An investigation of psychopathology in nonreferred suicidal and nonsuicidal adolescents

This investigation examined self-reported psychopathology in a school-based sample of 456 suicidal and nonsuicidal adolescents. The sample consisted of four groups: three at-risk for suicidal behavior based on current suicidal ideation as assessed by the Suicidal Ideation Questionnaire (SIQ; Reynolds, 1988), past suicide attempts, or both; and one nonsuicidal comparison group. Psychopathology was examined using ten scales from the Adolescent Psychopathology Scale (APS; Reynolds, 1998a) including: Major Depression, Conduct Disorder, Substance Abuse, Schizophrenia, Adjustment Disorder, Anorexia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder, Schizotypal Personality Disorder, and Avoidant Personality Disorder. Analyses were conducted separately for males and females using a MANOVA design that examined psychopathology severity among the four groups. Adolescents who engaged in past or current suicidal behavior had higher psychopathology severity scores compared to their nonsuicidal peers. Males with current suicidal thoughts who had attempted suicide had the highest levels of psychopathology severity compared to males in the other three groups. Females with a past suicide attempt or current suicidal ideation had higher psychopathology severity scores compared to nonsuicidal females. Results show greater psychopathology in school-based adolescents who have engaged in past and/or current suicidal behavior. The need for clinicians and mental health professionals working with at-risk youth to focus on concurrent psychopathology along with suicidal behavior is discussed.     

The associations between non-suicidal self-injury and borderline personality disorder features among Chinese adolescents

This study examined the relative importance of four major BPD features, that is, affective instability, disturbed interpersonal relationship, unstable sense of self, and behavioral impulsivity, in explaining the presence, initiation, repetition, and discontinuation of non-suicidal self-injury (NSSI) among a 2-year follow-up sample of 4,782 (68.5% girls) Hong Kong Chinese secondary school students. Affective instability, disturbed interpersonal relationship and behavioral impulsivity were significantly associated with the presence of NSSI both concurrently and longitudinally. These three BPD features were also related to the future initiation of NSSI. On the other hand, only behavioral impulsivity made a significant contribution to the repetition of NSSI. Additionally, a lower level of affective instability was also associated with quitting NSSI. We discussed some possible mechanisms underlying the effects of different BPD features on different developmental stages of NSSI.     

自伤青少年的冲动性

以自我报告、行为学和脑电为指标, 检验自伤青少年的冲动性。研究1, 对820名普通中学生和72名工读生进行问卷调查, 探讨自伤行为与情绪调节困难、冲动性的关系。结果表明, 冲动性能够预测自伤行为, 且预测效应量大于情绪调节困难。研究2, 采用Go/Nogo范式的ERPs实验, 检验自伤组与对照组冲动控制的行为学与脑电差异。结果表明, 自伤组Nogo正确反应的N2波幅显著高于对照组, N2潜伏期在部分电极点处高于对照组。脑电地形图显示两者的脑电差异主要体现在前额叶区。结论：自伤青少年的冲动性高于同龄普通青少年。     

Impulsivity and Nonsuicidal Self-Injury: Examining the Role of Affect Manipulation

The assessment of impulsivity is complicated by the construct’s multi-faceted nature and poor correspondence between self-report and behavioral measures. These complications extend to populations anecdotally described as impulsive, including individuals who engage in nonsuicidal self-injury (NSSI). Research suggests that self-injurers report impulsivity, primarily negative urgency. Thus, negative affect may be an important prerequisite for increased impulsive behaviors. The present laboratory study examined self-report impulsivity differences between individuals with and without a history of NSSI and if self-injurers demonstrated behavioral impulsivity when experiencing negative affect. Undergraduates with (N?=?54) and without (N?=?61) a history of NSSI participated in a two-part laboratory-based study that investigated the role of affect manipulation in impulsivity and NSSI. Participants were randomly assigned to either a negative or a neutral-relaxing mood induction. Participants completed self-report measures of impulsivity, NSSI, and negative affect. A behavioral measure of impulsivity was administered during Session 1 (prior to a mood induction task) and again during Session 2 (following a mood induction task) to determine whether affect had an effect on behavioral impulsivity task performance. Self-injurers reported higher negative urgency and lack of perseverance but did not display impulsivity on the behavioral task, even under conditions of negative affect.     

Nonsuicidal self-injury: relationship to behavioral and self-rating measures of impulsivity and self-aggression

Previous research using self-report measures has shown an association between nonsuicidal self-injurious behavior (NSSI) and impulsive tendencies. However, self-injurers have not been shown to be different from comparison groups on laboratory tasks putatively assessing impulsive behavior. One explanation for these contradictory findings is that self-report and laboratory measures of impulsive behavior tap into distinct but related constructs. Moreover, performance on laboratory measures of impulsive behavior can be influenced by myriad contextual and affective factors not present during past self-reported NSSI events. Accordingly, a relationship between behavioral tasks of impulsivity and self-injurious behavior could emerge if both are assessed relatively close in time under controlled laboratory conditions. To test this possibility, both self-ratings and laboratory task measures of self-injurious and impulsive behavior were employed in the current study. This multi-modal assessment approach revealed that self-rated impulsivity was associated with both self-report and behavioral measures of self-injurious behavior. Moreover, behavioral measures of impulsivity were associated with self-injurious behavior, but not NSSI history. These results provide support for the notion that a multi-modal approach to assessing self-injurious behavior is important for better understanding the correlates of nonsuicidal self-injury.     

Predictors of Unintentionally Severe Harm During Nonsuicidal Self‐Injury

This study aimed to identify predictors of unintentionally severe injury during nonsuicidal self‐injury (NSSI). The authors examined 3 potential predictors in a sample of 102 college students: addictive qualities of NSSI, impulsivity, and dissociation. Both impulsivity and addictive qualities of NSSI were associated with unintentionally severe injury during NSSI. In a logistic regression, only addictive qualities of NSSI emerged as a significant predictor of unintentionally severe injury during NSSI. Implications for counseling and research are discussed.     

The impact of weight, sex, and race/ethnicity on body dissatisfaction among urban children

The purpose of the current study was to examine the relative contributions of weight status, race/ethnicity, sex, and age on body dissatisfaction in a large group of diverse children. Participants were 4th–6th graders (N = 1212) in ten inner-city schools who participated in an obesity prevention study previously published. Children completed the body dissatisfaction subscale of the Eating Disorder Inventory-2 (EDI-2), and weight status was assessed by measured weights and heights. Multiple regression analyses were conducted. Relative weight status was the strongest predictor of body dissatisfaction, followed by race/ethnicity, and sex. Body dissatisfaction was greatest in obese, Asian, and female children. Overall, results indicated that children's body dissatisfaction varies based on relative weight status, as well as race/ethnicity and sex among urban children. Results highlight the strong need for additional research so that more definitive conclusions may be drawn regarding the development of body image among diverse groups of children.     

Psychometric properties of the eating disorders inventory-2 among women seeking treatment for binge eating disorder

Psychometric properties of the Eating Disorders Inventory-2 (EDI-2) when used for women with Binge Eating Disorder (BED) are assessed. The EDI-2 was administered to 144 outpatients seeking treatment for BED and 152 outpatients seeking treatment for Bulimia Nervosa (BN). Most EDI-2 scales had acceptable internal consistence for both the BED and BN samples. EDI-2 scales demonstrated adequate stability within a subsample of those with BED who were retested. Confirmatory factor analyses revealed a hypothesized second-order two-factor structure for the original EDI scales for the BED group but not for those with BN. When the provisional EDI-2 scales were included, a two-factor structure was not supported for any group. Some scales differentiated the BED from the BN sample, and the second-order factors correlated with measures of similar constructs. The original EDI scales can be used reliably for those with BED.     

The Eating Attitudes Test (EAT-26): reliability and validity in Spanish female samples

This paper focuses on the validation of the Spanish form of the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr & Garfinkel, 1982) across two studies. Participants in Study 1 were 778 females recruited from community settings (aged 12-21). Study 2 included 86 females recruited from clinical and 86 females from community settings (aged 12-35). Results from Principal and Simultaneous Component Analyses showed a unidimensional structure of the EAT-26 item scores. Reliability analyses supported the internal consistency of the scale. Study 1 also explores the ability of the EAT-26 to discriminate between subjects with Eating Disorder (ED), Symptomatic or Asymptomatic by means of ROC analyses and using results from the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O'Halloran, Mulholland, & Schneider, 1997) as criterion. The EAT-26 demonstrated good specificity but insufficient sensitivity to detect a full or partial ED. Study 2 explores the ability of the questionnaire to discriminate between subjects with and without ED. The EAT-26 demonstrated good specificity and moderate sensitivity to detect ED. Clinical and theoretical implications of these results are discussed.     

The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults

Eating disorders (ED) and non-suicidal self-injury (NSSI) present common aspects and factors which contribute to their onset and development. The last decade has seen an increasing circulation of online materials and interactions connected to ED and NSSI. There is a general agreement among mental health clinicians and researchers that this kind of online content involves serious risks, such as normalization and reinforcement of unhealthy behaviors, alongside with some benefits, like receiving peer support and validation. The aim of this paper is to offer an overview of major research contributions on this topic. After describing common aspects between these disorders, we analyze data concerning the usage of harm-advocating websites on internet and the characteristics of users. Furthermore, we define and explore the contents of both pro-ED and NSSI websites, and we extensively inspect risks and benefits of the exposure to these online content. Finally, we present clinical guidelines for assessment, intervention and prevention, particularly focusing on family interventions. Due to the rapidity of changes when technology is involved, the research on this topic is far from being concluded; more in-depth studies are needed, not only to explore long term effects of the use of the websites described, but also to investigate new alarming tendencies such as the diffusion of websites challenging self-destructive behaviors.     

Rates of Non-Suicidal Self-Injury: A Cross-Sectional Analysis of Exposure

Research on the social influences associated with rates of non-suicidal self-injury (NSSI) is scarce and limited to studies of contagion within inpatient and residential treatment settings. Using an archival dataset that included 1,965 college students, the current study examined whether exposure to acts of NSSI and/or suicidal behavior in others was associated with increased rates of NSSI. Results supported hypotheses in that participants who knew someone who had engaged in NSSI only, or knew someone who engaged in both NSSI and suicidal behavior were more likely to have engaged in NSSI compared to those not exposed. The findings provide preliminary, albeit indirect, evidence of the potential for social modeling to influence rates of NSSI within college students. Directions for future studies are offered.     

Fast screening of eating disorders among patients with bipolar disorder: Validation of the French version of BEDS questionnaire

IntroductionThe prevalence and morbidity of eating disorders (ED) is high in patients with bipolar disorder (BD). Simple tools are necessary to easily and rapidly screen for ED in bipolar patients.ObjectiveThe aim of this study was to validate the French version of Bipolar Eating Disorder Scale (BEDS-F).MethodED and BD diagnoses were established with a structured-interview in 80 patients according to the DSM-IV criteria. The BEDS was translated into French using appropriate methods. Patients were administered the following scales: BEDS-F, SCOFF, Bulimic Investigatory Test Edinburgh (BITE) and Eating Disorder Inventory-two (EDI-2).ResultsBEDS-F score were significantly higher in bipolar patients with ED. The BEDS-F showed high feasibility (no omission response), excellent discriminating abilities (ROC AUC = 0.97) with a sensibility of 98% and specificity of 85% for BEDS ≥ 11, high internal consistency (Cronbach's alpha coefficient = 0.86) and test-retest reliability (ICC = 0.99). No floor/ceiling effect was observed. The BEDS-F sensitivity was equivalent to that of the BITE and EDI-2 subscale B. The BEDS-F specificity was slightly lower than that of the EDI-2 subscale B, but equivalent to that of BITE.ConclusionThe BEDS-F is a valid scale for fast ED screening in patients with bipolar disorder, and easier to administer than other currently used scales.     

The Interactive Effects of Impulsivity and Negative Emotions on Adolescent Nonsuicidal Self‐injury: A Latent Growth Curve Analysis

This study employed latent growth curve analysis to evaluate the interactive effects of two specific facets of impulsivity (i.e., negative urgency [NU] and premeditation [PRE]) and negative emotions (NE) on the developmental trajectory of nonsuicidal self‐injury (NSSI) among 3,453 (57% females) Chinese community adolescents. Participants completed questionnaires assessing NSSI, NU, PRE, and NE (i.e., depression, anxiety, and stress) at three waves of time. The initial levels of NE and NU significantly predicted the initial level of NSSI. Changes in NE and NU significantly predicted change in NSSI. Moreover, the initial levels of NU and PRE significantly moderated the relationship between the initial levels of NE and NSSI, such that among individuals with higher NU or less PRE, the three NE were associated with a higher level of NSSI. Additionally, among individuals with a faster increase in NU, depression and anxiety were associated with a faster increase in NSSI. These findings suggest that adolescents with trait impulsivity, especially in the form of NU, are more vulnerable to the engagement in NSSI.     

Validation of the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents

We sought to validate the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents and investigate differences in eating behaviors among Chinese normal weight, overweight, and obese adolescents. Chinese middle and high school students completed the DEBQ, Eating Disorder Inventory-1, and the Self-Control Scale. Result showed that the DEBQ had good internal consistency, test–retest reliability and criterion validity. Furthermore, the obese and overweight adolescents scored significantly higher than normal weight adolescents on three subscales. The DEBQ is effective for assessing eating behaviors in Chinese adolescents.     

Day-Hospital Multifocal Integrated Treatment for Anorexia Nervosa in Adolescents: A One-Year Follow-Up

The current guidelines for treatment of Anorexia Nervosa (AN) in children and adolescents recommend an integrated multidisciplinary approach as the elective intervention for this disorder. Nevertheless, there is insufficient evidence on the results of an integrated approach for the treatment of AN adolescent patients, especially in a Hospital setting. This study aims to analyze clinical and psychological changes occurring in adolescent patients after completion of a Day-Hospital Multifocal Integrated Treatment (MIT) for Anorexia Nervosa. The sample consisted of 60 adolescents with AN or Eating Disorder Not Otherwise Specified (EDNOS) restrictive type, aged 11 to 18 years, and their parents. Clinical course was evaluated at 3, 6 and 12-month follow-up periods. Our results showed clinical remission in a good percentage of patients. In general, we found a significant reduction of the eating psychopathology, whereas we did not detect any significant improvement in body dissatisfaction, perfectionism, and relational difficulties. This positive trend was confirmed at 3, 6, and 12-month follow-up, despite the increase of drop-outs. These results suggest that the proposed treatment is reasonably effective, because it aims to contain and reduce the acute phase of the disease in a limited time and in a hospital setting, but it is necessary to continue the treatment with targeted psychotherapeutic interventions to address the deeper psychological discomfort underlying the eating disorder.     

Impulsivity predicts treatment outcome in obese children

Treatment for obesity is still running short, particularly on the long term. However, some people do take advantage of treatments and are able to retain their weight loss. What makes the difference between those who can keep their weight loss and those who cannot? One possible predictor of relapse in obesity treatment is impulsivity. Overall, obese people are found to be more impulsive than lean people, especially obese binge eaters. Intuitively, it would make sense that the most impulsive people are less able to keep control over eating behaviour. Therefore, impulsivity could serve as an obstacle for treatment. In the present study impulsivity was measured with a behavioural task (the stop signal task) in 26 obese children. Overweight of the children was measured before and after treatment and at 6 and 12 months follow ups. The results show that impulsivity was related to overweight at all moments: The most impulsive children were the most overweight ones; even after 12 months. Moreover, impulsivity predicted therapy success: the most impulsive children lost less weight. Impulsivity appears to contribute to the difference between succeeding or failing in attempts to lose weight.     

Self-induced vomiting in eating disorders: Associated features and treatment outcome

Self-induced vomiting is adopted by people with a variety of eating disorders (ED) to control body shape and weight. We tested the prevalence, the associated features and the role on treatment outcome of self-induced vomiting in 152 ED patients consecutively admitted to an inpatient cognitive-behavioral treatment (CBT), based on the transdiagnostic CBT for ED. The Eating Disorder Examination, together with the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Temperament and Character Inventory were recorded at entry and at end of treatment. Self-induced vomiting was reported in 35.5% of cases, and 21.1% had multiple purging with vomiting. Individuals with vomiting and those with multiple purging had significantly higher BMI and a higher frequency of bulimic episodes, but individuals with multiple purging were also characterized by higher levels of depression, longer ED duration, more severe ED psychopathology and lower self-directness. Individuals with vomiting had higher eating concern and novelty seeking compared with those without purging behaviors. However, the three groups had similar dropout rates and outcomes in response to inpatient CBT, in keeping with the transdiagnostic theory of EDs.     

Is severe obesity a form of addiction? Rationale, clinical approach, and controlled clinical trial.

For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a person's Body Mass Index (BMI, kg/m(2)) is over 40. If we compare the definitions and diagnostic criteria for "dependence" and "addiction" with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possible to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pressure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual reality. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures.     

Emotion Dysregulation Mediates the Relationship Between Child Maltreatment and Non-Suicidal Self-Injury

One risk factor for non-suicidal self-injury (NSSI) in adolescents is exposure to traumatic experiences, particularly child maltreatment. However, the mechanisms through which childhood maltreatment predicts NSSI are largely unknown. Emotion dysregulation (ED) is likely an important mechanism in this relationship. Therefore, this study examined the relationship between childhood maltreatment, ED, and NSSI in a sample of adolescent inpatients (n = 53). Results demonstrated that child physical and emotional maltreatment, but not child sexual abuse, was significantly associated with NSSI frequency. More specifically, ED mediated the relationship between child physical and emotional maltreatment and NSSI frequency. Findings support the importance of ED as a mediating factor in the relationship between childhood maltreatment and NSSI behaviors and highlight the need for teaching emotion regulation skills to youth affected by trauma.     

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.