Obsessive–compulsive symptoms in female patients with an eating disorder with or without impulsive non‐suicidal self‐injury

Abstract

Background and Aims In the present study, we investigated differences in obsessive–compulsive (OC) symptoms in patients with an eating disorder (ED) with or without recent/lifetime impulsive non‐suicidal self‐injury (NSSI). We included 429 female inpatients with an ED, of whom 31.9% engaged in recent impulsive NSSI and 56.4% in lifetime impulsive NSSI. Materials They filled out the Eating Disorder Evaluation Scale, the Self‐Injury Questionnaire‐Treatment Related and the Padua Inventory‐Revised (OC symptoms). Methods and Results Patients with anorexia nervosa, binge‐eating/purging type (AN‐BP) and bulimia nervosa (BN) engaged more frequently in recent/lifetime impulsive NSSI compared to patients with anorexia nervosa, restrictive‐type (AN‐R). Two MANCOVAs with OC symptoms as dependent variables, and ED subtypes and recent/lifetime impulsive NSSI as independent variables controlling for age and body mass index showed the main effects of ED subtypes and recent/lifetime impulsive NSSI. Patients with AN‐BP reported significantly more impulses (i.e., being afraid of losing control over motor behaviours) compared to patients with AN‐R and BN. ED patients with impulsive recent/lifetime NSSI scored significantly higher on all OC scales compared to patients without NSSI. Discussion and Conclusion In sum, the presence of recent/lifetime impulsive NSSI in patients with an ED seems to be related to more severe OC symptoms. Hence, this comorbidity needs to be addressed in psychotherapy, such as in transdiagnostic cognitive behavioural therapy for EDs.

Lifetime prevalence and clinical correlates of nonsuicidal self-injury in youth inpatients with eating disorders: a retrospective chart review

“…A recent meta-analysis summarizing research on NSSI in EDs quantified lifetime NSSI prevalence as 27% across different age groups and treatment settings ([ 20 ]; 29 studies). Specifically, in adult in- and outpatients with AN-R, AN-BP, and BN, approximately half engaged in NSSI [ 28 , 29 ]. Concerning minors suffering from AN and BN, only four studies focused on lifetime NSSI.…”

“…Overall, the broad range of lifetime NSSI varying between 15 and 88% could result from different treatment settings, populations, and measurements based on diverse NSSI conceptualizations [ 34 – 36 ]. Higher NSSI prevalence in binge-purge EDs [ 29 , 37 ] could be explained by affect regulation for the increased impulsivity and negative affect in BN and AN-BP vs. AN-R [ 38 , 39 ]. Taken together, only four studies were identified focusing on a history of NSSI in adolescents and adults with EDs.…”

“…According to a systematic review ([ 3 ]; 66 studies) and recent individual studies of youths and adults with EDs, NSSI was associated with female sex [ 32 ], older age [ 32 ], higher body weight [ 32 ], severe ED psychopathology [ 3 , 41 ], a longer duration of illness [ 32 ], a longer treatment duration [ 13 ], a history of childhood physical abuse [ 3 , 44 , 45 ], emotional abuse [ 3 , 40 , 45 ], and sexual abuse [ 3 , 44 , 45 ]. Further, NSSI was associated with more psychopathology [ 13 , 31 ], substance abuse [ 3 , 32 ], affective disorders [ 32 ], major depression [ 3 , 13 , 31 , 44 ], anxiety disorders [ 31 , 45 , 46 ], obsessive-compulsiveness [ 3 , 29 , 41 ], post-traumatic stress disorder [ 19 ], personality psychopathology [ 37 ], including borderline, histrionic [ 45 ], and not otherwise specified personality disorders [ 13 ]. NSSI correlated with more suicidal ideation [ 45 ] and suicide attempts [ 3 ], as well as antidepressant [ 47 , 48 ] and antipsychotic [ 48 ] medication prescription.…”

Detecting of Interrelationships between Eating Disorders and Self-Harm in Girls during Adolescence

“…Several authors have addressed the interrelationships between eating disorders and self-harm (Nitkowski & Petermann, 2011;Claes et al, 2007;2021, Depestele et al, 2015Sarbach-Andrae et al, 2007, Fialová & Krch, 2012. Eating disorders on their own very often induce self-harming behaviour (Hawton et al 2002;Dougherty et al, 2009;Fliege et al, 2009).…”

“…According to Kriegelová (2008), frequent and incorrect criticism from the parent or other close person results in fear of the parent, which according to our findings is related to self-harm and is one of the symptoms of eating disorders. Furthermore, it is an insufficient and disproportionately emotionally adequate response to manifestations in childhood, weak provision of space for the development of autonomy, great effort from parents to control the child and exposure to severe and stressful events such as death of a relative or loved one, accident or bullying of a child in school, internet, and another environment (Kriegelová, 2008, Claes et al, 2021. According to Sutton (1999), the factors influencing intentional self-harm are long-term child abuse, developing problems with one's own identity, feelings of sadness, frequent loneliness, or the occurrence of lacrimosity, and others.…”