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Riva A, Bizzi F, Borgatti R, Mensi M, Charpentier Mora S, Di Guardo S, Nacinovich R. Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self-injury. Clin Psychol Psychother 2024; 31:e2955. [PMID: 38356195 DOI: 10.1002/cpp.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
Family influence is a crucial factor in the onset and maintenance of eating disorders. Nonsuicidal self-injury (NSSI) and restrictive eating disorders (REDs) co-occur in a significant percentage of subjects but family functioning of these families remains underexplored. This study examines the family functioning perceptions of 80 families with adolescents experiencing RED, comparing those with and without NSSI, alongside a control group, utilising the FACES-IV assessment. The study also aims to compare the triadic (adolescent-mother-father) perception of family functioning in the three groups. The results reveal distinct family dynamics in adolescents with both RED and NSSI, marked by problematic functioning perceptions from all family members and low parental agreement. A further understanding of the family functioning of adolescents with RED with NSSI can help clinicians in defining the treatment setting.
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Affiliation(s)
- Anna Riva
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Mensi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | | | - Simona Di Guardo
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [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: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Cella S, Cipriano A, Aprea C, Milano W, Carizzone F, Cotrufo P. Non-suicidal self-injury in eating disorders: Prevalence, characteristics, DSM-5 proposed diagnostic criteria, and correlates. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Zinchuk M, Lavrishcheva A, Menshikova A, Voinova N, Artemieva M, Guekht A. Nonsuicidal self-injury in eating disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:70-78. [DOI: 10.17116/jnevro202212209170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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Puttevils L, Vanderhasselt MA, Horczak P, Vervaet M. Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Compr Psychiatry 2021; 109:152262. [PMID: 34265598 DOI: 10.1016/j.comppsych.2021.152262] [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: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. METHOD A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. RESULTS 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. CONCLUSIONS Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Paula Horczak
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium
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Vieira AI, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Group-based intervention for eating disorders with non-suicidal-self-injury: a case series. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Gonçalves
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
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Bout A, Kettani N, Berhili N, Aarab C, Rammouz I, Aalouane R. Les conduites d’automutilation non suicidaires dans une population recrutée pendant une hospitalisation en psychiatrie : À propos de 100 patients. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vieira AI, Moreira CS, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders. J Clin Psychol 2020; 77:607-628. [PMID: 32762121 DOI: 10.1002/jclp.23038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI. METHOD The sample included 171 outpatients (94.2% female; Mage = 28.78, SDage = 11.19). RESULTS Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year. CONCLUSIONS Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.
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Affiliation(s)
- Ana I Vieira
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
| | - Célia S Moreira
- Mathematics Department, Center of Mathematics (CMUP), Faculty of Sciences, University of Porto, Porto, Portugal
| | - Tânia F Rodrigues
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Hospital Center of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sónia Gonçalves
- School of Psychology, Center for Research in Psychology (CIPsi), Psychotherapy and Psychopathology Unit, University of Minho, Braga, Portugal
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Dzombak JW, Haynos AF, Rienecke RD, Van Huysse JL. Brief report: Differences in nonsuicidal self-injury according to binge eating and purging status in an adolescent sample seeking eating disorder treatment. Eat Behav 2020; 37:101389. [PMID: 32388487 PMCID: PMC9340432 DOI: 10.1016/j.eatbeh.2020.101389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) is elevated in adults with eating disorders (EDs), with a particularly increased incidence among individuals who engage in binge eating and/or purging (B/P) behaviors. Despite substantially elevated prevalence of NSSI in adolescence in general, NSSI in child and adolescent ED samples is understudied. There is some evidence for elevated prevalence of NSSI between B/P and restriction-only groups; however, this finding is not consistently reported and research in this area has excluded certain diagnostic groups (e.g., other specified feeding or eating disorder). Our aim was to identify the rates at which a transdiagnostic sample of adolescent patients with EDs (n = 155) report lifetime or past-month NSSI, and whether these rates differ between individuals who engaged in recent B/P behaviors vs. restriction only. Lifetime NSSI was present in 40.6% of the sample, and 23.2% of participants reported engaging in NSSI in the month prior to treatment. Individuals who reported recent B/P behaviors were more likely to report past-month (p = .005, OR = 5.57) and lifetime (p = .004, OR = 4.39) NSSI compared to individuals who did not report B/P behaviors. These results suggest an increase in risk for NSSI in child and adolescent patients in ED treatment who endorse B/P behaviors compared to patients who endorse restriction only. Research is needed to clarify the etiologic factors that may explain this association and the longitudinal changes in NSSI throughout the course of EDs.
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Affiliation(s)
- Jesse W.P. Dzombak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Renee D. Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Eating Recovery Center/Insight Behavioral Health Centers, Chicago, IL, United States of America,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States of America
| | - Jessica L. Van Huysse
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Corresponding author at: Department of Psychiatry, University of Michigan, C.S. Mott Children’s Hospital, 5th Floor Reception B, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States of America. (J.L. Van Huysse)
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Factor Structure of the Difficulties in Emotion Regulation Scale in Treatment Seeking Adults with Eating Disorders. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09765-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractThe Difficulties in Emotion Regulation Scale (DERS) is extensively used as a measure of emotion (dys-)regulation ability in both clinical and nonclinical populations. This is the first study to examine the factor structure of both the original 36-item and short 16-item version of the DERS in adults with eating disorders and to test measurement invariance across diagnostic subgroups. The factor structure of the scale was examined using confirmatory factor analysis in a psychiatric sample of adults with eating disorders (N = 857). Four primary factor structures were fitted to the data: (1) a unidimensional model, (2) a six-factor correlated-traits model, (3) a higher-order factor solution, and (4) a bifactor model. Measurement invariance was tested for diagnostic subgroups of anorexia nervosa and bulimia nervosa and associations between factors and eating pathology were examined in each diagnostic group. Results indicated that a modified bifactor solution fitted the data adequately for both the 36-item and 16-item version of the DERS. A general factor explained most of the variance (86%) and reliability was high for the general factor of DERS (total) but lower for the subscales. Measurement invariance of the bifactor model was supported across diagnostic subgroups and test of factor means reveled that bulimia nervosa had a higher factor mean than anorexia nervosa on the general factor. The general factor accounted for a significant proportion of variance in eating pathology. Our results support the use of the total scale of both the 36-item and 16-item version among adults with eating disorders.
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Wolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, Scopelliti K, Frazier EA, Liu RT. Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. Eur Psychiatry 2019; 59:25-36. [PMID: 30986729 DOI: 10.1016/j.eurpsy.2019.03.004] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists. METHODS The present study presents a comprehensive meta-analytic review of the literature on the association between NSSI and emotion dysregulation. A total of 48 publications, including 49 independent samples, were included in this analysis. RESULTS Overall, a significant association was found between emotion dysregulation and NSSI (pooled OR = 3.03 [95% CI = 2.56-3.59]). This association was reduced but remained significant (OR = 2.40 [95% CI = 2.01-2.86]) after adjustment for publication bias. Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior. Lack of emotional awareness/clarity and cognitive aspects of dysregulation yielded weaker, yet significant, positive associations with NSSI. CONCLUSIONS Findings support the notion that greater emotion dysregulation is associated with higher risk for NSSI among individuals across settings, regardless of age or sex. Furthermore, findings reveal facets of dysregulation that may have unique implications for NSSI. This meta-analysis highlights the importance of better understanding emotion dysregulation as a treatment target for preventing NSSI.
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Affiliation(s)
- Jennifer C Wolff
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States.
| | - Elizabeth Thompson
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Sarah A Thomas
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Jacqueline Nesi
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Alexandra H Bettis
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Briana Ransford
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Katie Scopelliti
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Elisabeth A Frazier
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
| | - Richard T Liu
- The Alpert Medical School of Brown University, 1 Hoppin St, Suite 204, 02093, Providence, RI, United States
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Muehlenkamp JJ, Suzuki T, Brausch AM, Peyerl N. Behavioral functions underlying NSSI and eating disorder behaviors. J Clin Psychol 2019; 75:1219-1232. [PMID: 30672588 DOI: 10.1002/jclp.22745] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/13/2018] [Accepted: 12/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Takakuni Suzuki
- Department of Psychiatry and Human BehaviorUniversity of Mississippi Medical CenterJackson Mississippi
- Department of Psychological SciencesPurdue University Indiana
| | - Amy M. Brausch
- Department of Psychological ScienceWestern Kentucky UniversityBowling Green Kentucky
| | - Naomi Peyerl
- Department of PsychologyUniversity of North DakotaGrand Forks North Dakota
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Zinchuk MS, Avedisova AS, Guekht AB. Nonsuicidal self-injury behavior in non-psychotic disorders: epidemiology, social and clinical risk factors. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:108-119. [DOI: 10.17116/jnevro2019119031108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Smithuis L, Kool-Goudzwaard N, de Man-van Ginkel JM, van Os-Medendorp H, Berends T, Dingemans A, Claes L, van Elburg AA, van Meijel B. Self-injurious behaviour in patients with anorexia nervosa: a quantitative study. J Eat Disord 2018; 6:26. [PMID: 30305903 PMCID: PMC6169009 DOI: 10.1186/s40337-018-0214-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/29/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136). METHODS A cross-sectional design using a self-report questionnaire. Mann-Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests. RESULTS Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts. CONCLUSIONS Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.
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Affiliation(s)
- Linda Smithuis
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands.,2Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Nienke Kool-Goudzwaard
- 2Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Intensive Treatment Centre, Fivoor, The Hague, The Netherlands
| | - Janneke M de Man-van Ginkel
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,5Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands.,6Department of Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tamara Berends
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - Alexandra Dingemans
- Rivierduinen Eating disorders Ursula, Rivierduinen, Leiden, The Netherlands.,9Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Laurence Claes
- 10Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,11Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annemarie A van Elburg
- Clinical Psychology, Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,13Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Berno van Meijel
- 14Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,15Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
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Campaioli G, Sale E, Simonelli A, Pomini V. The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults. CONTEMPORARY FAMILY THERAPY 2017. [DOI: 10.1007/s10591-017-9443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Pisetsky EM, Haynos AF, Lavender JM, Crow SJ, Peterson CB. Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample. Compr Psychiatry 2017; 73:143-150. [PMID: 27978502 PMCID: PMC5263187 DOI: 10.1016/j.comppsych.2016.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study examined the associations between specific dimensions of emotion dysregulation and eating disorder (ED) symptoms and behaviors, non-suicidal self-injury (NSSI), and suicide attempts in a heterogeneous ED sample. METHODS Participants (N=110) completed the Difficulties in Emotion Regulation Scale (DERS), the Eating Disorder Examination Questionnaire (EDE-Q), and self-reported the presence of lifetime NSSI and a lifetime suicide attempt. RESULTS The EDE-Q global score, a primarily cognitive measure of ED symptoms, was significantly positively correlated with DERS strategies, clarity, and awareness subscale scores and DERS total score (ps<0.01). Only the strategies subscale was uniquely positively associated with EDE-Q global score in a multivariate regression analysis. There was no association between the frequency of binge eating or frequency of driven exercise and any of the DERS subscale scores or total score (ps>0.01). Frequency of purging was significantly, positively associated with DERS impulse subscale score and total score (p<0.01). None of the DERS subscale scores were significantly different between those with and without NSSI or between those with and without a lifetime suicide attempt (ps>0.01). CONCLUSIONS Findings indicate that in a heterogeneous ED sample, emotion regulation deficits are more strongly associated with cognitively-oriented symptoms of EDs than behavioral symptoms such as a binge eating, purging, driven exercise, NSSI, or suicide attempts.
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Affiliation(s)
- Emily M. Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Ann F. Haynos
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Jason M. Lavender
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, 58203, USA,Department of Clinical Research, Neuropsychiatric Research Institute, 120 8 Street S., Fargo, ND 58103, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave., Minneapolis, MN, 55454, USA,The Emily Program, 2265 Como Ave, St Paul, MN 55108, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave., Minneapolis, MN, 55454, USA,The Emily Program, 2265 Como Ave, St Paul, MN 55108, USA
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