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Schmidt K, Fitzgerald E, Keel P. Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk? EUROPEAN EATING DISORDERS REVIEW 2024; 32:952-962. [PMID: 38760944 DOI: 10.1002/erv.3104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. METHOD We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). RESULTS SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. CONCLUSIONS OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.
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Affiliation(s)
| | | | - Pamela Keel
- Florida State University, Tallahassee, Florida, United States
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2
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Cole B. Understanding Eating Disorders and the Nurse's Role in Diagnosis, Treatment, and Support. J Christ Nurs 2024; 41:80-87. [PMID: 38436337 DOI: 10.1097/cnj.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
ABSTRACT Eating disorders (EDs) are a severe type of mental illness that nurses in many settings may encounter. The three primary eating disorders-anorexia nervosa, bulimia nervosa, and binge eating disorder-are described here. Signs, symptoms, and treatment of eating disorders are outlined, along with the importance of nurses in early identification of EDs and developing therapeutic relationships with patients. A case study and elements of spiritual care are presented.
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Affiliation(s)
- Britt Cole
- Britt Cole, MSN, RN, CPN, is an associate professor of nursing, teaching pediatrics in the BSN program at Miami University in Ohio. She has nearly 30 years of experience in pediatric nursing and is passionate about trauma-informed care of children exposed to adverse childhood events
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Akgül S, Pehlivantürk Kızılkan M, Yıldırım A, Derman O. Prevalence of suicide attempt, suicide ideation and self-harm at diagnosis in adolescents with eating disorders. Int J Psychiatry Clin Pract 2024; 28:63-67. [PMID: 38592409 DOI: 10.1080/13651501.2024.2337796] [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: 08/02/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Data concerning the suicide prevalence of eating disorder (ED) subtypes and predictive factors are lacking in youth. This study aimed to examine suicide attempts (SA), suicide ideation (SI) and self-harm (SH) upon diagnosis in adolescents with EDs. METHODS The prevalence of SA, SI and SH in ED subtypes was evaluated by retrospectively assessing the Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety (HEEADSSS) instrument of adolescents diagnosed with an ED. Clinical predictors of SI in anorexia nervosa (AN) and atypical AN (AAN) were assessed. RESULTS Among all participants (398), 41 (10.3%) reported SA, 126 (31.7%) SI and 60 (15.1%) SH. While SA did not differ statistically between ED subgroups (p = .123), they were two times more prevalent in the bulimia nervosa (BN) group (17.5%) than in the AN group (8.5%). In the BN group, SI was 2.3 times more prevalent than in the AN group (p = .001). The AN and ARFID groups exhibited substantially less SH (p = .036). Having a higher body mass index (BMI) was the only significant predictor of SI. CONCLUSIONS This study demonstrates that adolescents with EDs are at an increased risk for suicidality, highlighting the need for close screening, particularly in those with BN, AN-BP and AN with a higher BMI.
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Affiliation(s)
- Sinem Akgül
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
| | | | - Ayşegül Yıldırım
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
| | - Orhan Derman
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
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4
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Danon M, Duriez P, Gorwood P. Three clinical indicators of borderline personality disorder in anorexia nervosa: A pilot study. L'ENCEPHALE 2024; 50:4-10. [PMID: 36411120 DOI: 10.1016/j.encep.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%-40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity. METHODS After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R). RESULTS B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score. CONCLUSIONS The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.
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Affiliation(s)
- M Danon
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France.
| | - P Duriez
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
| | - P Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
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Soullane S, Israël M, Steiger H, Chadi N, Low N, Dewar R, Ayoub A, Auger N. Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders. Int J Eat Disord 2023; 56:2223-2231. [PMID: 37646466 DOI: 10.1002/eat.24052] [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: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.
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Affiliation(s)
- Safiya Soullane
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mimi Israël
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ron Dewar
- Cancer Care Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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Andersen ST, Strandberg-Larsen K, Skovgaard AM, Rimvall MK, Meyer LB, Olsen EM. Comparison of prevalence and mental health problems across symptom frequency of self-reported symptoms of binge-eating disorder in a community sample of adolescents. Int J Eat Disord 2023; 56:1947-1960. [PMID: 37458303 DOI: 10.1002/eat.24023] [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: 11/19/2022] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Binge-eating disorder (BED) and subthreshold BED (SBED) are prevalent in adults and associated with mental health problems including depression, non-suicidal self-injury, lower quality of life, and suicidality. There is solid evidence that binge-eating behaviors are also prevalent in adolescence, but knowledge about mental health in community adolescents with BED of different frequency thresholds is more limited. We aimed to investigate the prevalence and mental health problems associated with SBED of low frequency and/or limited duration compared with BED in a Danish community sample of adolescents. METHODS We included 2509 adolescents who completed the online survey of the 16-17-year follow-up of the Copenhagen Child Cohort (CCC2000), including items on BED symptoms approximating the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and items on mental health and quality of life. RESULTS The 1-year prevalence of SBED was 2.7% (95% confidence interval [CI]: 2.0%-3.3%) with a male:female ratio of 1:3.7; comparable to previous findings on BED in the same sample. SBED was also comparable to BED concerning cross-sectional associations with overall mental health problems, lower health-related quality of life, depressive symptoms, and suicidal ideation, whereas no associations were seen with non-suicidal self-injury after Holm-Bonferroni correction. In both groups, thoughts and behaviors concerning food and weight interfered significantly with daily life. DISCUSSION SBED and BED were equally prevalent in this adolescent community sample, and similarly associated with indicators of poor mental health. The findings indicate that community adolescents reporting symptoms approximating clinical criteria of BED need intervention irrespectively of symptom frequency or duration. PUBLIC SIGNIFICANCE This study adds knowledge to the field by comparing BED of low frequency and/or limited duration ("subthreshold BED," SBED) with full-syndrome BED in adolescents and showing that SBED in adolescence is both prevalent and associated with poor mental health to a similar extent as that of BED. Findings indicate that self-reported symptoms according to clinical criteria of SBED and BED alike constitute a public health problem and point to youngsters in need of intervention.
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Affiliation(s)
- Sofie Thor Andersen
- The Danish Patient Association of Eating Disorders and Self-Harm, Valby, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Martin Køster Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Lene Bomholt Meyer
- The Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Else Marie Olsen
- Section for Epidemiology, Center for Clinical Research and Prevention, The Capital Region, Copenhagen, Denmark
- Outpatient Clinic for Eating Disorders in Adults, Psychiatric Centre Ballerup, The Capital Region, Copenhagen, Denmark
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Duriez P, Goueslard K, Treasure J, Quantin C, Jollant F. Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study. Int J Eat Disord 2023; 56:1534-1543. [PMID: 37092760 DOI: 10.1002/eat.23974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. METHODS Individuals aged 12 to 25 years old hospitalized in 2013-2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. RESULTS This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3-65.3]) and higher all-cause mortality (HR = 12.6 [4.3-37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5-0.6]) but higher mortality (HR = 1.6 [1.0-2.4]) when compared to youths with any other mental disorder. CONCLUSION Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. PUBLIC SIGNIFICANCE We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders.
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Affiliation(s)
- Philibert Duriez
- CMME, Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris, France
- UMR_S1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm, Paris, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHRU Dijon, Dijon, France
| | - Janet Treasure
- Psychology and Neuroscience, Section of Eating Disorders, Institute of Psychiatry, London, UK
| | - Catherine Quantin
- CIC 1432, INSERM, Dijon, France
- Clinical Epidemiology Clinical Trials Unit, Clinical Investigation Center, CHU Dijon, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Fabrice Jollant
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU de Nîmes, Nîmes, France
- Department of Psychiatry, Faculty of Medicine, and McGill Group For Suicide Studies, McGill University, Montréal, Québec, Canada
- Team MOODS, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Mensinger JL, Shepherd BF, Schapiro S, Aware Y, Brochu PM, Calogero RM, Tylka TL. Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index. Eat Behav 2023; 49:101730. [PMID: 37121132 DOI: 10.1016/j.eatbeh.2023.101730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Stevie Schapiro
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Yashvi Aware
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Rachel M Calogero
- Department of Psychology, Western University, Westminster Hall, Office 321, London, ON N6K 5C2, Canada.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, 170F Morrill Hall, 1465 Mt. Vernon Avenue, Marion, OH 43302, United States of America.
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Confirmatory factor analysis of Acute Suicidal Affective Disturbance in a sample of treatment-seeking eating disorder patients. J Affect Disord 2023; 326:155-162. [PMID: 36724842 DOI: 10.1016/j.jad.2023.01.089] [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: 06/15/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We examined the factor structure of Acute Suicidal Affective Disturbance (ASAD) in individuals with eating disorders. ASAD is a proposed diagnosis with four symptoms: rapidly increasing suicidal intent, social or self-alienation, hopelessness regarding the previous symptoms, and overarousal. METHODS Patients with eating disorders (N = 378) completed self-report symptom questionnaires at admission to a partial hospitalization program for eating disorders. Using proxy measures, we conducted a confirmatory factor analysis (CFA) of the one-factor model of ASAD. RESULTS Initial model fit was poor. We iteratively revised the model to include theoretically-justified correlated residuals (i.e., those between items intended to measure the same ASAD symptom). After these modifications, model fit remained mediocre. We next conducted a multiple-group CFA to compare ASAD between individuals with the restricting subtype of anorexia nervosa (the "ANR" model, n = 145) and individuals with binge/purge disorders (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa; the "BP" model, n = 234). The final model had mediocre fit with partial invariance between subgroups; the ASAD factor mean was higher in the BP model. We additionally tested a bifactor model, with similar findings. LIMITATIONS Our use of proxy measures of ASAD items may have resulted in imprecise measurement of ASAD symptoms, pointing to the importance of future research using validated measures of ASAD. CONCLUSIONS We found moderate support for ASAD in an eating disorder sample, with invariance between eating disorder phenotypes. Our findings suggest that the ASAD diagnosis may not fully generalize to eating disorder samples.
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Sohn MN, Dimitropoulos G, Ramirez A, McPherson C, Anderson A, Munir A, Patten SB, McGirr A, Devoe DJ. Non-suicidal self-injury, suicidal thoughts and behaviors in individuals with an eating disorder relative to healthy and psychiatric controls: A systematic review and meta-analysis. Int J Eat Disord 2023; 56:501-515. [PMID: 36647184 DOI: 10.1002/eat.23880] [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: 08/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Eating disorders (ED) may be associated with an increased prevalence of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) relative to healthy (HC) and psychiatric (PC) controls. However, precise estimates of differences in prevalence between individuals with EDs and controls are unclear. We compared the prevalence of NSSI, suicidal ideation (SI), suicide attempts (SA), and deaths by suicide in controls and individuals with EDs. METHOD We searched MEDLINE, PsycINFO, EMBASE, and CINAHL for peer-reviewed publications reporting the prevalence of NSSI and/or STBs in EDs and HC or PC group (PROSPERO: CRD42021286754). A series of random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for NSSI, SI, SA, and death by suicide in EDs. RESULTS Across 32 studies, individuals with an ED had a significantly increased prevalence of NSSI (HC: OR = 6.85 [95% CI: 3.60, 13.04]; PC: OR = 2.74 [95% CI: 1.49, 5.06]), SI (HC: OR = 3.63 [95% CI: 2.43, 5.41]; PC: OR = 3.10 [95% CI: 2.01, 4.78]), and SA (HC: OR = 5.16 [95% CI: 4.27, 6.24]; PC: OR = 1.37 [95% CI: 0.37, 4.99]) relative to HC and PC groups. A 2.93-times increased odd of death by suicide did not achieve statistical significance. There was a high-level of heterogeneity between studies. DISCUSSION Our findings indicate that ED populations have an increased prevalence of NSSI, SI, and SA but not death by suicide compared to controls and emphasize the need for effective clinical strategies to address these behaviors in ED populations. PUBLIC SIGNIFICANCE This review provides evidence for an increased prevalence of non-suicidal self-injury, suicidal ideation, and suicide attempts in populations with eating disorders compared to controls. Our findings emphasize the need for effective clinical strategies to address these behaviors in patients with eating disorders.
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Affiliation(s)
- Maya N Sohn
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Ana Ramirez
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Claire McPherson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alida Anderson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Amlish Munir
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Daniel J Devoe
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
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12
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[Accomplished suicide in eating disorders in adolescent population (1976-2021)]. Med Clin (Barc) 2023; 160:179-180. [PMID: 36481119 DOI: 10.1016/j.medcli.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 12/10/2022]
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13
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Quesnel DA, Cooper M, Fernandez-Del-Valle M, Reilly A, Calogero RM. Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review. J Eat Disord 2023; 11:3. [PMID: 36627654 PMCID: PMC9832767 DOI: 10.1186/s40337-022-00685-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/01/2022] [Indexed: 01/12/2023] Open
Abstract
Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.
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Affiliation(s)
- Danika A Quesnel
- Department of Psychological Clinical Science, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada.
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Fernandez-Del-Valle
- Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Alanah Reilly
- Alanah Reilly Exercise Physiologist, Brisbane, Australia
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14
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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15
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Clinical correlates and prognostic impact of binge-eating symptoms in major depressive disorder. Int Clin Psychopharmacol 2022; 37:247-254. [PMID: 35815954 PMCID: PMC9521583 DOI: 10.1097/yic.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Binge-eating (BE) symptoms are relatively common in major depressive disorder (MDD), but their prognostic role is not fully understood. This study compared two groups of patients with MDD experiencing or not BE symptoms to ascertain differences in terms of clinical manifestations, presence of bipolar features, and antidepressant treatment outcomes. The study involved 482 outpatients collected within the Combining Medications to Enhance Depression Outcomes (CO-MED) trial, who were assessed with scales for depressive and hypomanic symptomatology, suicidality, comorbid mental disorders, and childhood traumas. BE symptoms were reported in 95 patients (20%). Patients with MDD experiencing BE symptoms were characterized by higher scores of negative self-outlook ( P = 0.0018), negative outlook of future ( P = 0.0014), irritability ( P = 0.0043), comorbid anxiety disorders (generalized anxiety disorder: P = 0.0006; panic disorder: P < 0.0001; social phobia: P < 0.0001), obsessive-compulsive disorder ( P = 0.0053), hypomanic symptoms (increased talkativeness: P = 0.0029; reduced need for sleep: P = 0.0171), and suicidality (suicidal propensity: P = 0.0013; suicidal risk: P = 0.0148; lifetime suicidal behavior: P = 0.0052). BE symptoms (OR = 2.02; 95% CI = 1.06-3.84) and depression severity (OR = 1.04; 95% CI = 1.00-1.08) were independently associated with lifetime attempted suicide. The presence of BE symptoms might indicate higher severity of depressive disorder. Suicidal risk is a major issue in these patients, whereas the association between BE and bipolar features needs further research.
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16
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Valenciano-Mendoza E, Fernández-Aranda F, Granero R, Vintró-Alcaraz C, Mora-Maltas B, Valero-Solís S, Sánchez I, Toro JJD, Gómez-Peña M, Moragas L, Jiménez-Murcia S. Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder. J Behav Addict 2022; 11:963-978. [PMID: 36287739 PMCID: PMC9881661 DOI: 10.1556/2006.2022.00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/23/2022] [Accepted: 09/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD. METHODS A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated. RESULTS The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD. DISCUSSION Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder. CONCLUSIONS Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.
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Affiliation(s)
- Eduardo Valenciano-Mendoza
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Valero-Solís
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Jessica Jimenez-de Toro
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
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17
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Shepherd BF, Brochu PM, Rodriguez-Seijas C. A critical examination of disparities in eating disorder symptoms by sexual orientation among US adults in the NESARC-III. Int J Eat Disord 2022; 55:790-800. [PMID: 35467039 DOI: 10.1002/eat.23717] [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: 09/15/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sexual minoritized persons evidence higher prevalence of eating disorders than heterosexual persons, yet it is unclear which specific symptoms drive these disparities. Empirical evidence also documents the importance of considering subclinical eating disorder presentations, as well as potential differentiation in expression of eating disorder symptoms based on gender. The current study complements that of Kamody et al. (2020), who examined sexual orientation-based disparities in eating disorder diagnoses using a nationally representative sample of the US adult population. METHOD Using the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we compared the prevalence of eating disorder symptoms across sexual minority status separately for men and women. RESULTS Sexual minoritized men were more likely than heterosexual men to report body mass index (BMI) < 18.5 kg/m2 (odds ratio [OR] = 1.76), thus, being screened into questions about restrictive eating. Sexual minoritized women were more likely than heterosexual women to endorse ever engaging in a binge-eating episode (OR = 2.25) and engaging in weekly binge eating for at least 3 months (OR = 1.58), thus, being screened into follow-up questions about binge eating. Sexual minoritized men were more likely than heterosexual men to fear gaining weight even when at their lowest weight (OR = 4.35) and experience a loss of control when overeating (OR = 3.13). DISCUSSION Sexual orientation-based disparities in eating disorder symptom endorsement were nuanced when stratifying the entire sample by gender. Findings expand previous research on disparities in clinical/diagnosed eating disorders, highlighting the importance of assessing symptomology beyond diagnosis, as well as the intersectional influence of sexual orientation and gender, in both research and practice.
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Affiliation(s)
- Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA
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18
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de la Barrera U, Montoya-Castilla I, Pérez-Albéniz A, Lucas-Molina B, Fonseca-Pedrero E. Mental Health Difficulties Related to Suicidal Behavior in Adolescents: The Moderating Role of Self-Esteem. Arch Suicide Res 2022; 26:716-730. [PMID: 33027593 DOI: 10.1080/13811118.2020.1823918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective was to analyze the moderating effect of self-esteem on the relationship between mental health difficulties and suicidal behavior in adolescence. METHOD The sample was composed of 1,790 Spanish adolescents (M = 15.70 years; SD = 1.26; 53.7% girls) through a stratified random sampling by cluster at classroom level. The participants completed questionnaires about emotional symptoms, behavioral problems, peer relationship difficulties, hyperactivity, suicidal behavior, and self-esteem. RESULTS The results evidenced gender differences, showing that girls tend to have more emotional symptoms (t = -15.27; p ≤ .001; d = -0.71), more difficulties in peer relationship (t=-2.49; p = .013; d = -0.12) and less self-esteem (t = 12.15; p ≤ .001; d = 0.57), as well as more suicidal behaviors (t = -5.36; p ≤ .001; d = -0.25) than boys. It is also noted that emotional and behavioral difficulties influence suicidal behavior (R2 = 0.35; ΔF = 197.42; p ≤ .001). In addition, self-esteem appeared to act as a protective factor, buffering the relationship between emotional and behavioral problems and suicidal behavior (R2 = 0.39; F = 376.92; p ≤ .001). CONCLUSIONS Adolescents who present mental health difficulties might commit suicidal behavior if they have an unfavorable attitude toward themselves. However, the risk of committing suicidal behavior decreases if their attitude toward themselves is favorable. Thus, the development of self-esteem may be included in intervention programs for the prevention of suicidal behavior.HIGHLIGHTSGirls present more suicidal behaviors and less self-esteem than boys.Mental health difficulties influence the appearance of suicidal behavior.Self-esteem moderates the relationship between emotional problems and suicidal behavior.
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19
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Irigoyen-Otiñano M, González-Pinto A, Llorca-Bofí V, Adrados-Pérez M, Arenas-Pijoan L, Torterolo G, Sánchez-Cazalilla M, Buil E, Nicolau-Subires E, Albert-Porcar C, Ibarra-Pertusa L, Puigdevall-Ruestes M. Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:142-146. [PMID: 35840281 PMCID: PMC9274210 DOI: 10.1016/j.rpsmen.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. METHOD We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. RESULTS Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p=0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p<0.001) and increasing suicidal behaviour (p=0.016) and behavioural disorder (p=0.022). CONCLUSIONS In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.
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Affiliation(s)
- María Irigoyen-Otiñano
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain; Biological Foundations of Mental Disorders Group, IRB Lleida, Lleida, Spain.
| | | | - Vicent Llorca-Bofí
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | | | - Giovanni Torterolo
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | - Esther Buil
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
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20
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Irigoyen-Otiñano M, González-Pinto A, Llorca-Bofí V, Adrados-Pérez M, Arenas-Pijoan L, Torterolo G, Sánchez-Cazalilla M, Buil E, Nicolau-Subires E, Albert-Porcar C, Ibarra-Pertusa L, Puigdevall-Ruestes M. Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:142-146. [PMID: 34868411 PMCID: PMC8628540 DOI: 10.1016/j.rpsm.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. Method We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. Results Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p = 0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p < 0.001) and increasing suicidal behaviour (p = 0.016) and behavioural disorder (p = 0.022). Conclusions In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.
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Affiliation(s)
- María Irigoyen-Otiñano
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
- Biological Foundations of Mental Disorders Group, IRB Lleida, Lleida, Spain
| | | | - Vicent Llorca-Bofí
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | | | - Giovanni Torterolo
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
| | | | - Esther Buil
- Psychiatry Service, Santa Maria University Hospital Lleida, Lleida, Spain
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21
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Cliffe C, Seyedsalehi A, Vardavoulia K, Bittar A, Velupillai S, Shetty H, Schmidt U, Dutta R. Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: a retrospective cohort study. BMJ Open 2021; 11:e053808. [PMID: 34972768 PMCID: PMC8720985 DOI: 10.1136/bmjopen-2021-053808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality. DESIGN AND SETTING This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust. PARTICIPANTS All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included. INTERVENTION AND MEASURES Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study. RESULTS The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a 'near perfect' and 'strong' agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001). CONCLUSION A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.
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Affiliation(s)
- Charlotte Cliffe
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Aida Seyedsalehi
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Katerina Vardavoulia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - André Bittar
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ulrike Schmidt
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Rina Dutta
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Miranda-Olivos R, Testa G, Lucas I, Sánchez I, Sánchez-González J, Granero R, Jiménez-Murcia S, Fernández-Aranda F. Clinical factors predicting impaired executive functions in eating disorders: The role of illness duration. J Psychiatr Res 2021; 144:87-95. [PMID: 34601380 DOI: 10.1016/j.jpsychires.2021.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 01/30/2023]
Abstract
Poor performance in executive functions is observed in individuals with eating disorders (EDs). These impairments have usually been associated with the presence of comorbid psychopathology or with higher severity of EDs. However, few studies have explored the interaction between illness duration and deficits in executive functions. The present study investigates the association between ED duration and performance in decision-making, inhibitory control, and cognitive flexibility in the anorexia nervosa restrictive subtype (AN-R), bulimic/purging subtype (AN-BP), and binge spectrum disorders (BSDs) (namely, bulimia nervosa and binge eating disorder) among 116 women with EDs compared with 123 women healthy controls (HCs). Using cumulative survival analysis, we estimated the risk of deficits related to illness duration. Predictors of executive dysfunctions were assessed by regression analysis, including as potential predictors illness duration, severity of general psychopathology, and ED symptomatology. Results showed poor decision-making and cognitive flexibility in participants with EDs compared with HCs. ED duration was associated with poor inhibitory control in the AN-BP group and poor cognitive flexibility in the BSD group. The illness duration increased the risk of presenting early deficits in executive function. In decision-making and inhibitory control, the AN-R group showed the earliest deficits, whereas in cognitive flexibility it was the BSD group. ED duration predicted impaired cognitive flexibility in the BSD group and impaired inhibitory control in the AN-BP group, whereas the severity of general psychopathological symptoms was a predictor of impaired cognitive flexibility in individuals with AN-R. These results highlight the relevance of illness duration in executive dysfunctions in EDs.
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Affiliation(s)
- Romina Miranda-Olivos
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Giulia Testa
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Isabel Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jessica Sánchez-González
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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23
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Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders. Nutrients 2021; 13:nu13072145. [PMID: 34201433 PMCID: PMC8308216 DOI: 10.3390/nu13072145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (EDs) are severe psychiatric illnesses that require individualized treatments. Decision-making deficits have been associated with EDs. Decision-making learning deficits denote a lack of strategies to elaborate better decisions that can have an impact on recovery and response to treatment. This study used the Iowa Gambling Task (IGT) to investigate learning differences related to treatment outcome in EDs, comparing between patients with a good and bad treatment outcome and healthy controls. Likewise, the predictive role of impaired learning performance on therapy outcome was explored. Four hundred twenty-four participants (233 ED patients and 191 healthy controls) participated in this study. Decision making was assessed using the Iowa Gambling Task before any psychological treatment. All patients received psychological therapy, and treatment outcome was evaluated at discharge. Patients with bad outcome did not show progression in the decision-making task as opposed to those with good outcome and the healthy control sample. Additionally, learning performance in the decision-making task was predictive of their future outcome. The severity of learning deficits in decision making may serve as a predictor of the treatment. These results may provide a starting point of how decision-making learning deficits are operating as dispositional and motivational factors on responsiveness to treatment in EDs.
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Galmiche M, Achamrah N, Déchelotte P, Ribet D, Breton J. Role of microbiota-gut-brain axis dysfunctions induced by infections in the onset of anorexia nervosa. Nutr Rev 2021; 80:381-391. [PMID: 34010427 DOI: 10.1093/nutrit/nuab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by low food intake, severe body weight loss, intense fear of gaining weight, and dysmorphophobia. This chronic disease is associated with both psychiatric and somatic comorbidities. Over the years, clinical studies have accumulated evidence that viral or bacterial infections may promote the onset of eating disorders such as AN. This review aims to describe how infections and the subsequent immune responses affect food intake regulation in the short term and also how these processes may lead to long-term intestinal disorders, including gut barrier disruption and gut microbiota dysbiosis, even after the clearance of the pathogens. We discuss in particular how infection-mediated intestinal dysbiosis may promote the onset of several AN symptoms and comorbidities, including appetite dysregulation, functional gastrointestinal disorders, and mood disorders.
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Affiliation(s)
- Marie Galmiche
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Najate Achamrah
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Pierre Déchelotte
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - David Ribet
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Jonathan Breton
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
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25
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Riehl ME, Scarlata K. Understanding Disordered Eating Risks in Patients with Gastrointestinal Conditions. J Acad Nutr Diet 2021; 122:491-499. [PMID: 33893063 DOI: 10.1016/j.jand.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022]
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26
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Forrest LN, Grilo CM, Udo T. Suicide attempts among people with eating disorders and adverse childhood experiences: Results from a nationally representative sample of adults. Int J Eat Disord 2021; 54:326-335. [PMID: 33372308 DOI: 10.1002/eat.23457] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE People with eating disorders (EDs) have elevated rates of suicide attempts. A need exists to identify factors that help predict which people with EDs might be at greater risk for suicidal behavior. Adverse childhood experiences (ACEs) are associated with both EDs and with suicide attempts. Thus, the current study examined whether having histories of ACEs and EDs augments lifetime risk for suicide attempts. METHOD This study included 36,146 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III who completed structured diagnostic interviews and answered questions regarding ACEs and suicide attempts. Weighted means, frequencies, and cross-tabulations were computed for prevalence of ACEs and suicide attempts by ED diagnosis. Multiple logistic regression was used to compare risk of lifetime suicide attempts by ED diagnosis and ACE history. RESULTS Prevalence of ACEs among people with EDs was 54.1-67.8%. ACE history and ED diagnosis were associated with elevated odds of experiencing a lifetime suicide attempt (AORs = 4.64-6.45 and 3.20-4.06, respectively). There was no ACE history-by-ED interaction on risk of suicide attempt, regardless of forms of EDs. DISCUSSION ACEs are common among people with EDs and associated significantly with suicide attempts, but ACEs and EDs do not appear to interact to augment risk for suicide attempts. Considering ACE exposure in theoretical models of suicidal behavior in people with and without EDs and in suicide risk assessment and management with people with EDs may prove useful.
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Affiliation(s)
- Lauren N Forrest
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, New York, USA
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27
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Bergner L, Himmerich H, Kirkby KC, Steinberg H. Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803-2017. Front Psychiatry 2021; 11:504157. [PMID: 33519534 PMCID: PMC7840701 DOI: 10.3389/fpsyt.2020.504157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/25/2020] [Indexed: 12/13/2022] Open
Abstract
The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category "anorexia nervosa," introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803-2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany after World War II, rather than in psychiatry. Viewed from today's perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders.
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Affiliation(s)
- Lukas Bergner
- Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, Leipzig, Germany
| | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Kenneth C. Kirkby
- Department of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Holger Steinberg
- Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, Leipzig, Germany
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28
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Zeppegno P, Calati R, Madeddu F, Gramaglia C. The Interpersonal-Psychological Theory of Suicide to Explain Suicidal Risk in Eating Disorders: A Mini-Review. Front Psychiatry 2021; 12:690903. [PMID: 34220592 PMCID: PMC8247462 DOI: 10.3389/fpsyt.2021.690903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/19/2021] [Indexed: 01/07/2023] Open
Abstract
Suicide is a major cause of death in Eating Disorders (EDs) and particularly in anorexia nervosa (AN). The aim of the present mini-review was to summarize the literature focusing on the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner, as applied to explain suicidal risk in EDs. PubMed database was used to search articles focused on IPTS in EDs; 10 studies were eventually included. The majority of the included studies reported data from the same sample, even though the hypotheses and analyses for each study were unique. The investigated suicidal outcomes were suicidal ideation (SI) (40%), non-suicidal self-injury (10%), suicide attempt (40%) and suicide (10%). In ED patients Perceived Burdensomeness (PB) may play an important role, especially regarding SI risk. ED patients may feel like a burden to their close ones, and actually some of the ED symptoms may be an expression of anger and hate against the self. Overall, currently available research has supported some IPTS derived predictions (i.e., ED symptoms may increase PB and thereby SI), but not others (i.e., the elevated suicide rate in AN may be due to higher acquired capability for suicide). Further research on IPTS tenets as well as on other theoretical perspectives and constructs (e.g., interoceptive awareness), hopefully with a longitudinal design and adequate follow-up duration, might allow a more thorough understanding of the complex topic of suicidal behavior in ED patients.
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Affiliation(s)
- Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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Mandelli L, Draghetti S, Albert U, De Ronchi D, Atti AR. Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature. J Affect Disord 2020; 277:927-939. [PMID: 33065835 DOI: 10.1016/j.jad.2020.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/21/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The high comorbidity between Eating Disorders (EDs) and Obsessive-Compulsive disorder (OCD) is well known, as well as its implications in terms of worse outcome and need to adapt treatment. Estimates of OCD comorbidities in EDs are variable in different studies and poorly informative for clinical purposes. In this study, we sought to derive more consistent estimates, taking into account potential methodological and sampling confounding factors. METHODS We searched published studies reporting lifetime and current rates of comorbid OCD in ED samples based on recent diagnostic criteria. Comorbidity rates were meta-analyzed using a binary random effects model. Heterogeneity among the studies and publication bias were systematically checked. Potential confounding factors were tested by meta-regression analysis and adjusted by sensitivity analysis. RESULTS Globally, respectively 18% and 15% of all patients with an ED had a lifetime and current comorbidity with OCD. Rates were slightly higher in anorexia (19% and 14%) than in bulimia nervosa (13% and 9%), although only the current comorbid OCD was significantly higher in anorexia than in bulimia. Prospective follow-up studies provided considerably higher lifetime estimates (EDs 38%, anorexia 44%, bulimia 19%). LIMITATIONS Temporal/causal relationship between ED and OCD could not be defined. CONCLUSIONS OCD comorbidity in EDs is a relevant phenomenon, affecting almost one fifth of the patients in cross-sectional observations and up to nearly 40% in prospective follow-up studies. These data indicate the need for focused attention to non-food or body-shape related OCD symptoms, for better diagnostic and prognostic accuracy, and targeted treatment.
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Affiliation(s)
- Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Stefano Draghetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, Trieste, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Anna-Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy.
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Sarrar L, Vilalta M, Schneider N, Correll CU. Body mass index and self-reported body image in German adolescents. J Eat Disord 2020; 8:61. [PMID: 33133600 PMCID: PMC7592544 DOI: 10.1186/s40337-020-00330-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite knowledge about eating disorder symptoms in children and adolescents in the general population, relatively little is known about self-reported and sex-specific eating-disorder-related psychopathology, as well as its specific correlates. METHODS 880 German school-attending adolescents (15.4 ± 2.2 years) and 30 female patients with AN (16.2 ± 1.6 years) were studied. All participants completed the Eating Disorder Inventory-2 and a Body Image Questionnaire. RESULTS There were more overweight males than females (15.2% vs 10.1%, p < 0.001), but more females with underweight than males (6.2% vs. 2.5%, p < .001). Negative body evaluations (p < .001) and dissatisfaction (p < .001) were significantly more frequent in females. Compared to underweight female patients with AN, underweight school-attending females had less negative body evaluations (p < .001) and lower scores on 5 of the 11 EDI-2 subscales (p < .001; p < .05). CONCLUSIONS Males were more overweight than females, females more underweight. Body image was more important to female than to male youth, yet without reaching pathological values when compared to female patients with AN. Complex emotional and cognitive challenges seem to be a representative factor for eating pathology rather than simply being underweight. These aspects may be relevant for the shift from a thinness-related focus in girls in the general population to the development of an eating disorder.
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Affiliation(s)
- Lea Sarrar
- Department of Psychology, Medical School Berlin, Germany, Rüdesheimer Straße 50, 14197 Berlin, Germany
- Department of Audiology and Phoniatrics, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marie Vilalta
- Department of Psychology, Medical School Berlin, Germany, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Nora Schneider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004 USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549 USA
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Wade TD, Hart LM, Mitchison D, Hay P. Driving better intervention outcomes in eating disorders: A systematic synthesis of research priority setting and the involvement of consumer input. EUROPEAN EATING DISORDERS REVIEW 2020; 29:346-354. [PMID: 32706169 DOI: 10.1002/erv.2759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Setting specific research priorities and involving consumers in this process is one pathway to driving better intervention outcomes in eating disorders (EDs). We reviewed research priority setting in the field and the involvement of consumers in this priority setting. METHOD A systematic review following the PRSIMA statement was conducted and eight studies were identified for inclusion; four included substantial input from consumers, and four were researcher led. Similarities and differences across the types of studies were examined. RESULTS Research priorities informed by consumers were primarily concerned with producing better interventions and outcomes. A large degree of overlap with researcher-led priorities was present. The former studies had a greater focus on early intervention, bridging the research-practice gap, and recovery, while the latter were more likely to address diagnosis, genetic factors, brain circuitry, and pharmacotherapy. Priorities endorsed across more than one consumer-informed study included: the role of self-harm, working with health care professionals to increase early detection, supporting transition between services, and six issues about improved treatments. CONCLUSIONS The ED field needs to engage in more meaningful involvement of co-design across consumers, clinicians and researchers along the entire research journey, not just research priority setting. An integrated research strategy incorporating a co-design perspective has the potential to drive better outcomes.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, Australia
| | - Laura M Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Centre for Mental Health, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
| | - Deborah Mitchison
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia.,Camden and Campbelltown Hospitals, SWSLHD, Sydney, Australia
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Wells KR, Jeacocke NA, Appaneal R, Smith HD, Vlahovich N, Burke LM, Hughes D. The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med 2020; 54:1247-1258. [PMID: 32661127 PMCID: PMC7588409 DOI: 10.1136/bjsports-2019-101813] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.
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Affiliation(s)
- Kimberley R Wells
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Nikki A Jeacocke
- Performance Services, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Renee Appaneal
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Hilary D Smith
- National Eating Disorders Collaboration, Sydney, New South Wales, Australia
| | - Nicole Vlahovich
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Louise M Burke
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Hughes
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
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Cliffe C, Shetty H, Himmerich H, Schmidt U, Stewart R, Dutta R. Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study. Int J Eat Disord 2020; 53:458-465. [PMID: 32043625 DOI: 10.1002/eat.23240] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Suicide attempts requiring hospitalization are known to be common in patients who are diagnosed with eating disorders. Attempting suicide is a major indicator for those at risk of completed suicide. Both the specific eating disorder diagnosis and the influence of psychiatric comorbidities on suicide attempts requiring hospitalization were investigated, with demographic and socioeconomic variables as confounders, over a 10-year observation period from January 2007 to March 2017. METHODS Anonymized health-record data from the South London and Maudsley NHS Foundation Trust (SLaM) were retrieved through the Clinical Record Interactive Search (CRIS) data resource; this is linked to national Hospital Episode Statistics (HES) data. These data include all diagnoses for inpatient admissions. Hazard ratios, with 95% confidence intervals (CIs), were calculated from cox regression analyses and the effects of a number of confounders were estimated by performing multivariable analyses. RESULTS In total, 4,895 patients were diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder otherwise not specified (EDNOS). Of these, 331 (6.7%) had attempted suicide requiring hospitalization and 21 (0.04%) completed suicide. The eating disorder category associated with the highest risk of a suicide attempt was AN (HR: 1.43, 95%CI: 1.08-1.89, p = .01). The risk was significantly increased further if the patient had a comorbid diagnosis of personality disorder, depression, bipolar affective disorder, and substance misuse. DISCUSSION Suicide attempts requiring hospitalization have a high incidence rate among patients with eating disorders, and the risk is significantly increased in AN. Comorbid psychiatric illness and suicidal ideation should be carefully assessed in all eating disorder patients.
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Affiliation(s)
- Charlotte Cliffe
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hitesh Shetty
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hubertus Himmerich
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Ulrike Schmidt
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Robert Stewart
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Rina Dutta
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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Moseley RL, Gregory NJ, Smith P, Allison C, Baron-Cohen S. Links between self-injury and suicidality in autism. Mol Autism 2020; 11:14. [PMID: 32039740 PMCID: PMC7008575 DOI: 10.1186/s13229-020-0319-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autistic individuals without intellectual disability are at heightened risk of self-injury, and appear to engage in it for similar reasons as non-autistic people. A wide divergence of autistic perspectives on self-injury, including those who frame it as a helpful coping mechanism, motivate investigating the link between self-injury, suicide ideation, and attempts which has been reported in typically developing individuals. METHOD One hundred three autistic participants completed the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the Suicide Behaviors Questionnaire (SBQ-R), and the Interpersonal Social Evaluation List (ISEL-12) across two online studies. Logistic regression was conducted to predict self-harming status via responses to questions on suicidality, and to predict whether certain self-injurious behaviors, including cutting, were especially associated with suicide ideation and attempts. Non-parametric correlation analysis examined relationships between suicide ideation/attempts and other variables that might characterize self-harmers especially at risk of suicidality. These included perceived access to social support, purposes or reasons for self-injury, the number of different self-injurious behaviors engaged in, the duration and lifetime incidence of self-injury, and the individual's feelings about their self-injury. RESULTS While self-injuring status was significantly predicted by responses to a question on suicide ideation and attempts, there was no relationship between suicide ideation/attempts and a participant's personal feelings about their self-injury. The method of cutting was also predicted by suicide ideation and attempts, though other methods common in autistic people were at borderline significance. Use of self-injury for the regulation of low-energy emotional states like depression, for self-punishment or deterrence from suicide, and for sensory stimulation, was associated with suicide ideation and attempts, as was the number of self-injurious behaviors engaged in. There was no significant relationship between suicide ideation/attempts and the duration and lifetime incidence of self-injury or social support. CONCLUSIONS These preliminary data suggest that while individuals might frame their self-injury as a positive or neutral thing, there remains a concerning relationship between self-injury and suicidality which exists regardless of individual feelings on self-injury. This is consistent with the theoretical perspective that self-injury can be a "gateway" through which individuals acquire capability for lethal suicidal behaviors. The data highlight that particular methods (cutting) and reasons for self-injury may be of significant concern, but this information, which might be of extreme value for clinicians, requires further investigation and validation.
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Affiliation(s)
- R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
| | - N. J. Gregory
- Department of Psychology, Bournemouth University, Poole, UK
| | - P. Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - C. Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S. Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Mehl A, Rohde P, Gau JM, Stice E. Disaggregating the predictive effects of impaired psychosocial functioning on future DSM-5 eating disorder onset in high-risk female adolescents. Int J Eat Disord 2019; 52:817-824. [PMID: 30977531 PMCID: PMC6609485 DOI: 10.1002/eat.23082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Impaired psychosocial functioning previously emerged as the only risk factor to predict future onset of each of the four Diagnostic and Statistical Manual of Mental Disorder (5th ed.) (DSM-5) eating disorders. The goal of this follow-up report was to refine understanding of this newly identified risk factor. METHOD Combining data from women at risk for eating disorders because of body image concerns (N = 1,153, mean age = 18.5 years, SD = 4.2), we investigated which subdomain(s) and individual item(s) of psychosocial functioning (friends, family, school, and work) at baseline predicted onset of any eating disorder, using Cox regression (CRA) and classification tree analysis (CTA). RESULTS Psychosocial impairment with friends, family, and at school, but not at work, significantly increased risk for disorder onset over 3-year follow-up in univariate models. A one-unit increase in each domain raw score was associated with a 107, 22, and 43% increased hazard of eating disorder onset, respectively. Multivariate CRA found friends functioning, with a 92% increased hazard of disorder onset, contributed the strongest unique effect. CTA suggested that loneliness was the most potent risk factor with a threefold increased onset risk (eating disorder incidence for high vs. low scorers was 27 and 8%). Three friends functioning items and one school functioning item produced additional CTA branches. DISCUSSION Results refine understanding of the relation of psychosocial impairment to future onset of eating disorders, suggesting that peer functioning is the most critical. Data imply it would be useful to target young women with impaired psychosocial functioning in prevention programs.
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Affiliation(s)
- Annette Mehl
- Institute of Psychology, University of Heidelberg, Hauptstraße 47-51, 69120 Heidelberg, Germany
| | - Paul Rohde
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Jeff M. Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
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