A comprehensive meta-analysis of the risk of suicide in eating disorders
ABSTRACT Past meta-analyses on suicide in eating disorders included few available studies.
PubMed/Medline search for papers including sample n ≥40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included.
Of 16,342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate=0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI=21.0-44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate=0.030 per 100 person-years): SMR was 7.5 (1.6-11.6). No suicide occurred among 246 patients with BED (mean follow-up=5.3 years).
AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated.
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ABSTRACT: We conducted four studies to examine the relationship between over-exercise and suicidality. Study 1 investigated whether over-exercise predicted suicidal behavior after controlling for other eating disorder behaviors in a patient sample of 204 women (144 with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Bulimia Nervosa [BN]). Study 2 tested the prospective association between over-exercise and acquired capability for suicide (ACS) in a sample of 171 college students followed for 3-4 weeks. Study 3 investigated whether pain insensitivity accounted for the relationship between over-exercise and ACS in a new sample of 467 college students. Study 4 tested whether ACS accounted for the relationship between over-exercise and suicidal behavior in a sample of 512 college students. In Study 1, after controlling for key covariates, over-exercise was the only disordered eating variable that maintained a significant relationship with suicidal behavior. In Study 2, Time 1 over-exercise was the only disordered eating behavior that was associated with Time 2 ACS. In Study 3, pain insensitivity accounted for the relationship between over-exercise and ACS. In Study 4, ACS accounted for the relationship between over-exercise and suicidal behavior. Over-exercise appears to be associated with suicidal behavior, an association accounted for by pain insensitivity and the acquired capability for suicide; notably, this association was found across a series of four studies with different populations.12/2012; 206(2-3). DOI:10.1016/j.psychres.2012.11.004
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ABSTRACT: Anxiety sensitivity (AS) and disordered eating are significant risk factors for suicidality. Although the physical concerns subfactor of AS—specifically lower physical concerns—has been associated with suicide attempts, we sought to further clarify this relationship by exploring the association between AS physical concerns and the physical capability component (acquired capability) of Joiner’s (Why people die by suicide. Harvard University Press, Cambridge, MA, 2005) interpersonal theory of suicide. We predicted an inverse relationship between AS physical concerns and the acquired capability for suicide in a sample of 342 female outpatients. Additionally, we hypothesized that AS physical concerns would moderate the relationship between disordered eating—another risk factor for suicidality—and acquired capability, such that a significant relationship between disordered eating and acquired capability would exist only for those reporting low AS physical concerns. Both hypotheses were supported. The implications for understanding the joint influence of AS and disordered eating, as well as for determining suicide risk, are discussed.Cognitive Therapy and Research 10/2012; 37(5). DOI:10.1007/s10608-012-9502-3 · 1.70 Impact Factor
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ABSTRACT: Current diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) account for a minority of individuals with clinically significant disorders of eating, raising concerns about the clinical utility of current definitions. This review examines evidence for the validity of current and alternative approaches to defining eating disorders and implications for draft criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Although this review largely supports the predictive validity of distinctions among AN, BN, and the newly proposed binge eating disorder (BED), it also highlights that our tendency to "study what we define" has created a gap between the problems that people have and what we know about those problems. Future research on the causes and consequences of eating disorders should include more heterogeneous groups to enable identification of meaningful boundaries that distinguish between disorders based on etiological and predictive validity.Annual Review of Clinical Psychology 04/2011; 8:381-404. DOI:10.1146/annurev-clinpsy-032511-143111 · 12.92 Impact Factor