Dorian R. Dodd

Restraint feeds stress: The relationship between eating disorder symptoms, stress generation, and the interpersonal theory of suicide

Integrating research on stress generation and the interpersonal theory of suicide we examined whether eating disorder symptoms are related to stress generation and whether negative life events (stressors) contribute to feelings of burdensomeness and low belongingness. At two time points (approximately 1month apart), participants (n=186; 75% female) completed questionnaires measuring eating disorder symptoms, negative life events, burdensomeness, and belongingness. Regression analyses indicated that while controlling for depression, anxiety, and baseline frequency of negative events, dietary restraint significantly predicted negative events at follow-up. Dietary restraint indirectly influenced higher levels of perceived burdensomeness and low belongingness through its influence on negative events. Thus, dietary restraint may contribute to stress generation, and in turn exacerbate feelings of burdensomeness and low belongingness, two important constructs of the interpersonal theory of suicide. Greater understanding of these factors could lead to more effective and targeted suicide interventions for individuals who restrict food intake.

Suicidality in adolescents and adults with binge‐eating disorder: Results from the national comorbidity survey replication and adolescent supplement

OBJECTIVE The relation between binge-eating disorder (BED) and suicidality (i.e., suicide ideation, plan, and/or attempt) has not been studied extensively, and it is unknown whether BED is uniquely associated with suicidality when adjusting for comorbid psychopathology. Moreover, the course of suicidality in BED has not been determined and it is unknown whether BED precedes suicidality or vice versa. METHOD A total of 10,123 adolescents and 2,980 adults from two nationally representative surveys were administered diagnostic interviews assessing psychopathology and suicidality, as well the retrospectively reported ages of onset. RESULTS Among adults and adolescents, BED was associated with elevated odds of suicide ideation, plan, and attempt at a univariate level, but BED was not associated with elevated odds of suicidality when adjusting for comorbid psychopathology. Kaplan-Meier estimates of temporal patterns displayed that most adolescents experienced suicidality onset following BED onset, whereas most adults experienced suicidality onset prior to BED onset. DISCUSSION BED, comorbid disorders, and suicidality share common factors and interrelations, and individuals with BED and comorbid disorders may be at particularly high risk for suicidal outcomes. The presence of BED in adolescence may serve as a marker for more severe symptomatology that precedes the occurrence of suicidality. Research is needed to understand how eating disorder symptoms, comorbid symptoms, and suicidality affect one another over time.

Does the interpersonal-Psychological theory of suicide provide a useful framework for understanding suicide risk among eating disorder patients? A test of the validity of the IPTS.

OBJECTIVE The current study tested whether the Interpersonal-Psychological Theory of Suicide (IPTS) provides a useful framework for understanding elevated suicide rates among individuals with eating disorders (EDs). METHOD Based on predictions of the IPTS, we tested whether the combination of thwarted belongingness and perceived burdensomeness was associated with suicidal desire, and whether the combination of thwarted belongingness, perceived burdensomeness, and fearlessness about death was associated with past suicide attempts in an ED sample (n = 100). We also compared these IPTS constructs in an ED sample versus general psychiatric inpatients (n = 85) and college students (i.e., non-clinical comparison group; n = 93). RESULTS Within the ED sample, no hypothesized interactions were found, but perceived burdensomeness was associated with suicidal desire, and perceived burdensomeness and fearlessness about death were associated with past suicide attempts. The ED and psychiatric samples had greater thwarted belongingness, perceived burdensomeness, and suicidal desire than the non-clinical comparison group. DISCUSSION The IPTS constructs of perceived burdensomeness and fearlessness about death appear to explain some facets of suicidality among people with EDs, but overall, support for the IPTS was limited. Future research on EDs and suicidality should look beyond the IPTS and consider other biological and sociocultural factors for suicide.

The joint influence of acquired capability for suicide and stoicism on over-exercise among women

We investigated longitudinal relationships among eating disorder behaviors, stoicism, and the acquired capability for suicide (ACS), which is a construct comprised of pain tolerance and fearlessness about death. University students (n=150) completed assessments measuring stoicism, ACS, and eating disorder behaviors at two time points approximately 30days apart. Among women, there was a quadratic relationship between ACS and over-exercise behaviors, such that as ACS increased the positive association between ACS and over-exercise became more pronounced. Further, among women, ACS moderated the relationship between stoicism and over-exercise, such that high levels of ACS in combination with stoicism predicted increases in over-exercise. Results suggest that ACS in combination with stoicism may lead women to engage in more eating disordered behaviors, like over-exercise.

Examining implicit attitudes toward emaciation and thinness in anorexia nervosa.

OBJECTIVE To determine if females with anorexia nervosa (AN) associate emaciation with beauty by examining implicit attitudes toward emaciated bodies relative to thin bodies. METHOD Thirty women with AN and 29 healthy control women were primed by viewing images of either emaciated or thin women. Participants then completed a lexical decision task (LDT), wherein they distinguished words from nonwords as quickly and accurately as possible. Response times were measured. Real words consisted of beautiful, ugly, neutral, and positive words. Body mass index (BMI) was measured and several clinical interviews were completed, including the Eating Disorders Examination Questionnaire 4 (EDEQ-4). RESULTS There was a significant effect of group in the emaciated condition; participants with AN responded faster to both beautiful and ugly words than control women did. Eating disorder symptom severity (as measured by the EDEQ-4 subscales) predicted the strength of the association between emaciation and beauty. DISCUSSION At an implicit, automatic level, women with AN in this study had stronger associations between emaciation and both beauty and ugliness than control women did, suggesting that women with AN may have atypical beliefs about beauty. Thin ideal internalization is an important factor in the development and maintenance of eating disorders; the type of thin ideal being internalized may be important to consider, particularly given the extent to which pro-eating disorder websites promote idealization of emaciation. The associations found by using the LDT highlight the utility of implicit measures, particularly when conducting assessments involving sensitive or atypical beliefs.

Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research

Suicide is the second leading cause of death among individuals with anorexia nervosa (AN), and suicidal behavior is elevated in bulimia nervosa (BN) and binge eating disorder (BED) relative to the general population. This paper reviews the suicidality literature within each ED, as well as theoretical explanations for the elevated risk for suicidality among those with EDs. Approximately one-quarter to one-third of people with AN, BN, or BED have thought about suicide, and one-quarter to one-third of people with AN and BN have attempted suicide. Relative to gender and aged matched comparison groups, individuals with AN are 18 times more likely to die by suicide, and individuals with BN are seven times more likely to die by suicide. However, the majority of the research in this area is cross-sectional or retrospective, which leaves the timing of the mortality risk unclear. Longitudinal work that is designed to examine dynamic and acute fluctuations in suicidality among ED samples is needed in order to determine meaningful risk factors.

Interoceptive Deficits, Nonsuicidal Self‐Injury, and Suicide Attempts Among Women with Eating Disorders

People with eating disorders (EDs) have an elevated risk for both nonsuicidal self-injury (NSSI) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI, and examining interoceptive deficits, NSSI, fearlessness about death, and pain tolerance as risk factors for suicide. Ninety-six adult, treatment-seeking women with EDs completed self-report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI, and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI, fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self-harm among individuals with EDs.

Beauty in the eye of the beholder: Using facial electromyography to examine the association between eating disorder symptoms and perceptions of emaciation among undergraduate women

Thin-ideal internalization, drive for thinness, and over-evaluation of the importance of thinness are associated with eating disorders (EDs). However, little research has examined to what extent perceptions of emaciation are also associated with ED symptoms. In the present study, 80 undergraduate women self-reported on ED symptomatology and perceptions of emaciated, thin, and overweight female bodies. While participants viewed images of these different body types, facial electromyography was used to measure activation of facial muscles associated with disgust reactions. Emaciated and overweight bodies were rated negatively and elicited facial responses consistent with disgust. Further, ED symptomatology was associated with pronounced aversion to overweight bodies (assessed via self-report pleasantness ratings), and attenuated negative affect to emaciated bodies (assessed via facial electromyography). The latter association was significant even when controlling for self-reported perceptions of emaciation, suggesting that psychophysiological methods in ED research may provide valuable information unavailable via self-report.

Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality

Purpose of ReviewThis narrative review evaluates recent literature on the associations between eating disorders and suicidality and discusses potential shared mechanisms that may account for these relationships. Additionally, the review highlights shortcomings with the literature to date and suggests avenues for future research.Recent FindingsIndividuals with anorexia nervosa, bulimia nervosa, and binge eating disorder experience elevated rates of suicidality compared to the general population. Suicide risk is higher when eating disorders occur with other psychological conditions. Additionally, genetic factors, emotion dysregulation, trauma, stressful life events, and lack of body regard may have roles in the development of both eating disorders and suicidality.SummaryMuch of the risk for suicidality in eating disorders appears to be driven by comorbid psychopathology and genetic factors. However, the lack of longitudinal research makes it difficult to draw conclusions about the directionality or temporality of these relations; thus, novel methods are needed.

Identity, Relationship Satisfaction, and Disclosure Predicting Suicide Risk Among Sexual Minority Women

We tested the usefulness of combining the Interpersonal–Psychological Theory of Suicide and minority stress models in studying suicidality among sexual minority women. According to the Interpersonal–Psychological Theory of Suicide, perceptions of being a burden on others and feelings of failed belongingness predict suicidal ideation. In a sample of sexual minority women (n = 51), we tested first, if the interaction of perceived burdensomeness and failed belongingness predicted lifetime suicidal behavior; second, if identity affirmation was negatively related to perceived burdensomeness and if this relation was moderated by disclosure; and third, if relationship satisfaction was negatively related to failed belongingness and if this relation was moderated by acceptance concerns. The proposed interaction of perceived burdensomeness and failed belongingness predicted lifetime suicide attempts. Moreover, among sexual minority women with greater disclosure of their sexual minority identities, low identity affirmation was related to higher perceived burdensomeness. For sexual minority women with high acceptance concerns, relationship satisfaction did not relate to lower feelings of failed belongingness. These findings suggest that sexual minority related stressors moderate risk factors for suicidality—in particular, perceptions of burdensomeness and failed belongingness. We suggest clinicians and others encourage sexual minority individuals to engage in activities that promote effectiveness and interpersonal closeness. Online slides for instructors who want to use this article for teaching are available to PWQ subscribers on PWQs website at http://pwq.sagepub.com/supplemental