Non‐suicidal self‐injury, suicidal thoughts and behaviors in individuals with an eating disorder relative to healthy and psychiatric controls: A systematic review and meta‐analysis

Sohn, Maya N; Dimitropoulos, Gina; Ramírez, Ana C.; McPherson, Claire; Anderson, Alida; Munir, Amlish; Patten, Scott B.; McGirr, Alexander; Devoe, Daniel J.

doi:10.1002/eat.23880

Cited by 13 publications

(20 citation statements)

References 67 publications

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“…Extending findings from Fox et al (2019), results suggest that self‐harm and ED behaviors may be viewed on a continuum. Current classifications of ED behaviors and NSSI as entirely distinct may hinder the importance of acknowledging the self‐harm component that our study and others support as highly comorbid with ED behaviors (e.g., Germain & Hooley, 2012; Sohn et al, 2023). Moreover, the strong indications of suicidal cognitions when engaging in restrictive behaviors underline the elevated prevalence of suicide among those with eating disorders (Arcelus et al, 2011; Fichter & Quadflieg, 2016), as restrictive eating is transdiagnostic (Lowe et al, 2018), and associated suicide‐related thoughts and intentions may be considered similarly.…”

Section: Discussionmentioning

confidence: 57%

“…Participants reported higher knowledge that they would die sooner due to NSSI and restrictive eating compared to binge eating. Finally, Germain & Hooley, 2012;Sohn et al, 2023). Moreover, the strong indications of suicidal cognitions when engaging in restrictive behaviors underline the elevated prevalence of suicide among those with eating disorders (Arcelus et al, 2011;Fichter & Quadflieg, 2016), as restrictive eating is transdiagnostic (Lowe et al, 2018), and associated suiciderelated thoughts and intentions may be considered similarly.…”

Section: Comparisons Of Suicide and Death Related Cognitions And Inte...mentioning

confidence: 99%

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Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury: Replication and extension in adolescents

Kline,

Jorgensen,

Lawson

et al. 2023

Intl J Eating Disorders

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ObjectiveEating disorder (ED) behaviors are often characterized as indirect forms of self‐harm. However, recent research has found less clear demarcations between direct self‐harming behaviors (e.g., nonsuicidal self‐injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating.MethodA total of 117 adolescents between ages 12–14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. The t‐tests and linear effects models were conducted to compare self‐harming thoughts and intentions across behaviors.ResultsParticipants reported at least some intent to hurt themselves physically in the moment and in the long‐term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self‐harming knowledge and intentions were most frequently reported with NSSI and longer‐term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors.DiscussionThis study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non‐zero self‐harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment.Public Significance StatementThis study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self‐injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self‐harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self‐harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

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Section: Discussionmentioning

confidence: 57%

Section: Comparisons Of Suicide and Death Related Cognitions And Inte...mentioning

confidence: 99%

Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury: Replication and extension in adolescents

Kline,

Jorgensen,

Lawson

et al. 2023

Intl J Eating Disorders

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“…Three previous meta-analyses on NSSI in individuals with EDs or disordered eating have been conducted within the past decade. One meta-analysis (using odds ratios) only included studies with a control group, included individuals without a confirmed ED diagnosis (i.e., self-reported symptoms) and focused specifically on NSSI, however, it is unclear how this was defined (Sohn et al, 2023). This previous study found that individuals with an ED are 6.85 times more likely to report NSSI compared to healthy controls.…”

Section: Previous Reviewsmentioning

confidence: 99%

“…Included studies must have examined prevalence of self-injurious behaviors, therefore case-control studies that created groups based on the presence of NSSI (e.g., Doktorova & Demuthova, 2021) were ineligible for inclusion. (Amiri & Khan, 2023;Cucchi et al, 2016;Sohn et al, 2023) were also reviewed for any manuscripts that met inclusion criteria but did not appear within database searches.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Non‐suicidal self‐injury among individuals with an eating disorder: A systematic review and prevalence meta‐analysis

Kirkpatrick,

Breton,

Biorac

et al. 2023

Intl J Eating Disorders

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ObjectiveThis study aimed to quantify the prevalence of non‐suicidal self‐injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so‐called prevalence, meta‐analysis.MethodIncluded studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the “metaprop” package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot.Results79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta‐analyses on self‐injury in EDs to date. Overall prevalence of non‐suicidal self‐injury was 34.59% (95%CI = 30.49–38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96–30.03%), 41.98% (95%CI = 32.35–51.91%), 36.97% (95%CI = 30.69–43.46%), 21.21% (95%CI = 14.93–28.12%) and 37.65% (95%CI = 28.59–47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies.DiscussionNon‐suicidal self‐injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self‐injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self‐injury in people with ED, irrespective of specific diagnoses. The method of determining self‐injury varied across studies and may limit this study.Public SignificanceThis study highlights the prevalence of self‐injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self‐injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self‐injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self‐injury.

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“…AN-associated mortality ranges from 2 to 8%, which is the highest mortality rate for a psychiatric disorder [7,13], mainly because of suicide and organic complications [1,14,15]. Mortality during initial stabilization stages is proportional to the degree of malnutrition [16] and is related to the use of intensive care facilities [17].…”

Section: Introductionmentioning

confidence: 99%

Hypercarbia in Hospitalized Children and Adolescents with Anorexia Nervosa as a Predictive Marker for Readmission: A Prospective Study

Viaño-Nogueira

Aparicio-López

Prieto-Campo

et al. 2023

Preprint

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Background Readmissions in anorexia nervosa (AN) are a common though understudied outcome. No organic alterations have been related to the likeliness of readmission to date. This study evaluated clinical and laboratory alterations associated to the risk of AN-related hospital readmissions in children and adolescents. Methods A prospective study was performed with every person ≤18 years old admitted due to AN destabilization to the Eating Disorder Ward of a freestanding children's hospital in Madrid (Spain) from November 2018 to October 2019. Both subtypes of AN were included. The participants were evaluated upon admission, at discharge and six months after discharge. T-tests or Mann-Whitney U tests were used for means comparison. Pearson or Spearman correlations were used for measuring the association between two variables. Logistic regression models were developed to evaluate the relationship between scoring methods and readmission. Results 154 persons were admitted during the study period. 131 met the inclusion criteria. Median age was 15.1 years (interquartile range 13.5-16.4). 71% of participants were malnourished at admission. 33 participants (25 %) had been previously admitted due to an eating disorder. Remarkable venous pH decrease and pCO2 elevation remained stable during the follow-up period. Hypercarbia at discharge was associated with readmission being twice more likely. The odds of readmission increased as discharge pCO2 rose. These findings did not depend on the AN subtype or the participant sex. Electrolytes persisted within the normal range. Conclusions Hypercarbia and respiratory acidosis are common alterations in children and adolescents hospitalized due to AN destabilization. Hypercarbia persists for at least 6 months after discharge, despite clinical improvement, and is associated with higher odds of readmission. This is the first study to identify a laboratory alteration as a potential indicator of readmission in AN. Further research is needed to fully understand the consequences of hypercarbia on people diagnosed of AN.

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Non‐suicidal self‐injury, suicidal thoughts and behaviors in individuals with an eating disorder relative to healthy and psychiatric controls: A systematic review and meta‐analysis

Cited by 13 publications

References 67 publications

Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury: Replication and extension in adolescents

Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury: Replication and extension in adolescents

Non‐suicidal self‐injury among individuals with an eating disorder: A systematic review and prevalence meta‐analysis

Hypercarbia in Hospitalized Children and Adolescents with Anorexia Nervosa as a Predictive Marker for Readmission: A Prospective Study

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