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Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa |
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| Authors: | Edward A. Selby Cynthia M. Bulik Laura Thornton Wade H. Berrettini Steve Crawford Katherine A. Halmi Craig L. Johnson Allan S. Kaplan Detlev O. Nutzinger Janet Treasure Walter H. Kaye |
| Affiliation: | a Department of Psychology, Florida State University, USA b University of North Carolina, Chapel Hill, USA c Department of Psychiatry, Toronto General Hospital, University of Toronto, Canada d Center for Neurobiology and Behavior, University of Pennsylvania, USA e Department of Psychiatry, Sheppard Pratt Health System, USA f Roseneck Hospital for Behavioral Medicine, University of Munich, Germany g Weill Cornell Medical College, Department of Psychiatry, USA h Klinik am Korso, Center for the Treatment of Eating Disorders, Germany i Laureate Psychiatric Hospital, USA j Department of Psychological Medicine, University of Birmingham, UK k Neuropsychiatric Research Institute, USA l Faculty of Medicine, University of Lübeck, Germany m David Geffen School of Medicine, University of California, Los Angeles, USA n Department of Academic Psychiatry, Kings College London, UK o Department of Psychiatry, University of California, San Diego, USA |
| Abstract: | Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR. |
| Keywords: | Anorexia Suicide Restricting Purging Self-injury |
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