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Velkoff EA, Perkins NM, Dodd DR, Brown TA, Kaye WH, Wierenga CE. Elevated interoceptive deficits in individuals with eating disorders and self-injurious thoughts and behaviors: A replication and extension. Suicide Life Threat Behav 2024; 54:129-137. [PMID: 38009622 DOI: 10.1111/sltb.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION People with eating disorders (EDs) frequently report self-injurious thoughts and behaviors (SITBs). We aimed to replicate and extend findings demonstrating greater interoceptive deficits according to SITB severity. We predicted that interoceptive deficits would be greater among people with versus without lifetime SITBs and among those with multiple suicide attempts compared with single attempts or nonsuicidal self-injury. We also predicted that interoception would be increasingly impaired with greater current suicidality severity. METHOD Adults (N = 118) seeking ED treatment reported current and lifetime SITBs upon admission to treatment. We used planned contrasts to compare interoceptive deficits (self-reported using the Eating Disorders Inventory) by SITB and current suicidality groups (assessed by self-report and clinical interview). RESULTS Interoceptive deficits were greater among people with any SITB history compared to those without. People with multiple suicide attempts did not differ in interoceptive deficits from those with single attempts or only nonsuicidal self-injury. Interoceptive deficits were elevated among those with any current suicidality compared to those with no suicidal symptoms; interoceptive deficits did not differ according to severity of suicidality. CONCLUSION Among those with EDs, interoceptive deficits are elevated among those with concurrent SITBs. Interventions aimed at improving interoception may reduce the risk for SITBs.
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Affiliation(s)
- Elizabeth A Velkoff
- Drexel University, Philadelphia, Pennsylvania, USA
- University of California, San Diego, La Jolla, California, USA
| | | | - Dorian R Dodd
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | | | - Walter H Kaye
- University of California, San Diego, La Jolla, California, USA
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Kirkpatrick RH, Breton E, Biorac A, Munoz DP, Booij L. Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis. Int J Eat Disord 2024; 57:223-248. [PMID: 38041221 DOI: 10.1002/eat.24088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis. METHOD Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot. RESULTS 79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies. DISCUSSION Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study. PUBLIC SIGNIFICANCE This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.
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Affiliation(s)
- Ryan H Kirkpatrick
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Edith Breton
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Aleksandar Biorac
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated Health and Social Services Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Quebec, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Shan D, Wang Y, Tousey-Pfarrer M, Guo C, Wan M, Wang P, Dai Z, Ge F, Zhang J. Association between patterns of biological rhythm and self-harm: evidence from the baoxing youth mental health (BYMH) cohort. Child Adolesc Psychiatry Ment Health 2024; 18:3. [PMID: 38172979 PMCID: PMC10765742 DOI: 10.1186/s13034-023-00685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Self-harm, a severe mental health concern among children and adolescents, has varying global prevalence rates. Previous studies have suggested potential associations between specific behavioral aspects of biological rhythm and self-harm risk in these populations. OBJECTIVE Our study aimed to elucidate the relationship between biological rhythm patterns and the propensity of self-harm among Chinese children and adolescents using the Baoxing Youth Mental Health (BYMH) cohort. METHODS We included 1883 Chinese children and adolescents from the BYMH cohort. The self-report questions used to assess biological rhythm and self-harm. We applied Principal Component Analysis (PCA) to distinguish patterns of biological rhythms. Logistic regression models were conducted to estimate the associations between biological rhythm, as well as biological rhythm patterns and risk of self-harm. RESULTS Of the participants, 35.0% reported experiencing lifetime self-harm. PCA revealed six significantly predominant biological rhythm patterns. Elevated risks of self-harm were linked with unhealthy eating practices, daytime tiredness, and unhealthy bedtime snacking. Conversely, patterns emphasizing physical exercise, family meals for breakfast, and nutritious diet exhibited decreased self-harm propensities. These trends persisted across varied self-harm attributes, including type, recency, and frequency of self-harm. CONCLUSIONS This study underscores the critical impact of biological rhythms on self-harm risks among Chinese youth. Targeted lifestyle interventions, focusing on improved sleep and dietary habits, could serve as potent preventive measures. Our findings lay the groundwork for future longitudinal studies to further probe these associations, fostering the creation of tailored interventions to curb self-harm and enhance mental well-being in younger populations.
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Affiliation(s)
- Dan Shan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Biobehavioral Sciences, Columbia University, New York, NY, USA
| | - Yue Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Marissa Tousey-Pfarrer
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Cancan Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengtong Wan
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peijie Wang
- School of Education, Tianjin University, Tianjin, China
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fenfen Ge
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
| | - Jun Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
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Velkoff EA, Smith AR. Temporal dynamics of interoceptive attention and positive and negative affect in adults engaging in disordered eating and nonsuicidal self-injury. J Clin Psychol 2023. [PMID: 36905648 DOI: 10.1002/jclp.23508] [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: 05/13/2022] [Revised: 12/28/2022] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Interoception (the sense of the body's state) is associated with eating disorders and nonsuicidal self-injury, potentially through relationships with affect. We examined the relationship between interoceptive attention and both positive and negative affect. METHODS Participants (N = 128) who reported recent self-harm (i.e., disordered eating and/or non-suicidal self-injury) completed ecological momentary assessment for 16 days. Participants completed multiple daily assessments of affect and interoceptive attention. We then tested the temporal dynamic relationship between interoceptive attention and affect. RESULTS There was a relationship between positive affect and interoceptive attention such that people with higher average positive affect, and times when people were above their typical positive affect, were associated with higher interoceptive attention. There was a negative relationship between negative affect and interoceptive attention, such that people with higher average negative affect, and times when people were above their own typical negative affect, were associated with lower interoceptive attention. CONCLUSIONS Better mood may associate with greater willingness to attend to body sensations. Our findings support active inference models of interoception and highlight the importance of refining our understanding of the dynamic nature of interoception and its relationship with affect.
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Affiliation(s)
- Elizabeth A Velkoff
- Department of Psychology, Miami University, Oxford, Ohio, USA.,Department of Psychiatry, The University of California, San Diego, California, USA
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio, USA.,Department of Psychology, Auburn University, Auburn, Alabama, USA
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Lavis A, McNeil S, Bould H, Winston A, Reid K, Easter CL, Pendrous R, Michail M. Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study. BMJ Open 2022; 12:e065065. [PMID: 35896287 PMCID: PMC9335036 DOI: 10.1136/bmjopen-2022-065065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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).
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Affiliation(s)
- Anna Lavis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheryllin McNeil
- Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School & Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | | | - Kalen Reid
- Youth Advisory Group, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Christina L Easter
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rosina Pendrous
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maria Michail
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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Gómez-Castillo MD, Escrivá-S V, Tolosa-Pérez MT, Navarro-Bravo B, Plateau CR, Ricarte JJ, Cuesta-Zamora C. The link between non-suicidal self-injury (NSSI), body image and activity on social networking sites among female adolescents with an eating disorder. Clin Child Psychol Psychiatry 2022; 27:730-744. [PMID: 35369739 DOI: 10.1177/13591045221081191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The link between engagement in non-suicidal self-injury (NSSI)-related activities on SNS (e.g. viewing, commenting, sharing and uploading NSSI content) with body image and NSSI behaviour remains under researched in adolescents with EDs. The main aim of the current research was to examine associations between NSSI-related activities on SNS with body image and NSSI behaviour severity among female adolescents diagnosed with an ED. A total of 52 female adolescents (mean age = 15.35 years, SD = 1.49) diagnosed with an ED completed self-report questionnaires related to NSSI behaviour, SNS usage and body image. Participants were divided into two groups: low NSSI behaviour severity (from 0 to 10 NSSI behaviours; n = 28) and high NSSI behaviour severity (more than ten NSSI behaviours; n = 24). Within the high NSSI severity group, individuals that comment and share NSSI online content significantly reported higher negative body image. A hierarchical binary logistic regression showed that the frequency of NSSI online content on SNS emerged as significant predictor of NSSI behaviour severity within last year after controlling for body image and searching for ED content on SNS. Our findings suggest that not only searching for ED content, but also being daily engaged in NSSI online activities may increase the risk of NSSI behaviour severity in female adolescents with EDs.
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Affiliation(s)
- María D Gómez-Castillo
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | - Verónica Escrivá-S
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | - María T Tolosa-Pérez
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | | | - Carolyn R Plateau
- Centre for Research into Eating Disorders and Behaviours, 5156Loughborough University, Loughborough, UK
| | - Jorge J Ricarte
- Psychology Department, 73073Castilla-La Mancha University, Albacete, Spain
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Cella S, Cipriano A, Aprea C, Milano W, Carizzone F, Cotrufo P. Non-suicidal self-injury in eating disorders: Prevalence, characteristics, DSM-5 proposed diagnostic criteria, and correlates. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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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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Abrams TE, McGarity SV. Psychosocial Determinants of Burn-Related Suicide: Evidence From the National Violent Death Reporting System. J Burn Care Res 2021; 42:305-310. [PMID: 32842149 DOI: 10.1093/jbcr/iraa152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Suicide is a unique phenomenon in humans. In 2017, over 47,000 Americans died by suicide, prompting a public health crisis. Suicide by burning, while one of the rarest forms of suicide, could be mitigated in part by early recognition and treatment of the underlying psychosocial factors. To date, investigators have attempted to tease out the risk factors associated with this phenomenon through the examination of burn center chart reviews and repository data, but these studies were limited by small sample sizes. In order to fill this gap in the literature, the authors analyzed 14 years of data (2003-2016) from the National Violent Death Reporting System. Suicides by burning (n = 722) were compared with a reference group containing all other suicide types (n = 166,949). Socio-demographic variables and psychosocial factors (eg, mental health, substance use, and alcohol use) were included in the model. Due to the imbalance between the target and reference groups, rare event data analysis was used to reduce potential small sample estimation bias. Results indicated that females (OR = 1.6, 95% CI: .50-2.83, P < .001), Caucasians (OR = 1.7, 95% CI: 1.1-2.7, P < .001), victims with schizophrenia (OR = 5.4, 95% CI: 3.7-7.8, P < .001), and victims with eating disorders (OR = 5.6, 95% CI: 1.9-8.6, P < .001) are significantly more likely to commit suicide by burning. These results contribute new knowledge to what is currently known about suicidal burn-related behaviors and supports interventions that focus on mitigating this insidious public health problem.
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Affiliation(s)
- Thereasa E Abrams
- College of Social Work, The University of Tennessee-Knoxville, Nashville
| | - Stephen V McGarity
- College of Social Work, The University of Tennessee-Knoxville, Nashville
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Devoe DJ, Anderson A, Bahji A, Singh M, Patten SB, Soumbasis A, Ramirez Pineda A, Flanagan J, Richardson C, Lange T, Dimitropoulos G, Paslakis G. The Prevalence of Impulse Control Disorders and Behavioral Addictions in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:724034. [PMID: 35069274 PMCID: PMC8770943 DOI: 10.3389/fpsyt.2021.724034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: Individuals with eating disorders (EDs) may present with impulse control disorders (ICDs) and behavioral addictions (BAs), which may result in additional suffering and treatment resistance. However, the prevalence of ICDs and BAs in EDs has not been systematically examined. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of ICDs and BAs in ED samples. Methods: A comprehensive electronic database search of the peer-reviewed literature was conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from their inception to May 2021. We restricted review eligibility to research studies reporting prevalence for ICDs or BAs in individuals with diagnosed EDs. The outcome for this review was the prevalence of ICDs or BAs in individuals with EDs. A series of random-effects meta-analyses were performed on eligible studies to estimate the pooled proportions and 95% confidence intervals (CIs). Results: Thirty-five studies met the inclusion criteria, including a total of 9,646 individuals identified as having an ED, 18 of these studies specifically examined ICDs/BAs in AN, BN, and BED. Random-effects pooled estimates demonstrated that the comorbid prevalence of any ICD was 22%. The prevalence of comorbid pathological/compulsive buying was highest (19%), followed by kleptomania (18%), pathological internet use (12%), intermittent explosive disorder (4%), trichotillomania (3%), and gambling disorder (2%). In addition, the prevalence of stealing/shoplifting behaviors was 30% in those with EDs. Conclusion: This is the first meta-analysis on the comorbid prevalence of EDs and ICDs/BAs. We found a moderate prevalence for these comorbid conditions, with approximately one out of five individuals with an ED also displaying a comorbid ICD/BA. Although causal inferences cannot be drawn, the numbers strongly suggest that clinical screening/monitoring of ICDs/BAs should be part of the clinical routine in cohorts with EDs. ED settings need either the capacity to manage these disorders or adequate access to relevant services. Further investigations are needed to reveal common underlying pathomechanisms. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202044.
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Affiliation(s)
- Daniel J Devoe
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alida Anderson
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anees Bahji
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Manya Singh
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Andrea Soumbasis
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Ana Ramirez Pineda
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jordyn Flanagan
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Tom Lange
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Lübbecke, Germany
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12
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Gonçalves SF, Machado BC, Martins C, Brandão I, Roma torres A, Machado P. Dysregulated behaviours in bulimia nervosa—A case‐control study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Carla Martins
- School of Psychology, University of Minho, Braga, Portugal,
| | - Isabel Brandão
- Psychiatry Department, Hospital of S.João, Porto, Portugal,
| | | | - Paulo Machado
- School of Psychology, University of Minho, Braga, Portugal,
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13
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Hielscher E, Whitford TJ, Scott JG, Zopf R. When the body is the target—Representations of one’s own body and bodily sensations in self-harm: A systematic review. Neurosci Biobehav Rev 2019; 101:85-112. [DOI: 10.1016/j.neubiorev.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/14/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
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14
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Abstract
Social anxiety disorder is one of the most common comorbid conditions in eating disorders (EDs). The aim of the current review and meta-analysis is to provide a qualitative summary of what is known about social anxiety (SA) in EDs, as well as to compare levels of SA in those with EDs and healthy controls. Electronic databases were systematically searched for studies using self-report measures of SA in ED populations. In total, 38 studies were identified, 12 of which were included in the meta-analyses. For both anorexia nervosa (AN) and bulimia nervosa, there were significant differences between ED groups and HCs, with medium to large effect sizes. Findings from the qualitative review indicate that levels of SA are similar across the ED diagnoses, and SA improves with treatment in AN. In addition, high levels of SA are associated with more severe ED psychopathology, but not body mass index. These findings add to the wider literature on socio-emotional functioning in EDs, and may have implications for treatment strategies.
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Affiliation(s)
- Jess Kerr-Gaffney
- King's College London,Institute of Psychiatry,Psychology and Neuroscience,Psychological Medicine,London,UK
| | - Amy Harrison
- Department of Psychology and Human Development,University College London,London,UK
| | - Kate Tchanturia
- King's College London,Institute of Psychiatry,Psychology and Neuroscience,Psychological Medicine,London,UK
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15
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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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16
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Pérez S, Marco JH, Cañabate M. Non-suicidal self-injury in patients with eating disorders: prevalence, forms, functions, and body image correlates. Compr Psychiatry 2018; 84:32-38. [PMID: 29679850 DOI: 10.1016/j.comppsych.2018.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/04/2018] [Accepted: 04/07/2018] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION More than one third of patients with eating disorders report NSSI. Moreover, negative attitudes and feelings toward the body, body dissatisfaction, and body image disturbances have been linked to NSSI in community and clinical samples. However, there is a lack of studies exploring NSSI frequency and functions and the specific relationship between multidimensional body image dimensions and NSSI in eating disorder patients. OBJECTIVES First, we explored the frequency, types, and functions of NSSI in a sample of 226 Spanish female participants with eating disorders (ED). Second, we explored differences in NSSI and body image depending on the ED restrictive-purgative subtype; and third, we explored differences in body dissatisfaction, body image orientation, and body investment in eating disorder patients without NSSI (n = 144), with NSSI in their lifetime (n = 19), and (b) with NSSI in the previous year (n = 63). RESULTS Of the overall sample, 37.1% (n = 89) had a history of self-injury during their lifetime, and 27.1% (n = 65) had self-injured in the previous year. Among the types of ongoing NSSI, the most frequent were banging (64.6%) and cutting (56.9%). Restrictive vs purgative patients differed on NSSI lifetime, Appearance Evaluation, Body Areas Satisfaction, Body Protection and Feelings and Attitudes toward the Body. Moreover, significant differences were found on Appearance Evaluation, Body Areas Satisfaction, Positive Feelings and Attitudes towards the Body, Body Protection, and Comfort with physical contact, between participants without a history of self-injury and both NSSI groups. DISCUSSION Body dissatisfaction and body investment have been found to be variables related to NSSI. Thus, the present study highlights the importance of working on body image in ED patients to reduce the frequency of NSSI.
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Affiliation(s)
- Sandra Pérez
- Department of Personality, Assessment and Therapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain.
| | - Jose H Marco
- Department of Personality, Assessment and Therapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| | - Montse Cañabate
- School of Doctorate, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
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17
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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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18
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Anderson NL, Smith KE, Mason TB, Crowther JH. Testing an Integrative Model of Affect Regulation and Avoidance in Non-Suicidal Self-Injury and Disordered Eating. Arch Suicide Res 2018; 22:295-310. [PMID: 28644927 PMCID: PMC5917567 DOI: 10.1080/13811118.2017.1340854] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This research tested a model that integrates risk factors among non-suicidal self-injury (NSSI) and eating disorder (ED) behaviors with the aim of elucidating possible shared and unique mechanisms underlying both behaviors. Emotional distress, limited access to emotion regulation (ER) strategies, experiential avoidance, and NSSI/ED frequency were examined in a sample of 230 female undergraduates. Structural equation modeling indicated that limited access to ER strategies and avoidance mediated relationship between emotional distress and avoidance, which in turn was associated with NSSI and ED behaviors. Results suggest NSSI and ED behaviors may serve similar emotion regulation functions, and specifically highlight the role of experiential avoidance in these behaviors.
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19
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Vieira AI, Machado BC, Machado PPP, Brandão I, Roma-Torres A, Gonçalves S. Putative Risk Factors for Non-Suicidal Self-Injury in Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2018; 25:544-550. [PMID: 29057605 DOI: 10.1002/erv.2545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/30/2017] [Accepted: 08/10/2017] [Indexed: 12/15/2022]
Abstract
Evidence suggests a common association between eating disorders (EDs) and non-suicidal self-injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self-evaluation, suicide attempts, substance abuse, parents' low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co-occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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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
| | - 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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20
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Giner-Bartolome C, Mallorquí-Bagué N, Tolosa-Sola I, Steward T, Jimenez-Murcia S, Granero R, Fernandez-Aranda F. Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety. Front Psychol 2017; 8:1163. [PMID: 28736544 PMCID: PMC5500653 DOI: 10.3389/fpsyg.2017.01163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety. Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected. Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI. Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.
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Affiliation(s)
- Cristina Giner-Bartolome
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Iris Tolosa-Sola
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Susana Jimenez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
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21
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Giner-Bartolome C, Mallorquí-Bagué N, Tolosa-Sola I, Steward T, Jimenez-Murcia S, Granero R, Fernandez-Aranda F. Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety. Front Psychol 2017. [PMID: 28736544 DOI: 10.3389/fpsyg.2017.00473/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety. Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected. Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI. Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.
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Affiliation(s)
- Cristina Giner-Bartolome
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Iris Tolosa-Sola
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Susana Jimenez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL)Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
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22
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Vieira AI, Ramalho S, Brandão I, Saraiva J, Gonçalves S. Adversity, emotion regulation, and non-suicidal self-injury in eating disorders. Eat Disord 2016; 24:440-52. [PMID: 27348732 DOI: 10.1080/10640266.2016.1198205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The comorbidity between non-suicidal self-injury and eating disorder behaviors suggests that psychosocial factors may play a role in both types of behaviors. This study aimed to assess the presence of non-suicidal self-injury in 66 eating disorder patients and to analyze the associations among adversity, emotion regulation, non-suicidal self-injury, and disordered eating behavior. A total of 24 participants (36.4%) reported non-suicidal self-injury. Patients endorsing self-injury had a higher severity of disordered eating behavior. More difficulties in emotion regulation and a greater number of methods of non-suicidal self-injury were associated with a higher severity of eating pathology. Clinicians should consider these relationships in the assessment and treatment of eating disorders.
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Affiliation(s)
- Ana Isabel Vieira
- a Center for Research in Psychology (CIPsi), School of Psychology , University of Minho , Braga , Portugal
| | - Sofia Ramalho
- a Center for Research in Psychology (CIPsi), School of Psychology , University of Minho , Braga , Portugal
| | - Isabel Brandão
- b Faculty of Medicine, Hospital of S. João , University of Porto , Porto , Portugal
| | - Joana Saraiva
- c Child and Adolescent Psychiatry Department , Hospital Centre of Porto , Porto , Portugal
| | - Sónia Gonçalves
- a Center for Research in Psychology (CIPsi), School of Psychology , University of Minho , Braga , Portugal
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23
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Freitas-Rosa M, Gonçalves S, Antunes H. Is being overweight associated with engagement in self-injurious behaviours in adolescence, or do psychological factors have more "weight"? Eat Weight Disord 2016; 21:493-500. [PMID: 26753879 DOI: 10.1007/s40519-015-0251-7] [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: 07/17/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The purpose of this study was to examine the prevalence of non-suicidal self-injurious behaviours (NSSI) among healthy weight and overweight adolescents and to examine the role of age, gender, weight status, treatment condition for weight control, and psychological variables (psychopathological symptoms and emotional skills) in the prediction of NSSI. METHODS The study had a cross-sectional design, and participants (n = 370) were aged 14-19 years and were divided in three groups: 205 adolescents with normal weight, 82 adolescents from the community with overweight/obesity, and 83 adolescents with overweight/obesity and in outpatient treatment for weight control. RESULTS The prevalence of these behaviours in the overweight community group (25.6 %) and in the overweight clinical group (14.5 %) was similar to their healthy weight peers (19 %). Not attending an outpatient treatment for weight control, higher psychopathology and less ability to regulate emotions predict the presence of NSSI. CONCLUSION Being overweight is not associated with NSSI, but psychosocial variables such as psychopathology, emotional deregulation and the absence of medical care predict these behaviours.
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Affiliation(s)
- Marta Freitas-Rosa
- School of Psychology, University of Minho, Campus Gualtar, 4710, Braga, Portugal.
| | - Sónia Gonçalves
- School of Psychology, University of Minho, Campus Gualtar, 4710, Braga, Portugal
| | - Henedina Antunes
- Pediatric, Gastroenterology, Hepatology and Nutrition Unit of Braga´s Hospital, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
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24
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Cucchi A, Ryan D, Konstantakopoulos G, Stroumpa S, Kaçar AŞ, Renshaw S, Landau S, Kravariti E. Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis. Psychol Med 2016; 46:1345-1358. [PMID: 26954514 DOI: 10.1017/s0033291716000027] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Against a backdrop of increasing research, clinical and taxonomic attention in non-suicidal self-injury (NSSI), evidence suggests a link between NSSI and eating disorders (ED). The frequency estimates of NSSI in ED vary widely. Little is known about the sources of this variation, and no meta-analysis has quantified the association between ED and NSSI. METHOD Using random-effects meta-analyses, meta-regression analyses, and 1816-6466 unique participants with various ED, we estimated the weighted average percentage of individuals with ED, those with anorexia nervosa (AN) and those with bulimia nervosa (BN) who are reported to have a lifetime history of NSSI across studies. We further examined predictors of NSSI in ED. RESULTS The weighted average percentage of patients with a lifetime history of NSSI was 27.3% [95% confidence interval (CI) 23.8-31.0%] for ED, 21.8% (95% CI 18.5-25.6%) for AN, and 32.7% (95% CI 26.9-39.1%) for BN. The difference between BN and AN was statistically significant [odds ratio (OR) 1.77, 95% CI 1.14-2.77, p = 0.013]. The odds of NSSI increased by 24% for every 10% increase in the percentage of participants with histories of suicide attempts (OR 1.24, 95% CI 1.04-1.48, p = 0.020) and decreased by 26% for every 10% increase in the percentage of participants with histories of substance abuse (OR 0.74, 95% CI 0.58-0.95, p = 0.023). CONCLUSIONS In the specific context of ED, NSSI is highly prevalent and correlates positively with attempted suicide, urging for NSSI-focused treatments. A novel finding is that NSSI is potentially antagonized by substance abuse.
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Affiliation(s)
- A Cucchi
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - D Ryan
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - G Konstantakopoulos
- Section of Cognitive Neuropsychiatry,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - S Stroumpa
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - A Ş Kaçar
- KOC University,School of Medicine,Istanbul,Turkey
| | - S Renshaw
- Department of Psychology,Brunel University,Middlesex,UK
| | - S Landau
- Department of Biostatistics,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - E Kravariti
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
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Islam MA, Steiger H, Jimenez-Murcia S, Israel M, Granero R, Agüera Z, Castro R, Sánchez I, Riesco N, Menchón JM, Fernández-Aranda F. Non-suicidal Self-injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender. EUROPEAN EATING DISORDERS REVIEW 2015; 23:553-60. [DOI: 10.1002/erv.2374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A. Islam
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Susana Jimenez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Zaida Agüera
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Rita Castro
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
- Ciber Salud Mental (CIBERSAM); Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
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26
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Olatunji BO, Cox R, Ebesutani C, Wall D. Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect. J Psychiatr Res 2015; 65:37-46. [PMID: 25868550 DOI: 10.1016/j.jpsychires.2015.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022]
Abstract
Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed.
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Affiliation(s)
| | | | | | - David Wall
- Remuda Ranch Programs for Eating Disorders, USA
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27
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Klomek AB, Lev-Wiesel R, Shellac E, Hadas A, Berger U, Horwitz M, Fennig S. The relationship between self-injurious behavior and self-disclosure in adolescents with eating disorders. Eat Weight Disord 2015; 20:43-8. [PMID: 25112791 DOI: 10.1007/s40519-014-0145-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/21/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of the current study is to examine the association between self disclosure and self-injurious behaviors among adolescent patients diagnosed with an eating disorder. METHODS Sixty three female patients who fulfilled the DSM-IV diagnostic criteria of eating disorders were included (i.e. anorexia, bulimia, binge eating disorder and eating disorders not otherwise specified). Participants' age ranged from 11.5 to 20 years (M = 15.42, SD = 1.82). Participants completed self- report questionnaires about eating disorders, self-disclosure, self-injurious behaviors (FASM) and depression (BDI-II) RESULTS: 82.5% of the sample endorsed severe self-injurious behaviors. A moderate negative relationship was found between general disclosure to parents and self-injurious behaviors indicating that patients who generally self-disclose to their parents (on different topics, apart from suicidal ideation) engage less frequently in self-injurious behaviors. In addition, the more patients self-disclose their suicidal ideation to others, the more they tend to self-injure. CONCLUSION Self-disclosure to parents on any topic may buffer against self-injurious behaviors and therefore it is important to work with adolescents suffering from eating disorders on effective self disclosure. In addition, self-disclosure about suicidal ideation to others by adolescents suffering from eating disorders should always be taken seriously, since it may be related to self-injurious behaviors.
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Affiliation(s)
- Anat Brunstein Klomek
- Psychological Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel,
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28
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Abstract
Extant research indicates that dissociation may act as a risk factor for nonsuicidal self-injury (NSSI), but the data are mixed. In this study, 75 university and community females ages 18-35 were assessed for rates of normative, clinical, and severely clinical dissociation as well as for NSSI. Significant differences in normative dissociation were found between the control group and the group reporting a history of NSSI. In addition, normative dissociation--but not clinical or severely clinical dissociation--was found to be significantly associated with NSSI in this sample. Considering this finding in the context of the existing literature, we propose a quartile risk model of dissociation and NSSI as a new approach to the influences of levels of dissociation on NSSI risk.
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Affiliation(s)
- Madeleine G Karpel
- a Psychology Department , Suffolk University , Boston , Massachusetts , USA
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29
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A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women. Eat Behav 2014; 15:578-81. [PMID: 25215476 DOI: 10.1016/j.eatbeh.2014.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/23/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.
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30
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Affiliation(s)
- Moya Alfonso
- a Department of Aging and Mental Health Disparities , University of South Florida , Tampa , FL , 33620
| | - Robert F. Dedrick
- b College of Education , University of South Florida, Department of Educational Measurement & Research , Tampa , FL , 33620
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31
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Claes L, Fernández-Aranda F, Jimenez-Murcia S, Botella C, Casanueva FF, de la Torre R, Fernández-Real JM, Frühbeck G, Tinahones FJ, Vilarrasa N, Montserrat-Gil de Bernabé M, Granero R, Agüera Z, Sancho C, Muehlenkamp J, Menchón JM. Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2012.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Iannaccone M, Cella S, Manzi SA, Visconti L, Manzi F, Cotrufo P. My body and me: self-injurious behaviors and body modifications in eating disorders--preliminary results. Eat Disord 2013; 21:130-9. [PMID: 23421696 DOI: 10.1080/10640266.2013.761087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We investigated self-injurious behaviors and body modification practices in eating disorder patients, considering different ED diagnoses and illness severities. Of the total sample, 50.9% showed at least one form of self-injury and 50.9% reported at least one tattoo, piercing, or both. Patients reporting only body modifications showed more positive feelings toward their bodies, higher levels of self-esteem, less impulsivity, depression, and anxiety, and lower levels of social dysfunction than those reporting only self-injury or both self-injury and body modifications. Self-injury was influenced by both diagnosis and severity of disorders.
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Affiliation(s)
- Mara Iannaccone
- Observatory on Eating Disorders, Department of Psychology, Second University of Naples, Caserta, Italy.
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33
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Abstract
Different types of self-injury have been classified as reflecting impulsive and compulsive characteristics (article by Simeon and Favazza [Self-injurious Behaviors: Assessment and Treatment {pp 1-28}. Washington, DC: American Psychiatric Publishing, Inc, 2001]). The current research used a prospective design to evaluate whether there is a progression between these different types of self-injurious behaviors (SIB) over time. Support was found for a progression from compulsive SIB (including hair pulling, nail-biting, skin picking, scratching, and preventing wounds from healing) to impulsive SIB (including cutting, burning, carving, pin sticking, and punching) in a group of adult women (N = 106). Other factors hypothesized to be linked to this outcome were disordered eating, age, and personality facets of impulsivity (specifically, urgency and lack of perseverance). Of these variables, only urgency positively predicted impulsive SIB at the study's conclusion. These findings are discussed, limitations of the study are noted, and directions for future research are outlined.
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34
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Peterson CM, Fischer S. A prospective study of the influence of the UPPS model of impulsivity on the co-occurrence of bulimic symptoms and non-suicidal self-injury. Eat Behav 2012; 13:335-41. [PMID: 23121784 DOI: 10.1016/j.eatbeh.2012.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/20/2012] [Accepted: 05/31/2012] [Indexed: 11/27/2022]
Abstract
Individuals with bulimia nervosa (BN) often report co-morbid symptoms of non suicidal self-injury (NSSI). This study examined the influence of (lack of) perseverance, (lack of) premeditation, sensation seeking, and negative urgency (the tendency to act rashly when experiencing negative affect) on these two behavior patterns. We hypothesized that negative urgency influences vulnerability to multiple maladaptive behavior patterns, thus influencing the co-occurrence of NSSI and BN symptoms. 489 young adult women completed baseline assessments, and 209 completed an eight month follow-up assessment. Structural equation modeling was used to examine the influence of four personality pathways to impulsive behavior simultaneously on both behaviors at baseline, and the incremental predictive utility of traits on both behaviors at eight month follow up. Additionally, we examined the influence of NSSI at baseline on symptoms of BN at follow up, and symptoms of BN at baseline on NSSI at follow up. Negative urgency accounted for significant variance in NSSI and eating pathology. Baseline (lack of) perseverance contributed significantly to binge eating frequency at follow-up, when accounting for baseline symptoms. NSSI at baseline was associated with increased purging at follow-up. Individual differences in impulsivity appear to influence both NSSI and eating pathology.
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Affiliation(s)
- Claire M Peterson
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA 30602, United States.
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35
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Muehlenkamp JJ, Peat CM, Claes L, Smits D. Self-injury and disordered eating: expressing emotion dysregulation through the body. Suicide Life Threat Behav 2012; 42:416-25. [PMID: 22646483 DOI: 10.1111/j.1943-278x.2012.00100.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous research has suggested that emotion dysregulation, body-related concerns, and depressive symptoms are associated with nonsuicidal self-injury (NSSI) and disordered eating (DE) separately and in combination. However, it has been difficult to ascertain to what extent these constructs contribute to NSSI and DE given the relatively small number of studies examining their co-occurrence, particularly among nonclinical samples. Based on responses to self-report questionnaires, college-aged women who completed the study were divided into three groups: NSSI only; DE only; and NSSI + DE based on clinical cutoff criteria. Results support hypotheses that emotion dysregulation is a shared vulnerability and that body-related concerns and depression exhibit unique patterns of association across the three groups. It appears that NSSI is best understood as a response to negative affective states relative to DE, which is best understood as a set of behaviors motivated by body image concerns. The presence of both NSSI and DE is primarily influenced by emotion dysregulation and the dominant difficulties linked to each behavior; depression and body dissatisfaction. These findings suggest that treatment and prevention efforts should emphasize emotion regulation skills and differentially target body concerns or depressive symptoms according to the primary behavioral dysfunction that is present.
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36
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Abstract
The present study is an exploratory investigation assessing the role of forgiveness of self and forgiveness of others in adolescent nonsuicidal self-injury (NSSI). Participants included a diverse sample of self-injuring adolescents (N = 30). Results indicated that lack of self-forgiveness was associated with engaging in NSSI for specific reasons related to the regulation of emotions and social functioning, namely to get rid of unwanted emotions, to feel something due to feeling numb or empty, and to communicate with others. Lack of self-forgiveness was also associated with greater lifetime frequency of NSSI. No relationship was found between forgiveness of others and NSSI. The implications of these findings are discussed in relation to Dialectical Behavior Therapy for NSSI, traditional forgiveness interventions, and treatment of youth who engage in NSSI.
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37
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Gordon KH, Holm-Denoma JM, Troop-Gordon W, Sand E. Rumination and body dissatisfaction interact to predict concurrent binge eating. Body Image 2012; 9:352-7. [PMID: 22564247 DOI: 10.1016/j.bodyim.2012.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 03/10/2012] [Accepted: 04/06/2012] [Indexed: 01/24/2023]
Abstract
Based upon the escape theory (Baumeister, 1991; Heatherton & Baumeister, 1991) and the emotional cascade model (Selby, Anestis, & Joiner, 2008), it was hypothesized that body dissatisfaction and rumination tendencies would interact to predict concurrent binge eating symptoms. This hypothesis was tested in a sample of 780 undergraduate students. The results conformed to prediction, in that individuals with high levels of body dissatisfaction were most likely to report binge eating behavior when they also had a tendency to ruminate. This interaction had a significant association with binge eating, above and beyond variance accounted for by participant sex, depression symptoms, and body mass index. Moreover, there was evidence of specificity for the model, as the interaction did not predict concurrent problematic drinking. Our findings suggest compatibility between the escape theory and emotional cascade models, and identify two factors that, in combination, may render individuals particularly vulnerable to binge eating.
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Affiliation(s)
- Kathryn H Gordon
- Department of Psychology, North Dakota State University, Fargo, ND 58108-6050, USA.
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38
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Body image as a mediator of non-suicidal self-injury in adolescents. J Adolesc 2012; 35:1-9. [DOI: 10.1016/j.adolescence.2011.06.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 04/08/2011] [Accepted: 06/28/2011] [Indexed: 11/23/2022]
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Cheung YTD, Lee AM, Ho SY, Li ETS, Lam TH, Fan SYS, Yip PSF. Who wants a slimmer body? The relationship between body weight status, education level and body shape dissatisfaction among young adults in Hong Kong. BMC Public Health 2011; 11:835. [PMID: 22039977 PMCID: PMC3305917 DOI: 10.1186/1471-2458-11-835] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 10/31/2011] [Indexed: 02/07/2023] Open
Abstract
Background Body shape dissatisfaction has been thought to have an indispensable impact on weight control behaviors. We investigated the prevalence of body shape dissatisfaction (BSD) and explored its association with weight status, education level and other determinants among young adults in Hong Kong. Methods Information on anthropometry, BSD, and socio-demographics was collected from a random sample of 1205 young adults (611 men and 594 women) aged 18-27 in a community-based household survey. BSD was defined as a discrepancy between current and ideal body shape based on a figure rating scale. Cross-tabulations, homogeneity tests and logistic regression models were applied. Results The percentages of underweight men and women were 16.5% and 34.9% respectively, and the corresponding percentages of being overweight or obese were 26.7% and 13.2% for men and women respectively. Three-quarters of young adults had BSD. Among women, 30.9% of those underweight and 75.5% of those with normal weight desired a slimmer body shape. Overweight men and underweight women with lower education level were more likely to have a mismatch between weight status and BSD than those with higher education level. After controlling for other determinants, underweight women were found to have a higher likelihood to maintain their current body shapes than other women. Men were found to be less likely to have a mismatch between weight status and BSD than women. Conclusions Overweight and obesity in men and underweight in women were prevalent among Hong Kong young adults. Inappropriate body shape desire might predispose individuals to unhealthy weight loss or gain behaviors. Careful consideration of actual weight status in body shape desire is needed in health promotion and education, especially for underweight and normal weight women and those with a low education level.
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Affiliation(s)
- Yee Tak Derek Cheung
- Centre for Health Policy, Programs and Economics, School of PopulationHealth, The University of Melbourne, Melbourne, Australia
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40
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Claes L, Jiménez-Murcia S, Agüera Z, Castro R, Sánchez I, Menchón JM, Fernández-Aranda F. Male Eating Disorder Patients With and Without Non-suicidal Self-injury: A Comparison of Psychopathological and Personality Features. EUROPEAN EATING DISORDERS REVIEW 2011; 20:335-8. [DOI: 10.1002/erv.1161] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Laurence Claes
- Department of Psychology; Catholic University of Leuven; Leuven; Belgium
| | | | - Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn); Instituto Salud Carlos III; Barcelona; Spain
| | - Rita Castro
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona; Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona; Spain
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41
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Abstract
The treatment of self-injury, or self-destruction of one's own body tissue, has become a new focus for both researchers and clinicians. Traditionally, the field of self-injury has distinguished between the behaviors exhibited among individuals with a developmental disability (self-injurious behaviors [SIBs]) and those present within a normative population (nonsuicidal self-injury [NSSI]). Despite this distinction, many pharmacotherapies for self-injury have been administered for both populations. The current review begins by summarizing the available efficacy studies investigating common pharmacological interventions in the treatment of self-injury. These studies are organized based on the most empirically supported neurochemical pathways in the development or maintenance of NSSI: endogenous opiods and monoamines. Although significant advances have been made in the field, conclusions based on efficacy studies of the pharmacological interventions used in the treatment of self-injury have been somewhat inconsistent. Finally, the review includes a discussion about potential avenues in the pharmacological treatment of NSSI via animal models of self-injury. Animal models present a unique opportunity to test neurobiological theories of self-injury using a controlled, systematic approach. Clinical considerations are presented as they relate to the available research findings and best practices in the treatment of self-injury.
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42
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Non-suicidal self-injury in eating disordered patients: a test of a conceptual model. Psychiatry Res 2011; 188:102-8. [PMID: 21216476 DOI: 10.1016/j.psychres.2010.12.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 10/09/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
A theoretical model explaining the high co-occurrence of non-suicidal self-injury (NSSI) in eating disordered populations as resulting from childhood traumatic experiences, low self-esteem, psychopathology, dissociation, and body dissatisfaction was previously proposed but not empirically tested. The current study empirically evaluated the fit of this proposed model within a sample of 422 young adult females (mean age=21.60; S.D.=6.27) consecutively admitted to an inpatient treatment unit for eating disorders. Participants completed a packet of questionnaires within a week of admission. Structural equation modeling procedures showed the model provided a good fit to the data, accounting for 15% of the variance in NSSI. Childhood trauma appears to have an indirect relationship to NSSI that is likely to be expressed via relationships to low self-esteem, psychopathology, body dissatisfaction, and dissociation. It appears that dissociation and body dissatisfaction may be particularly salient factors to consider in both understanding and treating NSSI within an eating disordered population.
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Wright F, Bewick BM, Barkham M, House AO, Hill AJ. Co-occurrence of self-reported disordered eating and self-harm in UK university students. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 48:397-410. [DOI: 10.1348/014466509x410343] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ross S, Heath NL, Toste JR. Non-suicidal self-injury and eating pathology in high school students. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2009; 79:83-92. [PMID: 19290728 DOI: 10.1037/a0014826] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although past research has explored self-injurious behaviors and disordered eating among adults in clinical settings, little research has been conducted examining nonsuicidal self-injury (NSSI) and eating pathology in community samples of adolescents. Four hundred and 40 students were screened for the presence of NSSI; a prevalence rate of 13.9% was found. Those who indicated that they engaged in NSSI (n = 59) and a comparison group of non-self-injurers (n = 57) completed the Eating Disorders Inventory. Results indicate that students who engage in NSSI display significantly more eating pathology than their non-NSSI peers, including poor interoceptive awareness; difficulties with impulse regulation; an increased sense of ineffectiveness, distrust, and social insecurity; and increased bulimic tendencies and body dissatisfaction. Relationships were found between increased lifetime frequency of NSSI behaviors and poor impulse control and deficits in affective regulation. In addition, adolescents who had stopped self-injuring reported comparable rates of eating pathology as did adolescents who continued to self-injure. The theoretical connection between NSSI and eating pathology are discussed with reference to enhancing knowledge regarding the characteristics of NSSI.
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Krug I, Bulik CM, Vall-Llovera ON, Granero R, Agüera Z, Villarejo C, Jiménez-Murcia S, Fernández-Aranda F. Anger expression in eating disorders: clinical, psychopathological and personality correlates. Psychiatry Res 2008; 161:195-205. [PMID: 18838172 DOI: 10.1016/j.psychres.2007.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 07/04/2007] [Accepted: 10/04/2007] [Indexed: 12/01/2022]
Abstract
The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.
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Affiliation(s)
- Isabel Krug
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
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46
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Perspectives of mental health professionals and patients on self-injury in psychiatry: a literature review. Arch Psychiatr Nurs 2008; 22:180-9. [PMID: 18640537 DOI: 10.1016/j.apnu.2007.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 07/18/2007] [Accepted: 07/20/2007] [Indexed: 11/23/2022]
Abstract
Professionals in psychiatry often encounter patients who injure themselves. To explore the perspectives of mental health professionals and patients on self-injurious behavior and treatment, the authors carried out a literature review. The reviewers found little documented data that elucidated or discussed any shared understanding about self-injurious behavior between patients and professionals or between professionals themselves. Many of the problems experienced in relation to self-injury may be due to this lack of a common view. There were few evidence-based strategies for managing self-injury that received any attention in the literature. Future studies should focus on the development and testing of preventative interventions, putting particular emphasis on effective communication between professionals and patients.
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Fernández-Aranda F, Pinheiro AP, Thornton LM, Berrettini WH, Crow S, Fichter MM, Halmi KA, Kaplan AS, Keel P, Mitchell J, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM. Impulse control disorders in women with eating disorders. Psychiatry Res 2008; 157:147-57. [PMID: 17961717 DOI: 10.1016/j.psychres.2007.02.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 09/29/2006] [Accepted: 02/11/2007] [Indexed: 01/04/2023]
Abstract
We compared symptom patterns, severity of illness, and comorbidity in individuals with eating disorders with and without impulse control disorders (ICD), and documented the temporal pattern of illness onset. Lifetime ICD were present in 16.6% of 709 women with a history of eating disorders. The most common syndromes were compulsive buying disorder and kleptomania. ICD occurred more in individuals with binge eating subtypes, and were associated with significantly greater use of laxatives, diuretics, appetite suppressants and fasting, and with greater body image disturbance, higher harm avoidance, neuroticism, cognitive impulsivity, and lower self-directedness. In addition, individuals with ICD were more likely to have obsessive-compulsive disorder, any anxiety disorder, specific phobia, depression, cluster B personality disorder, avoidant personality disorder, and to use psychoactive substances. Among those with ICD, 62% reported the ICD predated the eating disorder and 45% reported the onset of both disorders within the same 3-year window. The presence of a lifetime ICD appears to be limited to eating disorders marked by binge eating and to be associated with worse eating-related psychopathology, more pathological personality traits, and more frequent comorbid Axis I and II conditions. Untreated ICD may complicate recovery from eating disorders.
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Ribasés M, Fernández-Aranda F, Gratacòs M, Mercader JM, Casasnovas C, Núñez A, Vallejo J, Estivill X. Contribution of the serotoninergic system to anxious and depressive traits that may be partially responsible for the phenotypical variability of bulimia nervosa. J Psychiatr Res 2008; 42:50-7. [PMID: 17055531 DOI: 10.1016/j.jpsychires.2006.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 07/31/2006] [Accepted: 09/01/2006] [Indexed: 11/19/2022]
Abstract
Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric phenotypes influenced by both genetic and environmental factors. We investigated the genetic contribution of four single nucleotide polymorphisms (SNPs) within the serotonin receptor 5HT2C and two sequence variants within the serotonin transporter SLC6A4 to different ED-related psychopathological symptoms in a total sample of 82 ED patients. All patients were diagnosed according to DSM-IV criteria and underwent diagnostic and psychopathological assessments by means of structured clinical interviews and rating scales. We detected significant evidence of association between the -995A/-759T/-697C/Cys23 haplotype of the 5HT2C gene and different anxious and depressive subscales of the SCL90-R instrument, that included Somatization (p = 0.029), Obsessive-Compulsiveness (p = 0.021), Depression (p = 0.032), Anxiety (p = 0.004), Hostility (p = 0.028), Phobic Anxiety (p = 0.029) and Paranoid Ideation (p = 0.008), in BN patients. We also observed a strong association between the 5HTTLPR polymorphism of the SLC6A4 gene and Anxiety in the same group of BN patients (p = 0.004). However, no epistatic effects between the 5HT2C and SLC6A4 genes on the different anxious and depressive subscales were observed. Our preliminary data suggest that the serotoninergic system contributes to the different psychopathological symptoms that may be partially responsible for the phenotypical variability within the bulimic phenotype.
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Affiliation(s)
- Marta Ribasés
- Genes and Disease Program, Center for Genomic Regulation, Barcelona Biomedical Research Park, Barcelona, Catalonia, Spain
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Fernández-Aranda F, Jiménez-Murcia S, Alvarez-Moya EM, Granero R, Vallejo J, Bulik CM. Impulse control disorders in eating disorders: clinical and therapeutic implications. Compr Psychiatry 2006; 47:482-8. [PMID: 17067872 DOI: 10.1016/j.comppsych.2006.03.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 02/03/2006] [Accepted: 03/15/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. METHOD A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. EVALUATION Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices. RESULTS In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01). CONCLUSIONS Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.
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