Eating disorder behaviors as predictors of suicidal ideation among people with an eating disorder 

The following article discusses suicidality. If you or someone you know is in immediate danger, please contact 000, visit your nearest hospital or call any of the below services: 

Police and ambulance 000 

Lifeline (24/7) 13 11 14 or visit lifeline.org.au 

Suicide Call Back Service (24/7) 1300 659 467 or visit suicidecallbackservice.org.au 

Kids Helpline (24/7) 1800 55 1800 or visit kidshelpline.com.au 

For non-crisis support for eating disorders and body image issues, contact the Butterfly Foundation National Helpline on 1800 33 4673 or chat online or email 

For non-crisis support for mental health, call Head to Health on 1800 595 212 or visit https://www.headtohealth.gov.au/ 

For more information about suicide warning signs, visit https://www.suicidecallbackservice.org.au/worried-about-someone/learn-about-suicide-warning-signs/  

Why is this research important? 

Previous studies have identified that people experiencing eating disorders have higher rates of suicidality (suicidal ideation and suicide attempts) than people without eating disorders (Duffy et al., 2021; Kostro et al., 2014; Preti et al., 2011; Smith et al., 2018). These elevated rates of suicidality have been identified across eating disorder diagnostic groups, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (Duffy et al., 2021). Most of the previous research on suicidality and eating disorders has been cross-sectional or retrospective, and researchers have called for longitudinal research to be conducted in order to better understand the timing of suicide risk and to identify meaningful risk factors (Smith et al., 2021).  

This recent longitudinal study by Joiner et al. (2022) tested whether different eating disorder behaviours (purging, restricting, and binge eating) were predictors of suicidal ideation (thoughts about engaging in suicidal behaviour). The authors found that purging behaviours predicted both the presence/absence of suicidal ideation (β = .22, t = 2.48, p = .01; OR = 1.25, 95% CI [1.05, 1.49]), and intensity of suicidal ideation (β = .04, t = 2.31, p = .02). The authors noted that these findings have potential clinical implications for estimating suicide risk in patients with an eating disorder, although acknowledged that the clinical implications of the work should be contextualised by the relatively small effect sizes observed in the study findings. As suicidality is challenging to predict, the authors argue that additional risk assessment targets such as purging behaviours may prove valuable, and that the presence/absence and severity of purging behaviours should be considered along with other risk factors (including the presence of an eating disorder) when conducting suicide risk assessment.  

Authors:  

Thomas E. Joiner, Morgan Robison, Susan McClanahan, Megan Riddle, Jamie Manwaring, Renee D. Rienecke, Daniel Le Grange, Alan Duffy, Philip S. Mehler, Dan V. Blalock 

Abstract/Summary: 

Objective: Suicidality is known to be elevated among people with an eating disorder. The aim of the current study was to examine whether any of three specific behavioural facets of eating disorders (i.e., purging, binge eating, restricting) would be the strongest predictors of suicidal ideation, controlling for one another, in longitudinal analyses from admission to discharge. We hypothesized that purging, above and beyond restricting or binge eating, would be the most important predictor of suicidal ideation. 
Method: In the present study, patients with an eating disorder (N = 936), the majority of whom met criteria for a current DSM-5 diagnosis of Anorexia Nervosa (n = 560), completed the Eating Pathology Symptoms Inventory (EPSI) and the Beck Depression Inventory II-Item 9 suicidal ideation index, at admission and again at discharge. The settings were eating disorder treatment facilities offering inpatient, residential, partial hospitalization program (PHP), and intensive outpatient (IOP) levels of care. We pitted EPSI purging, EPSI restriction, and EPSI binge eating against one another in a regression framework predicting discharge suicidal ideation controlling for suicidal ideation at admission. 
Results: EPSI Purging significantly predicted both presence/absence of suicidal ideation (β = .22, t = 2.48, p = .01; OR = 1.25, 95% CI [1.05, 1.49]) and intensity of suicidal ideation (β = .04, t = 2.31, p = .02) at discharge, whereas neither EPSI Restricting nor EPSI Binge Eating did (p > .30). 
Discussion: Study results suggest that purging may have particular relevance in estimating suicide risk in patients with an eating disorder. 

Access:  

Closed access 

Link:  

https://doi.org/10.1002/eat.23770  

Citation:  

Duffy, M. E., Siegfried, N., Bass, G., & Joiner, T. E. (2021). Presence and severity of suicidal thoughts and behaviors across the eating disorder diagnostic spectrum: A pilot study. Journal of Clinical Psychology, 77(4), 1045-1053. 

Joiner, T. E., Robison, M., McClanahan, S., Riddle, M., Manwaring, J., Rienecke, R. D., ... & Blalock, D. V. (2022). Eating disorder behaviors as predictors of suicidal ideation among people with an eating disorder. International Journal of Eating Disorders. Early view.  

Kostro, K., Lerman, J. B., & Attia, E. (2014). The current status of suicide and self-injury in eating disorders: a narrative review. Journal of eating disorders, 2(1), 1-9. 

Preti, A., Rocchi, M. B. L., Sisti, D., Camboni, M. V., & Miotto, P. (2011). A comprehensive meta‐analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica, 124(1), 6-17. 

Smith, A. R., Zuromski, K. L., & Dodd, D. R. (2018). Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Current Opinion in Psychology, 22, 63-67.