Non-Suicidal Self-Injury and Pathological Buying in Community Adults and Patients with Eating Disorders: Associations with Reactive and Regulative Temperament

Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis

OBJECTIVE

This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis.

METHOD

Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot.

RESULTS

79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies.

DISCUSSION

Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study.

PUBLIC SIGNIFICANCE

This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.

Self-regulation profiles in addictive behaviors among adolescents: A transdiagnostic approach

Dual-pathway models suggest that poor self-regulation (immature regulatory combined with strong reactive processes) is an important factor underlying addictive behaviors among adolescents. This study examined whether there are different self-regulation profiles among community adolescents, and how these profiles are related to the presence, severity and comorbidity of different addictive behaviors. A community sample of 341 adolescents (54.5% female; 13-17 years) was recruited. Participants self-reported on regulatory (inhibitory control) and reactive (reward and punishment sensitivity) processes, as well as on different addictive behaviors (binge eating, tobacco-, cannabis- and alcohol use, gaming, gambling and pathological buying). A model-based clustering analysis found evidence for three meaningful profiles: 'impulsive/under-controlled', 'anxious' and 'protective'. The 'impulsive/under-controlled' profile was characterized by the highest prevalence and severity of cannabis use and the most severe alcohol use. The 'impulsive/under-controlled' and 'protective' profiles demonstrated the highest prevalence and severity of tobacco use, whereas the 'impulsive/under-controlled' and 'anxious' profiles showed the highest binge eating scores. Adolescents who reported more than three types of addictive behaviors generally belonged to the 'impulsive/under-controlled' profile. The profiles did not differ for gaming, gambling and pathological buying. The 'impulsive/under-controlled' profile emerged as the most vulnerable profile in the context of addictive behaviors (especially for binge eating and substance use).

Prevalence of engagement and frequency of non-suicidal self-injury behaviors in adolescence: an investigation of the longitudinal course and the role of temperamental effortful control

Non-suicidal self-injury (NSSI) is among the most frequent maladaptive behaviors reported in adolescence, with prevalence rates around 18-22% in community samples worldwide. The onset of NSSI typically occurs between early and middle adolescence, with a peak during middle adolescence (14-15 years) and a subsequent decline during late adolescence. This study investigated the growth curves of NSSI across four years during adolescence, analyzing simultaneously the probability of engagement in NSSI at least once (i.e., prevalence) and the frequency of engagement once initiated (i.e., severity). Furthermore, the study examined the predicting role of effortful control on NSSI over time (time-varying effects), net of other key risk factors for NSSI, such as anxiety-depression and bullying victimization. A sample of 430 Italian adolescents enrolled in Grade 9 at baseline was involved in the study. Based on the Latent Growth Curve Zero-inflated Poisson methodology, the results indicated a negative quadratic trend of both NSSI prevalence, with an increase between T1 and T3 followed by a decrease in the subsequent wave, and NSSI frequency once initiated, with a peak at T2 followed by a decline over time. The results also showed that adolescents who reported low effortful control abilities had a heightened probability of involvement in NSSI at each time point, whereas no significant association was found with NSSI frequency once initiated. Findings from this study offer important insights into the developmental course of NSSI and point out the need for future in-depth investigations of the mechanisms that might underlie NSSI prevalence and severity throughout adolescence.

[Behavioral Addictions in Psychosomatic Care]

OBJECTIVE

It is commonly agreed, that Behavioral Addictions are accompanied by mental disorders and are still underdiagnosed. The multicenter cross-sectional study aimed at estimating the prevalence of Behavioral Addictions in a consecutive sample of patients seeking treatment for mental disorders other than Behavioral Addiction.

METHODS

The study included 801 patients from eight psychosomatic university hospitals. Behavioral Addictions were assessed via standardized questionnaires.

RESULTS

24.1% of the sample reported at least one Behavioral Addiction. The majority of those patients reported symptoms of a single Behavioral Addiction. Questionnaire-based prevalence rates were 3.4% for Pathological Gambling, 1.9% for Pathological Internet Use, 16.7% for Pathological Buying, 5.4% for Hypersexual Disorder, and 3.5% for pathological exercising (exercise dependence). Neither center nor setting (outpatient, inpatient, day clinic) effects were observable.

DISCUSSION

Within this clinical sample, symptoms of shopping addiction are highly common in patients undergoing psychosomatic-psychotherapeutic treatment. These are rather women. Men are more likely to suffer from gambling and sex addiction. Generally, symptoms of Behavioral Addictions are commonly reported. Till today, Behavioral Addictions are often still underdiagnosed.

CONCLUSION

Patients within psychosomatic treatment commonly suffer from symptoms of Behavioral Addictions, which should be considered for treatment strategies.