Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders

doi:10.1016/j.comppsych.2018.03.013

Comprehensive Psychiatry

Volume 84, July 2018, Pages 22-25

https://doi.org/10.1016/j.comppsych.2018.03.013 Get rights and content

Highlights

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Participants above the cut off for body dissatisfaction are more likely to endorse suicidal ideation than those who are not.
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Participants above the cut off for body dissatisfaction are more likely to endorse previous attempts than those who are not.
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Even after controlling for depression, body dissatisfaction above the cut off was associated with a higher suicidal ideation.
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After controlling for emotion regulation, body dissatisfaction above the cut off was associated with a higher suicidal ideation.

Abstract

The current study the relationship between eating disorders (EDs) and suicidal ideation and suicide attempt in adult inpatients. In particular, the present study investigated one potential mechanism, body dissatisfaction (BD), which may contribute to increased risk for suicide in adult ED patients. A sample of 432 psychiatric inpatients ranging from 18 to 65 years of age participated in the current study. Findings indicated that patients who have higher levels of BD also had higher levels of passive and active suicidal ideation and previous suicide attempts. Higher levels of BD were also related to increased suicidal ideation after controlling for depression and emotion dysregulation. Although additional risk factors for suicide should be investigated in adults with EDs, this study provides evidence regarding the relationship between BD and risk for suicide ideation and attempt.

Section snippets

Body dissatisfaction and suicidal ideation among psychiatric inpatients

Eating disorders (EDs) are characterized by issues with body image, excessive or no control over eating habits, and extreme behaviors to maintain body weight [1]. It has been suggested that EDs manifest due to an exposure to a thin ideal, which is then internalized, and used to compare one's body to the ideal. This body disturbance can lead to body dissatisfaction (BD) and dietary restrictions. BD has been defined as one's negative perception of one's own body and is associated with increased

Participants

The present study included 432 psychiatric inpatients ranging from 18 to 65 years of age (M = 28.59, SD= 10.72) who were referred for an ED consult by their treatment team. These patients were evaluated by a member of the ED team for participation in the ED specialty treatment track based on previous history of an ED, self-reported symptoms of an ED, and/or clinical judgment of the treatment team. Patients in this setting typically manifest multiple, comorbid conditions, prominently mood,

Results

Analyses in this study utilized the groupings of participants who were at or above the clinical level (45 or above) compared to those who were below the clinical threshold (0–44) for BD, as indicated by the guidelines in the EDI-3 [17]. Pearson's Chi-square tests were conducted to determine the relationship between BD and passive vs. active suicidal ideation as well as previous attempts in adults with ED symptoms. Results revealed a significant association between BD and passive ideation χ²

Discussion

The primary aim of this study was to add to the current knowledge on how EDs may increase risk for suicidal ideation and suicide attempts. Results demonstrated that patients who have higher levels of BD also have higher levels of passive and active suicidal ideation and previous suicide attempts. Furthermore, the relationship between higher BD and increased suicidal ideation remained after controlling for depression and emotion dysregulation, which comports with previous research examining the

Acknowledgements

This research was supported in part by the University of Houston – Downtown Office of Research and Sponsored Programs UHD: 2064D092B0578. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the University of Houston - Downtown. The authors additionally wish to thank the Menninger Clinic Foundation for their generous support of this research.

References (26)

E. Stice et al.
Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings
J Psychosom Res
(2002)
A. Keshaviah et al.
Re-examining premature mortality in anorexia nervosa: a meta-analysis redux
Compr Psychiatry
(2014)
L.N. Forrest et al.
Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients
J Affect Disord
(2016)
T. Rodriguez-Cano et al.
Body dissatisfaction as a predictor of self-reported suicide attempts in adolescents: a Spanish community prospective study
J Adolesc Health
(2006)
B. Löwe et al.
Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9)
J Affect Disord
(2004)
B. Löwe et al.
Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses
J Affect Disord
(2004)
D.-S. Kim et al.
Body-image dissatisfaction as a predictor of suicidal ideation among Korean boys and girls in different stages of adolescence: a two-year longitudinal study
J Adolesc Health
(2009)
R.H. Striegel-Moore et al.
Risk factors for eating disorders
Am Psychol
(2007)
Center for Disease Control & Prevention
National center for injury prevention and control
T.D. Wade et al.
Epidemiology of eating disorders

S.A. Swanson et al.

Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement

Arch Gen Psychiatry

(2011)

E. Chesney et al.

Risks of all-cause and suicide mortality in mental disorders: a meta-review

World Psychiatry

(2014)

S. Crow et al.

Increased mortality in bulimia nervosa and other eating disorders

Am J Psychiatry

(2009)

Cited by (16)

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours
2022, Journal of Affective Disorders
Citation Excerpt :
Different studies have also shown that both negative attitudes towards one's own body and negative body experiences were associated with suicidality in males and females with or without a history of psychiatric disorder (Miotto et al., 2003; Orbach et al., 2006). Accordingly, individuals scoring higher on body dissatisfaction are more likely to endorse suicidal ideation, even after controlling for other risk factors, such as depression, poor emotion regulation, past suicidal behaviour, and hopelessness (Rufino, Viswanath, Wagner, & Patriquin, 2018). A possible explanation of the association between BID and suicidality is that dysfunctional views of the self, such as body dissatisfaction, increase the risk for self-destructive behaviour (Orbach, 1996; Orbach et al., 2001).
This study examined whether self-disgust added incremental variance to and mediated the multivariate association between measures of body image disturbance and suicidal thoughts and behaviours. We hypothesized that self-disgust would be associated with suicidal ideation above the effects of body image disturbance, and that self-disgust would mediate the relationship between body image disturbance and suicidal ideation. A total of N=728 participants completed The Body Image Disturbance Questionnaire, The Self-Disgust Scale, and the Suicidal Behaviours Questionnaire-Revised. Suicidality was significantly related to increased levels of self-disgust and body image disturbance, whereas self-disgust was associated with greater body image disturbance. Linear regression analysis showed that self-disgust was associated with suicidal thoughts and behaviours, over and above the effects of body image disturbance. Multiple mediation modelling further showed that self-disgust mediated the relationship between body image disturbance and suicidal thoughts and behaviours. Our findings highlight the role of self-disgust in the context of body image disturbance and support the notion that body image disturbance is associated with aversive self-conscious emotions. Interventions aiming to reduce the risk of suicidality in people with body image disturbance may address self-disgust and negative self-conscious emotions.
The relationship between emotion dysregulation and suicide ideation and behaviour: A systematic review
2021, Journal of Affective Disorders Reports
Citation Excerpt :
Martin et al. (2017) recruited general acute mental health inpatients, while some studies recruited from specialised units including those for substance use disorders (Dixon-Gordon et al., 2014) gambling disorders (Mallorqui-Bague et al., 2018) eating disorders (Gomez-Exposito et al., 2016) and suicidality and affective disorders (Bentley et al., 2018). Other studies included mental health inpatients with referrals relating to specific diagnoses, such as bipolar type II (Palagini et al., 2019a) and eating disorders (Rufino et al., 2018). Harris et al. (2018) recruited mental health outpatients and Silvers et al. (2016) recruited participants with a diagnosis of BPD via clinician and self-referral.
: Suicide is a major public health issue. Psychological models and theories have suggested that difficulties regulating emotions may contribute to suicidal experiences. This systematic review aims to evaluate empirical research examining the relationship between emotion regulation and suicide ideation and behaviour in adults.
: Articles were required to include any measure of suicide ideation or attempt and the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) to assess emotion regulation. Peer reviewed, quantitative empirical papers, written in the English language were considered. All participants had to be aged 18 years or over. EMBASE, Medline and Psychinfo were searched for relevant articles. A quality assessment measured risk of bias. PRISMA guidelines were followed.
: Twenty-one papers were identified as eligible. Significant positive associations were reported between emotion dysregulation and suicide ideation and attempts. However, emotion dysregulation was often not predictive of ideation or attempts when controlling for other psychological variables.
: Findings suggest that clinical intervention targeting emotion dysregulation alone would not be enough to reduce suicide ideation and behaviour. Longitudinal, experimental research is required to further analyse this relationship alongside potential covariates. The majority of studies were cross-sectional in design so causality cannot be inferred.
Body mass index weight categories in adults who died by suicide: An observational study
2019, Journal of Affective Disorders
Citation Excerpt :
This should be interpreted with caution. Body dissatisfaction is a key element in the development and maintenance of eating disorders and has been linked to increased suicidal ideation and suicide attempts in people with eating disorders (Rufino et al., 2018; Forrest et al., 2016). Eating disorders carry a greater risk of suicide compared to the general population (Preti et al., 2011; Crow et al., 2009).
There is conflicting evidence about the relationship between body mass index (BMI) and suicide death. This study aimed to characterize and compare suicide deaths by weight using BMI weight categories.
We examined suicide deaths in adults in the city of Toronto (2009–2015); grouped them by BMI categories (underweight, normal weight, overweight, and obese) and compared groups based on demographics, clinical variables and method of suicide death.
Suicide decedents’ (n = 1429) mean age was 48.6 years (SD = 17.4) and mean BMI was 25.5 (SD = 5.4). Underweight decedents were more likely to be female and to have cancer while obese decedents were more likely to have diabetes. Underweight decedents were more likely to have an identified history of any medical condition. Obese and overweight decedents were significantly more likely to have an identified history of any psychiatric condition. Non-violent methods (e.g., self-poisoning) were used at a higher proportion by people with obesity and by people who were underweight.
Psychological autopsies were not available and it was not possible to assess for change in or stability of BMI over time.
These findings add to our understanding of the relationship between suicide and weight. A higher prevalence of females as well as those with a history of cancer and any medical condition in underweight decedents was noteworthy and of potential clinical significance.
Characterizing the phenomenology of passive suicidal ideation: A systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation
2020, Psychological Medicine
Is cognitive behavioral therapy more effective than pharmacotherapy for binge spectrum disorders? A systematic review and meta-analysis
2024, Australian and New Zealand Journal of Psychiatry
Thinness and Muscularity-Oriented Eating Disorder Symptoms: Investigating Body Image Concerns and the Moderating Role of Emotion Dysregulation in Cyclists
2024, Research Square

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Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders

Highlights

Abstract

Section snippets

Body dissatisfaction and suicidal ideation among psychiatric inpatients

Participants

Results

Discussion

Acknowledgements

J Psychosom Res

Compr Psychiatry

J Affect Disord

J Adolesc Health

J Affect Disord

J Affect Disord

J Adolesc Health

Risk factors for eating disorders

Am Psychol

National center for injury prevention and control

Epidemiology of eating disorders

Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement

Arch Gen Psychiatry

Risks of all-cause and suicide mortality in mental disorders: a meta-review

World Psychiatry

Increased mortality in bulimia nervosa and other eating disorders

Am J Psychiatry