Vieira AI, Machado BC, Moreira CS, Machado PP, Brandão I, Roma-Torres A, Gonçalves S. Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual model. EUROPEAN EATING DISORDERS REVIEW 2018; 26:431-437. [DOI: 10.1002/erv.2611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/27/2018] [Accepted: 05/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychotherapy and Psychopathology Research Unit-CIPsi, School of Psychology; University of Minho; Braga Portugal
| | - Bárbara C. Machado
- CEDH-Centre for Studies in Human Development, Faculty of Education and Psychology; Catholic University of Portugal; Porto Portugal
| | - Célia S. Moreira
- Psychotherapy and Psychopathology Research Unit-CIPsi, School of Psychology; University of Minho; Braga Portugal
| | - Paulo P.P. Machado
- Psychotherapy and Psychopathology Research Unit-CIPsi, School of Psychology; University of Minho; Braga Portugal
| | - Isabel Brandão
- Psychiatry Department, Faculty of Medicine; Hospital of S. João; Porto Portugal
| | - António Roma-Torres
- Psychiatry Department, Faculty of Medicine; Hospital of S. João; Porto Portugal
| | - Sónia Gonçalves
- Psychotherapy and Psychopathology Research Unit-CIPsi, School of Psychology; University of Minho; Braga Portugal
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