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Suicide attempts in bulimia nervosa: Personality and psychopathological correlates

Published online by Cambridge University Press:  16 April 2020

Laura Forcano ,
Fernando Fernández-Aranda ,
Eva Álvarez-Moya ,
Cynthia Bulik ,
Roser Granero ,
Mònica Gratacòs ,
Susana Jiménez-Murcia ,
Isabel Krug ,
Josep M. Mercader  and
Nadine Riesco
...Show all authors
Laura Forcano
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Fernando Fernández-Aranda*
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Eva Álvarez-Moya
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Cynthia Bulik
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599-7160, USA
Roser Granero
Affiliation:
Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
Mònica Gratacòs
Affiliation:
Genetic Causes of Disease Group, Genes and Disease Program Center for Genomic Regulation (CRG-UPF), Dr. Aiguader, 88, 08003Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1a Planta, 08003Barcelona, Spain
Susana Jiménez-Murcia
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Isabel Krug
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Josep M. Mercader
Affiliation:
Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
Nadine Riesco
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain
Ester Saus
Affiliation:
Genetic Causes of Disease Group, Genes and Disease Program Center for Genomic Regulation (CRG-UPF), Dr. Aiguader, 88, 08003Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1a Planta, 08003Barcelona, Spain
Juan José Santamaría
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907Barcelona, Spain
Xavier Estivill
Affiliation:
Genetic Causes of Disease Group, Genes and Disease Program Center for Genomic Regulation (CRG-UPF), Dr. Aiguader, 88, 08003Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1a Planta, 08003Barcelona, Spain Department of Health and Experimental Life Sciences, Pompeu Fabra University (UPF), c/ Dr. Aiguader, 88, 08003Barcelona, Catalonia, Spain
*
*Corresponding author. Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907 Barcelona, Spain. Tel.: +34 93 2607922; fax: +34 93 2607658. E-mail address: ffernandez@bellvitgehospital.cat (F. Fernandez-Aranda)
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Abstract

Background

Little evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.

Method

Five hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.

Results

Lifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).

Conclusion

Our results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.

Keywords

Eating disordersSuicidal behaviorPredictorsPsychopathologyEating disorder not otherwise specifiedSuicidePsychiatry in EuropePsychometry and assessments in psychiatry
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 2 , March 2009 , pp. 91 - 97
Copyright
Copyright © Elsevier Masson SAS 2009

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References

Alvarez-Moya, E.M., Jiménez-Murcia, S., Granero, R., Vallejo, J., Krug, I., Bulik, C.M.et al.Comparison of personality risk factors in bulimia nervosa and pathological gambling. Compr Psychiatry 2007;48(5):452–457CrossRefGoogle ScholarPubMed
Anderson, C.B., Joyce, P.R., Carter, F.A., McIntosh, V.V., Bulik, C.M.The effect of cognitive–behavioral therapy for bulimia nervosa on temperament and character as measured by the temperament and character inventory. Compr Psychiatry 2002;43(3):182–188CrossRefGoogle ScholarPubMed
APA, DSM-IV-TR: diagnostic and statistical manual of mental disorders 4th ed.Washington, DC: American Psychiatric Association; 2000. RevisedGoogle Scholar
Arendt, M., Sher, L., Fjordback, L., Brandholdt, J., Munk-Jorgensen, P.Parental alcoholism predicts suicidal behavior in adolescents and young adults with cannabis dependence. Int J Adolesc Med Health 2007;19(1):67–77CrossRefGoogle Scholar
Beautrais, A.L., Joyce, P.R., Mulder, R.T.Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide Life Threat Behav 1999;29(1):37–47Google ScholarPubMed
Boardman, A.P., Healy, D.Modelling suicide risk in affective disorders. Eur Psychiatry 2001;16(7):400–405CrossRefGoogle ScholarPubMed
Bulik, C.M., Sullivan, P.F., Joyce, P.R.Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatr Scand 1999;100(1):27–32CrossRefGoogle ScholarPubMed
Bulik, C.M., Sullivan, P.F., Joyce, P.R., Carter, F.A.Temperament, character, and personality disorder in bulimia nervosa. J Nerv Ment Dis 1995;183(9):593–598CrossRefGoogle ScholarPubMed
Bulik, C.M., Thornton, L.M., Pinheiro, A.P., Klump, K.L., Brandt, H., Crawford, S.et al.Suicide attempts in anorexia nervosa. Psychosom Med 2008;70:378–383CrossRefGoogle ScholarPubMed
Casasnovas, C., Fernandez-Aranda, F., Granero, R., Krug, I., Jimenez-Murcia, S., Bulik, C.M.et al.Motivation to change in eating disorders: clinical and therapeutic implications. Eur Eat Disord Rev 2007;15(6):449–456CrossRefGoogle ScholarPubMed
Castro, J., Toro, J., Salamero, M., Guimerá, E.The eating attitudes test: validation of the Spanish version. Eval Psicologica/Psychol Assess 1991;7:175–190Google Scholar
Cloninger, C.R.A systematic method for clinical description and classification of personality variants: a proposal. Arch Gen Psychiatry 1987;44:573–588CrossRefGoogle ScholarPubMed
Cloninger, C.R.The temperament and character inventory–revised St. Louis, MO: Center for Psychobiology of Personality, Washington University; 1999.Google Scholar
Corcos, M., Taieb, O., Benoit-Lamy, S., Paterniti, S., Jeammet, P., Flament, M.F.Suicide attempts in women with bulimia nervosa: frequency and characteristics. Acta Psychiatr Scand 2002;106(5):381–386CrossRefGoogle ScholarPubMed
Derogatis, L.SCL-90-R. Cuestionario de 90 síntomas-Manual Madrid: TEA; 2002 EditorialGoogle Scholar
Derogatis, L.R.SCL-90-R. Cuestionario de 90 síntomas Madrid: TEA; 1994Google Scholar
Dumais, A., Lesage, A.D., Alda, M., Rouleau, G., Dumont, M., Chawky, N.et al.Risk factors for suicide completion in major depression: a case–control study of impulsive and aggressive behaviors in men. Am J Psychiatry 2005;162(11):2116–2124CrossRefGoogle ScholarPubMed
Erinoff, L., Compton, W.M., Volkow, N.D.Drug abuse and suicidal behavior. Drug Alcohol Depend 2004;76(Suppl.):S1–S2CrossRefGoogle ScholarPubMed
Favaro, A., Caregaro, L., Di Pascoli, L., Brambilla, F., Santonastaso, P.Total serum cholesterol and suicidality in anorexia nervosa. Psychosom Med 2004;66(4):548–552CrossRefGoogle ScholarPubMed
Favaro, A., Santonastaso, P.Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatr Scand 1997;95(6):508–514CrossRefGoogle ScholarPubMed
Fernandez-Aranda, F., Turon, V.Trastornos alimentarios. Guia basica de tratamiento en anorexia y bulimia Barcelona: Masson; 1998.Google Scholar
Fernandez-Aranda, F., Jimenez-Murcia, S., Alvarez, E., Granero, R., Vallejo, J., Bulik, C.M.Impulse control disorders in eating disorders: clinical and therapeutic implications. Compr Psychiatry 2006;47(6):482–488CrossRefGoogle ScholarPubMed
Fernandez-Aranda, F., Pinheiro, A.P., Thornton, L.M., Berrettini, W.H., Crow, S., Fichter, M.M.et al.Impulse control disorders in women with eating disorders. Psychiatry Res 2008;157(1–3):147–157CrossRefGoogle ScholarPubMed
Fernandez-Aranda, F., Pinheiro, A.P., Tozzi, F., Thornton, L.M., Fichter, M.M., Halmi, K.A.et al.Symptom profile of major depressive disorder in women with eating disorders. Aust N Z J Psychiatry 2007;41(1):24–31CrossRefGoogle ScholarPubMed
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., Benjamin, L.Structured clinical interview for axis II personality disorders (SCID-II) Barcelona: Masson S.A; 1999Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W.Structured clinical interview for DSM-IV axis I disorders—clinical version (SCID-CV) Washington: American Psychiatric Press; 1997Google Scholar
Franko, D.L., Keel, P.K.Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev 2006;26(6):769–782CrossRefGoogle ScholarPubMed
Franko, D.L., Keel, P.K., Dorer, D.J., Blais, M.A., Delinsky, S.S., Eddy, K.T.et al.What predicts suicide attempts in women with eating disorders?. Psychol Med 2004;34(5):843–853CrossRefGoogle ScholarPubMed
Fu, Q., Heath, A.C., Bucholz, K.K., Nelson, E.C., Glowinski, A.L., Goldberg, J.et al.A twin study of genetic and environmental influences on suicidality in men. Psychol Med 2002;32(1):11–24CrossRefGoogle ScholarPubMed
Fullerton, D.T., Wonderlich, S.A., Gosnell, B.A.Clinical characteristics of eating disorder patients who report sexual or physical abuse. Int J Eat Disord 1995;17(3):243–2493.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Garner, D.M.Eating disorder inventory-2 Odessa: Psychological Assessment Resources; 1991Google Scholar
Garner, D.M.Inventario de trastornos de la conducta alimentaria (EDI-2)-manual Madrid: TEA; 1998Google Scholar
Garner, D.M., Garfinkel, P.E.The eating attitude test: an index of the symptoms of bulimia nervosa. Psychol Med 1979;9:273–279CrossRefGoogle Scholar
Grucza, R.A., Przybeck, T.R., Cloninger, C.R.Personality as a mediator of demographic risk factors for suicide attempts in a community sample. Compr Psychiatry 2005;46(3):214–222CrossRefGoogle Scholar
Gunnell, D., Middleton, N.National suicide rates as an indicator of the effect of suicide on premature mortality. Lancet 2003;362(9388):961–962CrossRefGoogle Scholar
Gutiérrez-Zotes, J.A., Bayón, C., Montserrat, C., Valero, J., Labad, A., Cloninger, R.C.et al.Inventario del temperamento y el carácter-revisado (TCI-R). baremación y datos normativos en una muestra de población general Temperament and character inventory-revised (TCI-R). Scalement and normative data in a general population sample. Actas Esp Psiquiatr 2004;32(1):8–15Google Scholar
Gutierrez, F., Torrens, M., Boget, T., Martin-Santos, R., Sangorrin, J., Perez, G.et al.Psychometric properties of the temperaments and character inventory (TCI) questionnaire in a Spanish psychiatric population. Acta Psychiatr Scand 2001;103:143–147CrossRefGoogle Scholar
Henderson, M., Freeman, C.P.L.A self-rating scale for bulimia. The “BITE. Br J Psychiatry 1987;150:18–24CrossRefGoogle Scholar
Kessler, R.C., Borges, G., Walters, E.E.Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999;56(7):617–626CrossRefGoogle ScholarPubMed
Koerner, K., Linehan, M.M.Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatr Clin North Am 2000;23(1):151–167CrossRefGoogle ScholarPubMed
Kposowa, A.J.Marital status and suicide in the National Longitudinal Mortality Study. J Epidemiol Community Health 2000;54(4):254–261CrossRefGoogle ScholarPubMed
Krug, I., Bulik, C.M., Nebot-Llovera, O., Granero, R., Agüera, Z.P., Villarejo, C.et al.Anger expression in eating disorders: clinical, psychopathological and personality correlates. Psychiatry Res 2007;161(2):195–205CrossRefGoogle Scholar
Kuo, W.H., Gallo, J.J., Tien, A.Y.Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland. Psychol Med 2001;31(7):1181–1191CrossRefGoogle ScholarPubMed
Lacey, J.H., Evans, C.D.The impulsivist: a multi-impulsive personality disorder. Br J Addict 1986;81(5):641–649CrossRefGoogle ScholarPubMed
Loas, G., Guilbaud, O., Perez-Diaz, F., Verrier, A., Stephan, P., Lang, F.et al.Dependency and suicidality in addictive disorders. Psychiatry Res 2005;137(1–2):103–111CrossRefGoogle ScholarPubMed
Lorant, V., Kunst, A.E., Huisman, M., Costa, G., Mackenbach, J.Socio-economic inequalities in suicide: a European comparative study. Br J Psychiatry 2005;187:49–54CrossRefGoogle ScholarPubMed
Malone, K.M., Haas, G.L., Sweeney, J.A., Mann, J.J.Major depression and the risk of attempted suicide. J Affect Disord 1995;34(3):173–185CrossRefGoogle ScholarPubMed
Mann, J.J., Waternaux, C., Haas, G.L., Malone, K.M.Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156(2):181–189Google Scholar
McGirr, A., Renaud, J., Bureau, A., Seguin, M., Lesage, A., Turecki, G.Impulsive–aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med 2007:1–11Google ScholarPubMed
Milos, G., Spindler, A., Buddeberg, C., Ruggiero, G.Eating disorders symptomatology and inpatient treatment experience in eating-disordered subjects. Int J Eat Disord 2004;35(2):161–168CrossRefGoogle ScholarPubMed
Milos, G., Spindler, A., Hepp, U., Schnyder, U.Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. Gen Hosp Psychiatry 2004;26(2):129–135CrossRefGoogle ScholarPubMed
Morrell, S., Page, A.N., Taylor, R.J.The decline in Australian young male suicide. Soc Sci Med 2007;64(3):747–754CrossRefGoogle ScholarPubMed
Nagata, T., Kawarada, Y., Kiriike, N., Iketani, T.Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity. Psychiatry Res 2000;94(3):239–250CrossRefGoogle ScholarPubMed
Phillips, K.A., Coles, M.E., Menard, W., Yen, S., Fay, C., Weisberg, R.B.Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry 2005;66(6):717–725CrossRefGoogle ScholarPubMed
Renaud, J., Berlim, M.T., McGirr, A., Tousignant, M., Turecki, G.Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case–control study. J Affect Disord 2008;105(1–3):221–228CrossRefGoogle ScholarPubMed
Renberg, E.S.Self-reported life-weariness, death-wishes, suicidal ideation, suicidal plans and suicide attempts in general population surveys in the north of Sweden 1986 and 1996. Soc Psychiatry Psychiatr Epidemiol 2001;36(9):429–436CrossRefGoogle ScholarPubMed
Rivas, T., Bernabé, R., Jiménez, M.Fiabilidad y validez del test de investigación bulímica de Edimburgo (BITE) en una muestra de adolescentes españoles. Psicología Conducta 2004;12(3):447–461Google Scholar
Rosenberger, P.H., Henderson, K.E., Bell, R.L., Grilo, C.M.Associations of weight-based teasing history and current eating disorder features and psychological functioning in bariatric surgery patients. Obes Surg 2007;17(4):470–477CrossRefGoogle ScholarPubMed
Ruuska, J., Kaltiala-Heino, R., Rantanen, P., Koivisto, A.M.Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients. Eur Child Adolesc Psychiatry 2005;14(5):276–281CrossRefGoogle ScholarPubMed
Salaberría, K., Echeburúa, E.Tratamiento psicológico de la fobia social: un estudio experimental. Anál Modificación Conducta 1995;21:151–179Google Scholar
Schneider, B., Muller, M.J., Philipp, M.Mortality in affective disorders. J Affect Disord 2001;65(3):263–274CrossRefGoogle ScholarPubMed
Stein, D., Lilenfeld, L.R., Wildman, P.C., Marcus, M.D.Attempted suicide and self-injury in patients diagnosed with eating disorders. Compr Psychiatry 2004;45(6):447–451CrossRefGoogle ScholarPubMed
Sullivan, P.F.Mortality in anorexia nervosa. Am J Psychiatry 1995;152(7):1073–1074Google ScholarPubMed
Tozzi, F., Thornton, L.M., Mitchell, J., Fichter, M.M., Klump, K.L., Lilenfeld, L.R.et al.Features associated with laxative abuse in individuals with eating disorders. Psychosom Med 2006;68(3):470–477CrossRefGoogle ScholarPubMed
Verona, E., Sachs-Ericsson, N., Joiner, T.E. Jr.Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry 2004;161(3):444–451CrossRefGoogle Scholar
Wardle, J., Cooke, L.The impact of obesity on psychological well-being. Best Pract Res Clin Endocrinol Metab 2005;19(3):421–440CrossRefGoogle ScholarPubMed
Yamaguchi, N., Kobayashi, J., Tachikawa, H., Sato, S., Hori, M., Suzuki, T.et al.Parental representation in eating disorder patients with suicide. J Psychosom Res 2000;49(2):131–136CrossRefGoogle ScholarPubMed
Yen, S., Shea, M.T., Pagano, M., Sanislow, C.A., Grilo, C.M., McGlashan, T.H.et al.Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol 2003;112(3):375–381CrossRefGoogle ScholarPubMed
Youssef, G., Plancherel, B., Laget, J., Corcos, M., Flament, M.F., Halfon, O.Personality trait risk factors for attempted suicide among young women with eating disorders. Eur Psychiatry 2004;19(3):131–139CrossRefGoogle ScholarPubMed
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