Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Abstract

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed. Keywordsnon-suicidal self-injury; emotion regulation; EMA; deliberate self-harm; bulimia; eating disorder Non-suicidal self-injury (NSSI; the deliberate damage of one's body tissue without suicidal intent, Muehlenkamp, 2005) is a troubling behavior that many clinicians are encountering, yet struggle to understand (White-Kress, 2003;Zila & Kiselica, 2001). Prevalence rates among non-clinical samples of adolescents and young adults range from 4% (Klonsky & Muehlenkamp, 2007) to 38% (Whitlock, Eckenrode, & Silverman, 2006;Lloyd-Richardson et al 2007), whereas prevalence rates among inpatient adolescents have been reported at 30 to 68% (Makikyro et al., 2004;Nixon, Cloutier, & Aggarwal, 2002). Of particular interest are findings that rates of NSSI tend to be quite high among a subset of persons with select psychiatric disorders including borderline personality disorder (Zanarini, Frankenburg, Ridolfi, & Jager-Hyman, 2006), and eating disorders; especially bulimia nervosa (BN; Anderson, Carter, & McIntosh, 2002;Claes, Vandereycken, & Vertommen, 2001;Favaro & Santonastaso, 1999;Wonderlich, Myers, Norton, & Crosby, 2002).Correspondence regarding this article should be addressed to: Jennifer J Muehlenkamp, PhD, Department of Psychology, 319 Harvard St stop 8380, University of North Dakota, Grand Forks, ND 58202; E-mail: jennifer.muehlenkamp@und.edu; Phone: 701-777-4496, Fax: 701-777-3454. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2010 January 1. & Telch, 1998; Kjelsas, Borsting, & Gudde, 2004;Smyth, Wonderlich, & Heron, 2007;Telch & ...

Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis

“…countries (Garner et al 1985;Yellowlees, 1985;Mitchell et al 1986;Gleaves & Eberenz, 1993;Pryor et al 1996;Tobin & Griffing, 1996;Wiederman & Pryor, 1996a, b;Favaro & Santonastaso, 1997, 1998Nagata et al 2000a;Steiger et al 2001;Anderson et al 2002;Dohm et al 2002;Paul et al 2002;Stein et al 2004;Ruuska et al 2005;Corstorphine et al 2007;Ahren-Moonga et al 2008;Bulik et al 2008;Fichter et al 2008;Muehlenkamp et al 2009;Liang & Meg Tseng, 2011;Peebles et al 2011;Iannaccone et al 2013;Vansteelandt et al 2013;Bueno et al 2014). The 29th publication (Solano et al 2005) shared participants with the sample in Bueno et al (2014).…”

Occurrence and co-occurrence of nonsuicidal self-injury and disordered eating in a daily diary study: Which behavior, when?

“…Our results corroborate previous micro-longitudinal studies that have shown that weekly co-occurrence of NSSI and DE may be quite common. Even when study samples are recruited based on their engagement in one of these behaviors, secondary analyses show that roughly 15 to 40% of participants have engaged in other selfdamaging behaviors during the monitoring periods (Anestis et al, 2012;Muehlenkamp et al, 2009;Shingleton et al, 2013). In the current study, 25 of the 60 participants (42%) who were selected for their engagement in NSSI reported some DE behavior during the two-week diary period.…”

TelEMA: a low-cost and user-friendly telephone assessment platform

“…Bolger, Davis, and Rafaeli (2003) provide a review of the benefits of such programs, including timestamps for responses, flexibility in presentation of questions, and more efficient data entry and management. Recent studies have used electronic handheld devices to investigate physical symptoms (e.g., physical anxiety symptoms; Pfaltz, Michael, Grossman, Margraf, & Wilhelm, 2010;Smyth & Stone, 2003), behaviors such as alcohol consumption (Collins et al, 1998;Hufford, Shields, Shiffman, Paty, & Balabanis, 2002;Kashdan, Ferssizidis, Collins, & Muraven, 2010;Simons, Dvorak, Batien, & Wray, 2010;Swendsen et al, 2000), drug use (Buckner, Crosby, Silgado, Wonderlich, & Schmidt, 2012;Buckner et al, 2011), eating disorder symptoms (Engel et al, 2007;le Grange, Gorin, Dymek, & Stone, 2002;Muehlenkamp et al, 2009;Wegner et al, 2002), and psychological constructs such as affect (Juth, Smyth, & Santuzzi, 2008;Trull et al, 2008), mood disorders/depressive symptoms (aan het Rot, Hogenelst, & Schoevers, 2012;Vranceanu, Gallo, & Bogart, 2009;Wenze & Miller, 2010), self-esteem (Kernis, 2005), social anhedonia and social anxiety (Brown, Silvia, Myin-Germeys, & Kwapil, 2007;Buckner, Crosby, Wonderlich, & Schmidt, 2012), and anxiety symptoms in general (Gallagher, Schoemann, & Pressman, 2011). A recent review has highlighted the use of electronic EMA as a part of psychosocial and health behavior interventions (Heron & Smyth, 2010).…”