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Lieberman A, Robison M, Wonderlich SA, Crosby RD, Mitchell JE, Crow SJ, Peterson CB, Le Grange D, Bardone-Cone AM, Kolden G, Joiner TE. Self-hate, dissociation, and suicidal behavior in bulimia nervosa. J Affect Disord 2023; 335:44-48. [PMID: 37178824 DOI: 10.1016/j.jad.2023.05.015] [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: 11/28/2022] [Revised: 03/27/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs. METHODS In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior. RESULTS Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior. LIMITATIONS Future work should include longitudinal analyses to understand temporal relationships among study variables. CONCLUSIONS In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs.
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Affiliation(s)
- Amy Lieberman
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America.
| | - Morgan Robison
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, Fargo, ND, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, ND, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, Fargo, ND, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, United States of America; Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL (Emeritus), United States of America
| | - Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States of America
| | - Gregory Kolden
- Department of Psychiatry, University of Wisconsin, Madison, WI, United States of America
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States of America
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Ortiz SN, Grunewald W, Morgan R, Smith A. Examining the relationship between dysmorphia symptoms and suicidality through the lens of the Interpersonal Theory of Suicide. J Clin Psychol 2023; 79:541-557. [PMID: 35988134 PMCID: PMC10087364 DOI: 10.1002/jclp.23433] [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: 11/22/2021] [Revised: 07/04/2022] [Accepted: 08/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Using the Interpersonal Theory of Suicide (IPTS) as a framework, this two-study investigation tested whether burdensomeness and low belongingness explained the association between body and muscle dysmorphia symptoms and suicidal ideation (tested in Study 1 and Study 2), and if fearlessness about death and pain tolerance explained the association between dysmorphia symptoms and previous suicide attempt frequency (tested in Study 2). METHODS Study 1 used a community sample (n = 273) and Study 2 used an at-risk population sample (n = 261). Participants completed cross-sectional questionnaires online. RESULTS In Study 1, both types of dysmorphic symptoms related to suicidal ideation through burdensomeness, but only body dysmorphic symptoms related to suicidal ideation through low belongingness. In Study 2, results were replicated as both types of dysmorphic symptoms related to suicidal ideation through burdensomeness. While both types of symptoms related to low belonging, low belonging did not relate to suicidal ideation. Neither dysmorphic symptoms nor capability for suicide related to frequency of suicide attempts. CONCLUSIONS Results suggest that improving interpersonal needs, such as feeling more effective, may be important treatment targets for individuals with dysmorphic symptoms who also experience suicidal ideation. Future work should continue to identify mediators for suicide attempts among individuals with dysmorphia symptoms.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | | | - Robert Morgan
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | - April Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
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Meneguzzo P, De Mico A, Gori P, Ajello A, Ceccato E, Consolati MD, Vita A, Sala A, Santonastaso P. A Multicenter Network Analysis Examining the Psychological Effects of the COVID-19 Pandemic on Patients with Eating Disorders versus Their Healthy Siblings. J Clin Med 2022; 11:7187. [PMID: 36498760 PMCID: PMC9736149 DOI: 10.3390/jcm11237187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: The impact of the COVID-19 pandemic on individuals with eating disorders (EDs) has been recorded all over the world; the traumatic effects of COVID-19 have exacerbated specific and general psychopathologies in those with EDs. Comparing patients' and their healthy siblings' responses might help one evaluate whether there are significant differences between healthy individuals and those struggling with EDs in regard to posttraumatic psychological symptoms. (2) Methods: A sample of 141 ED patients and 99 healthy siblings were enrolled in this study in two different centers specializing in ED treatment. All participants completed the posttraumatic stress disorder (PTSD) checklist and an eating and general psychopathological self-report questionnaire. Network analysis was then applied to evaluate the differences between the populations. (3) Results: No significant differences emerged between the network structures despite the significant differences between patients and their healthy siblings in regard to posttraumatic symptoms, eating, and general psychopathology. (4) Conclusion: The complex nature of the interaction between environmental and personal factors should be evaluated further in individuals with EDs due to how they respond to traumatic events, which exacerbate patients' psychopathology.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35122 Padova, Italy
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
| | - Alberto De Mico
- Department of General Psychology, University of Padova, 35122 Padova, Italy
| | - Pietro Gori
- Department of General Psychology, University of Padova, 35122 Padova, Italy
| | - Alessio Ajello
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Enrico Ceccato
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 “Berica”, 36100 Vicenza, Italy
| | - Mauro Domenico Consolati
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Alessandra Sala
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 “Berica”, 36100 Vicenza, Italy
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Grunewald W, Troop-Gordon W, Smith AR. Relationships between eating disorder symptoms, muscle dysmorphia symptoms, and suicidal ideation: A random intercepts cross-lagged panel approach. Int J Eat Disord 2022; 55:1733-1743. [PMID: 36200702 DOI: 10.1002/eat.23819] [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: 06/19/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms correlate with suicidality; yet the strength of these relationships in men is unclear. Muscle dysmorphia (MD) symptoms may reflect a more accurate index of body-related concerns for men, as they better target muscularity concerns typical of men. However, no studies have tested a model in which ED/MD symptoms and suicidality are simultaneously examined. We longitudinally tested whether ED/MD symptoms were related to suicidal ideation among a community sample of men. METHODS Men with MD symptoms (N = 272) were recruited to complete three surveys over 6 weeks. A random intercepts cross-lagged panel model tested predictive associations between ED/MD symptoms and suicidal ideation, while disaggregating between/within-person variance. RESULTS ED/MD symptoms were significantly associated with suicidal ideation at the between-subjects level (ED: b = .04; MD: b = .09) and showed significant within-wave covariances with suicidal ideation (ED: b = .02-.04; MD: b = .02-.05). Those who experienced increases in ED symptoms showed increased suicidal ideation at the next wave (b = .32). Those who experienced increases in suicidal ideation showed increases in MD symptoms at the next wave (b = .85). DISCUSSION Results highlight ED symptoms as a potential risk factor for suicidal ideation among men. Further, suicidal ideation predicted MD symptoms. ED symptoms may create intra- and interpersonal distress predicting suicidal ideation. Suicidal ideation may lead to muscle-building behaviors to cope with suicidal thoughts. Clinicians should assess for suicidal ideation among men at risk for MD/EDs, and for MD symptoms among those reporting suicidal ideation. PUBLIC SIGNIFICANCE Eating disorder (ED) symptoms are related to suicidality, but these relationships are understudied among men. Since men report concerns surrounding muscularity, muscle dysmorphia (MD) may be a better ED index for this population. However, little research has investigated relationships between ED symptoms, MD symptoms, and suicidality among men. This study investigated relationships between ED/MD symptoms and suicidality among 272 men. Results may inform clinical assessment, treatment, and classification of MD.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Wendy Troop-Gordon
- Department of Human Development and Family Studies, Auburn University, Auburn, Alabama, USA
| | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Grunewald W, Ortiz SN, Kinkel-Ram SS, Smith AR. Longitudinal relationships between muscle dysmorphia symptoms and suicidal ideation. Suicide Life Threat Behav 2022; 52:683-695. [PMID: 35253940 DOI: 10.1111/sltb.12852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship. METHODS Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6 weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model. RESULTS Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance. CONCLUSIONS Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | | | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Felton JW, Collado A, Cinader M, Key K, Lejuez CW, Yi R. The Role of Delay Discounting in the Generation of Stressful Life Events Across Adolescence. Res Child Adolesc Psychopathol 2022; 50:1529-1541. [DOI: 10.1007/s10802-022-00950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
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The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk. Body Image 2021; 38:162-170. [PMID: 33892440 DOI: 10.1016/j.bodyim.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.
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Lieberman A, Joiner TE, Duffy ME, Wonderlich SA, Crosby RD, Mitchell JE, Crow SJ, Peterson CB, Le Grange D, Bardone-Cone AM. An Examination of the Interpersonal Theory of Suicide's Tenets among Women with Bulimic-Spectrum Pathology. Psychiatry 2021; 84:137-149. [PMID: 33944699 DOI: 10.1080/00332747.2021.1917244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Suicide attempts and self-injurious behaviors (SIBs) are known to be elevated among people with bulimia nervosa (BN). The aim of the current study was to examine the Interpersonal-Psychological Theory of Suicide (IPTS) as a framework for understanding, assessing, and mitigating suicidal behavior among women with BN. The IPTS suggests that for individuals to enact lethal suicide attempts, they must have both the desire to die (consisting of thwarted belongingness and perceived burdensomeness) as well as the capability to die (often acquired through repeated exposure to provocative or painful experiences).Method: Two-hundred and four women with eating disorders, the majority of whom met criteria for a current DSM-IV diagnosis of BN, completed measures from which proxies for IPTS variables were formed. Bivariate correlations and multiple regressions tested main effects and interactions of study variables. Tests of the difference between dependent correlations probed differential associations between study variables and suicidal ideation versus suicidal behavior.Results and Conclusions: Results yielded considerable but not unalloyed support for the theory, with desire to die variables (particularly perceived burdensomeness) more strongly associating with suicidal ideation than behavior, and the opposite holding true regarding capability. These findings suggest that the IPTS may provide a useful framework for understanding, assessing, and mitigating suicide risk among individuals with BN.
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Ortiz SN, Smith A. A longitudinal examination of the relationship between eating disorder symptoms and suicidal ideation. Int J Eat Disord 2020; 53:69-78. [PMID: 31479165 DOI: 10.1002/eat.23162] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cross-sectional research demonstrates significant correlations between eating disorders (EDs) and suicidal thoughts and behaviors. Although suicide ideation (SI) is a risk factor for suicidal behavior, longitudinal research investigating SI among EDs is limited. Thus, the aim of this study was to offer insight into the dynamic relationship between EDs and SI by investigating if these variables predicted one another at weekly time points. METHOD Autoregressive cross-lagged modeling was used to test bidirectional relationships between ED symptoms and suicidal ideation among an ED patient sample (n = 92). Participants completed a measure of suicidal ideation and the Eating Disorder Examination-Questionnaire (EDE-Q) weekly for 5 weeks. RESULTS SI and ED symptoms were correlated with each other at each time point. Unexpectedly, the majority of cross-lagged pathways were nonsignificant. However, SI at Week 4 predicted ED symptoms at Week 5, while controlling for Week 4 ED symptoms. This pattern of results was found when the shape concerns, weight concerns, and eating concerns subscales of the EDE-Q were entered into the model. Moreover, Week 2 shape concerns predicted Week 3 SI and Week 3 eating concerns predicted Week 4 SI. No significant cross-lagged pathways were found with the dietary restraint subscale. DISCUSSION Nonsignificant cross-lagged pathways may indicate that third variables better explain the relations between certain ED symptoms and SI over time. However, there were instances where ED symptoms and SI predicted one another. Given this, targeting suicidal thoughts in therapy may help to reduce eating pathology and vice versa.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - April Smith
- Department of Psychology, Miami University, Oxford, Ohio
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Trujillo A, Forrest LN, Claypool HM, Smith AR. Assessing Longitudinal Relationships among Thwarted Belongingness, Perceived Burdensomeness, and Eating Disorder Symptoms. Suicide Life Threat Behav 2019; 49:1609-1620. [PMID: 30730079 DOI: 10.1111/sltb.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Past work has documented a cross-sectional relationship between eating disorders (ED) and suicidality, but few studies have examined the directionality of this relationship. Informed by the interpersonal-psychological theory of suicide (IPTS), this study examines the bidirectional, longitudinal relationship between ED symptoms and two determinants of suicide ideation-thwarted belongingness (TB) and perceived burdensomeness (PB). METHOD Ninety-two treatment-seeking individuals with ED (94.5% White, 95.6% female) completed baseline (T1) measures of ED symptoms along with TB and PB. Of those, 75 (81.5%) completed a follow-up assessment eight weeks later (T2). RESULTS Separate linear regression models revealed that T1 ED symptoms did not predict T2 TB (b = .03, p = .42) or T2 PB (b = -.01, p = .68). Similarly, T1 TB did not predict T2 ED symptoms (b = .25, p = .37). T1 PB did significantly predict T2 ED symptoms (b = 0.52, p = .04). Further, among participants with AN/sub-AN, T1 TB and PB predicted T2 ED symptoms (p's ≤ .03). CONCLUSION Our results reveal the need for a nuanced understanding of the relationship between ED and suicidality. This study found that PB predicts greater ED symptoms and, among the AN/sub-AN sample, TB does as well.
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Perkins NM, Brausch AM. Body dissatisfaction and symptoms of bulimia nervosa prospectively predict suicide ideation in adolescents. Int J Eat Disord 2019; 52:941-949. [PMID: 31184380 PMCID: PMC6687556 DOI: 10.1002/eat.23116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Symptoms of eating disorders have been established as significant concurrent correlates with suicide ideation and behaviors in adolescent samples, but very few studies have examined eating disorder symptoms as prospective risk factors for suicide. The current study examined eating disorder symptoms as prospective risk factors for suicide ideation in an unselected community sample of adolescents. METHOD Data were collected from 436 adolescents in middle and high school at baseline and 6- and 12-month follow-ups. Adolescents completed self-report measures assessing eating disorder symptoms and suicide ideation and behaviors at each time point during school hours. RESULTS Regression analyses found that body dissatisfaction was a significant prospective predictor of suicide ideation severity at the 6- and 12-month follow-ups, symptoms of bulimia nervosa (binge-eating disorder and purging) predicted suicide ideation severity at the 12-month follow-up only, and symptoms of anorexia nervosa (drive for thinness and restricting) were not significant predictors of suicide ideation at either follow-up. Exploratory analyses found the same pattern of results for the sample of girls only, while no significant predictors were found for boys only. DISCUSSION This is the first longitudinal study of disordered eating and suicide ideation in American adolescents. Symptoms of bulimia nervosa and body dissatisfaction seem to be true risk factors for suicidal ideation. The current study demonstrates the importance of disordered eating behaviors in the development of suicidal ideation in adolescents, particularly for adolescent girls.
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Bodell LP, Cheng Y, Wildes JE. Psychological Impairment as a Predictor of Suicide Ideation in Individuals with Anorexia Nervosa. Suicide Life Threat Behav 2019; 49:520-528. [PMID: 29578246 PMCID: PMC6158119 DOI: 10.1111/sltb.12459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 01/01/2018] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by severe food restriction resulting in low body weight and an intense fear of gaining weight. This disorder has one of the highest suicide rates of any psychiatric illness; however, few studies have investigated prospective predictors of suicide ideation (SI) in this population. Quality-of-life impairment may be particularly relevant for understanding suicide risk in AN, given associations with SI in other psychiatric disorders and associations with chronicity and severity in AN. This study explored associations between eating disorder-related impairment and SI in individuals with AN (n = 113) who completed assessments at treatment discharge and 3, 6, and 12 months after discharge. Greater psychological impairment predicted future occurrence of SI controlling for age, depression, history of SI, and eating disorder variables. Associations were specific to psychological impairment as other domains of impairment did not predict SI over time. Findings highlight the potential importance of targeting interpersonal-psychological consequences of AN to decrease future suicide risk.
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Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality. Curr Psychiatry Rep 2018; 20:77. [PMID: 30094518 DOI: 10.1007/s11920-018-0931-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This narrative review evaluates recent literature on the associations between eating disorders and suicidality and discusses potential shared mechanisms that may account for these relationships. Additionally, the review highlights shortcomings with the literature to date and suggests avenues for future research. RECENT FINDINGS Individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder experience elevated rates of suicidality compared to the general population. Suicide risk is higher when eating disorders occur with other psychological conditions. Additionally, genetic factors, emotion dysregulation, trauma, stressful life events, and lack of body regard may have roles in the development of both eating disorders and suicidality. Much of the risk for suicidality in eating disorders appears to be driven by comorbid psychopathology and genetic factors. However, the lack of longitudinal research makes it difficult to draw conclusions about the directionality or temporality of these relations; thus, novel methods are needed.
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Smith AR, Zuromski KL, Dodd DR. Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Curr Opin Psychol 2018; 22:63-67. [DOI: 10.1016/j.copsyc.2017.08.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
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Shih JH, Barstead MG, Dianno N. Interpersonal predictors of stress generation: Is there a super factor? Br J Psychol 2017; 109:466-486. [PMID: 29226316 DOI: 10.1111/bjop.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/30/2017] [Indexed: 11/28/2022]
Abstract
Hammen's (1991, Journal of Abnormal Psychology, 100, 555-561) seminal paper on stress generation highlighted the reciprocal relationship between stress and depression. Not only does stress predict depression, but women with a diagnosis of depression also experienced subsequent increased levels of stress. In the ensuing years, depression researchers have moved beyond clinical predictors and examined whether depression vulnerability factors also contribute to stress generation. This interest has led to a growing focus on interpersonal vulnerability factors that contribute to stress generation. To date, the research examining interpersonal predictors of stress generation has tended to examine vulnerability factors singly and thus potential overlap and unique predictions among vulnerability factors have not been determined. This study examines interpersonal vulnerability factors from various schools of thought (dependency, attachment, and unmitigated communion) as predictors of interpersonal stress generation. Three hundred and sixty-four young adults completed baseline measures of interpersonal vulnerabilities and provided weekly reports of depressive symptoms and stressful life events. Multilevel models were estimated to examine their unique predictions of interpersonal stress generation. Despite converging theories, there does not appear to be a single super factor. Of the interpersonal vulnerability factors tested, anxious attachment emerged as a consistent predictor of interpersonal stress generation both when examined singly and when in combination with related variables.
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Affiliation(s)
- Josephine H Shih
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA
| | | | - Nicole Dianno
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA
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Kwan MY, Minnich AM, Douglas V, Gordon KH, Castro Y. Bulimic symptoms and interpersonal functioning among college students. Psychiatry Res 2017; 257:406-411. [PMID: 28837928 DOI: 10.1016/j.psychres.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/04/2017] [Accepted: 08/12/2017] [Indexed: 11/26/2022]
Abstract
Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.
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Affiliation(s)
- Mun Yee Kwan
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA.
| | - Allison M Minnich
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA
| | - Valerie Douglas
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA
| | - Kathryn H Gordon
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA; Neuropsychiatric Research Institute, 120 8th Street S., Fargo, ND 58102, USA
| | - Yessenia Castro
- School of Social Work, The University of Texas at Austin, HLP 295D, Austin, TX 78712, USA
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Kwan MY, Gordon KH, Carter DL, Minnich AM, Grossman SD. An Examination of the Connections Between Eating Disorder Symptoms, Perceived Burdensomeness, Thwarted Belongingness, and Suicide Risk Among Undergraduate Students. Suicide Life Threat Behav 2017; 47:493-508. [PMID: 27807882 DOI: 10.1111/sltb.12304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/23/2016] [Indexed: 11/27/2022]
Abstract
Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.
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Affiliation(s)
| | - Kathryn H Gordon
- North Dakota State University, Fargo, ND, USA.,Neuropsychiatric Research Institute, Fargo, ND, USA
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Smith CE, Pisetsky EM, Wonderlich SA, Crosby RD, Mitchell JE, Joiner TE, Bardone-Cone A, Le Grange D, Klein MH, Crow SJ, Peterson CB. Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa? Eat Weight Disord 2016; 21:199-204. [PMID: 26462683 PMCID: PMC4833682 DOI: 10.1007/s40519-015-0226-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the association between specific forms of childhood abuse and neglect with lifetime suicide attempts in women with bulimia nervosa (BN). METHODS Two hundred and four women aged 18-65 (mean 25.6 years, SD 9.13) with full or subclinical BN were recruited in five US Midwestern communities and specialized eating disorder clinics. Participants completed questionnaires including the Childhood Trauma Questionnaire (CTQ) and self-reported whether they had ever had a lifetime suicide attempt. Logistic regression analyses were used to predict lifetime suicide attempts from each subscale of the CTQ. RESULTS Childhood emotional, physical, and sexual abuse were significantly associated with the presence of a lifetime suicide attempt in women with BN. Childhood emotional and physical neglect were not associated with suicide attempts. CONCLUSIONS Individuals with BN who have experienced childhood emotional and sexual abuse are at increased risk of a lifetime suicide attempt. Future research is needed to understand the mechanism to address in treatment and prevention efforts. It is important for clinicians to be aware of the potential increased risk of suicide in individuals with BN with a history of childhood abuse.
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Affiliation(s)
- Christina E Smith
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA.
| | - Stephen A Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Ross D Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anna Bardone-Cone
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
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Forrest LN, Bodell LP, Witte TK, Goodwin N, Bartlett ML, Siegfried N, Eddy KT, Thomas JJ, Franko DL, Smith AR. Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients. J Affect Disord 2016; 195:127-35. [PMID: 26895090 DOI: 10.1016/j.jad.2016.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/14/2016] [Accepted: 02/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. METHOD We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. RESULTS The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LIMITATIONS The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. CONCLUSIONS Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.
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Affiliation(s)
- Lauren N Forrest
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States
| | - Lindsay P Bodell
- University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, United States
| | - Tracy K Witte
- Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States
| | - Natalie Goodwin
- Eating Recovery Center of Washington, 1231 116th Ave NE, Bellevue, WA 98004, United States
| | - Mary L Bartlett
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Nicole Siegfried
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Bouvé College of Health Sciences and Department of Counseling and Applied Educational Psychology, Northeastern University, 123 Behrakis Health Sciences Center, Boston, MA 02115, United States
| | - April R Smith
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States.
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Kwan MY, Gordon KH. An examination of the prospective impact of bulimic symptoms and dietary restraint on life hassles and social support. J Affect Disord 2016; 191:24-8. [PMID: 26610190 DOI: 10.1016/j.jad.2015.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The stress generation hypothesis posits that individuals with psychopathology engage in maladaptive behaviors that create stress. Although extensively researched in the depression literature, few studies have investigated whether the stress generation hypothesis applies to eating disorders. This study examined whether bulimic symptoms and dietary restraint predict future life hassles and low social support among undergraduate students. METHODS Three hundred seventy-four undergraduate students participated in this two-part prospective study through a secure online system. They completed questionnaires assessing depressive symptoms, bulimic symptoms, dietary restraint, life hassles, and social support. RESULTS Regression analyses revealed that baseline bulimic symptoms predicted greater life hassles but not lower social support one month later, after statistically controlling for baseline measures. Baseline dietary restraint did not predict future life hassles or social support. LIMITATIONS Limitations include use of self-report measures, suboptimal response rates at the follow-up assessment, and use of a non-clinical sample with primarily White participants. CONCLUSIONS These results provide preliminary support for the stress generation hypothesis in relation to bulimic symptoms. Individuals with bulimic symptoms may generate stressors similar to those experiencing depressive symptoms. Our findings suggest that emphasizing stress management in the treatment of individuals with bulimic symptoms could potentially improve treatment outcomes.
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Affiliation(s)
- Mun Yee Kwan
- North Dakota State University, Fargo, ND, United States.
| | - Kathryn H Gordon
- North Dakota State University, Fargo, ND, United States; Neuropsychiatric Research Institute, Fargo, ND, United States
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21
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Restrictive eating: Associated with suicide attempts, but not acquired capability in residential patients with eating disorders. Psychiatry Res 2016; 235:90-6. [PMID: 26710984 DOI: 10.1016/j.psychres.2015.11.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/20/2015] [Accepted: 11/22/2015] [Indexed: 11/21/2022]
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