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

Abstract

Background. Against a backdrop of increasing research, clinical and taxonomic attention in non-suicidal self-injury (NSSI), evidence suggests a link between NSSI and eating disorders (ED). The frequency estimates of NSSI in ED vary widely. Little is known about the sources of this variation, and no meta-analysis has quantified the association between ED and NSSI.Method. Using random-effects meta-analyses, meta-regression analyses, and 1816-6466 unique participants with various ED, we estimated the weighted average percentage of individuals with ED, those with anorexia nervosa (AN) and those with bulimia nervosa (BN) who are reported to have a lifetime history of NSSI across studies. We further examined predictors of NSSI in ED.Results. The weighted average percentage of patients with a lifetime history of NSSI was 27.3% [95% confidence interval (CI) 23.8-31.0%] for ED, 21.8% (95% CI 18.5-25.6%) for AN, and 32.7% (95% CI 26.9-39.1%) for BN. The difference between BN and AN was statistically significant [odds ratio (OR) 1.77, 95% CI 1.14-2.77, p = 0.013]. The odds of NSSI increased by 24% for every 10% increase in the percentage of participants with histories of suicide attempts (OR 1.24, 95% CI 1.04-1.48, p = 0.020) and decreased by 26% for every 10% increase in the percentage of participants with histories of substance abuse (OR 0.74, 95% CI 0.58-0.95, p = 0.023).Conclusions. In the specific context of ED, NSSI is highly prevalent and correlates positively with attempted suicide, urging for NSSI-focused treatments. A novel finding is that NSSI is potentially antagonized by substance abuse.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

“…Notably, similar ER difficulties have been postulated for EDs and NSSI behaviors; namely, both reveal difficulties in thinking, planning, or implementing adaptive coping strategies (Solano et al, 2005; Claes et al, 2010; Muehlenkamp et al, 2012; Vansteelandt et al, 2013; Claes and Muehlenkamp, 2014; Kostro et al, 2014; Islam et al, 2015; Cucchi et al, 2016). Within this clinical population both maladaptive food intake and NSSI behaviors can be implemented as a maladaptive ER strategy that enables the individual to avoid, manage or lessen unpleasant emotions (Chapman et al, 2006; Andover and Morris, 2014; McKenzie and Gross, 2014).…”

“…Increasing evidence supports preceding emotion regulation (ER) models (Linehan, 1993; Gross, 1998) that postulate that ER difficulties often lead to the implementation of less appropriate strategies (e.g., maladaptive food intake or deliberate self-harm) to mollify unpleasant emotions. Likewise, deficits in ER observed among individuals suffering from EDs have been hypothesized to underlie the high prevalence of non-suicidal self-injury (NSSI) behaviors, which range from 21 to 59% in this clinical population (Kostro et al, 2014; Claes et al, 2015b; Islam et al, 2015; Cucchi et al, 2016). Still, among individuals with clinical EDs, those who engage in NSSI have higher dietary restrictions and higher rates of binging and/or purging symptomatology (Stein et al, 2004; Selby et al, 2010).…”

Emotional reactivity in a clinical sample of patients with eating disorders and nonsuicidal self-injury

“…Eating disorders (EDs) and nonsuicidal self-injury (NSSI) are two maladaptive behaviors with substantial co-occurrence that represent significant mental and physical health concerns (Cucchi et al, 2016; Kostro et al, 2014). Among those with EDs, a recent meta-analysis reported a lifetime history of NSSI of 32.7% among those with bulimia nervosa (BN) and 27.3% among those with anorexia nervosa (AN) (Cucchi et al, 2016).…”

“…Among those with EDs, a recent meta-analysis reported a lifetime history of NSSI of 32.7% among those with bulimia nervosa (BN) and 27.3% among those with anorexia nervosa (AN) (Cucchi et al, 2016). Among those with NSSI, one study found 19.4% of participants with a history of NSSI also experience ED symptoms (Muehlenkamp et al, 2012), while another study found 29.9% of people being treated for NSSI engaged in binging, purging, or food restriction (Washburn et al, 2015).…”

Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample

“…Additionally, there is a high prevalence of suicide attempts in individuals with EDs, with lifetime prevalence estimates ranging from 3.0% to 40% [18–21]. The majority of research indicates that both NSSI and suicide attempts are more prevalent in individuals who engage in purging behaviors [12, 20, 22], which are also associated with deficits in emotion regulation.…”