Erin L. Fink

Exercise caution: over-exercise is associated with suicidality among individuals with disordered eating.

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.

Do major depressive disorder and dysthymic disorder confer differential risk for suicide

BACKGROUND Although there has been a tremendous amount of research examining the risk conferred for suicide by depression in general, relatively little research examines the risk conferred by specific forms of depressive illness (e.g., dysthymic disorder, single episode versus recurrent major depressive disorder [MDD]). The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness. METHODS To accomplish this aim, we conducted a cluster analysis using the aforementioned suicide-related variables in a sample of 494 outpatients seen between January 2001 and July 2007 at the Florida State University Psychology Clinic. Patients were diagnosed using DSM-IV criteria. RESULTS Two distinct clusters emerged that were indicative of lower and higher risk for suicide. After controlling for the number of comorbid Axis I and Axis II diagnoses, the only depressive illness that significantly predicted cluster membership was recurrent MDD, which tripled an individuals likelihood of being assigned to the higher risk cluster. LIMITATIONS The use of a cross-sectional design; the relatively low suicide risk in our sample; the relatively small number of individuals with double depression. CONCLUSIONS Our results demonstrate the importance of both chronicity and severity of depression in terms of predicting increased suicide risk. Among the various forms of depressive illness examined, only recurrent MDD appeared to confer greater risk for suicide.

Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation

OBJECTIVE Keel et al. introduced the diagnostic category of purging disorder (PD), an eating disorder characterized by recurring purging behaviors in the absence of objective binges. The current study sought to investigate psychological correlates among individuals with a lifetime diagnosis of PD as compared to those with other eating disorders, and those with no eating disorder. METHOD The current sample included 294 ethnically diverse undergraduate women. Subjects diagnosed with different types of eating disorders [i.e., anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD)] were compared to one another, as well as to individuals with no eating disorder on a variety of indices. RESULTS Women with PD displayed similar levels of drive for thinness as women with AN and BED. Individuals with BN and BED exhibited anxiety levels significantly higher than those with PD. Those with PD displayed levels of impulsivity that were significantly higher than those of individuals with AN or BED, but significantly lower than those of individuals with BN. They also displayed similar levels of bulimic symptoms as those with AN and BED; however, analysis of item 53 on the EDI revealed that those with PD had similar levels of purging ideation as those with BN. Women with any eating disorder diagnosis were more likely to have a comorbid Axis I disorder than women in the non-eating disorder group. CONCLUSION Our data replicated and extended the findings of Keel et al. and gave further support to the validity and distinctiveness of PD.

The Joint Influence of Disordered Eating and Anxiety Sensitivity on the Acquired Capability for Suicide

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.