The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.     

Attempted suicide and self-injury in patients diagnosed with eating disorders

Eating disorders (ED) patients are at high risk for developing suicidal behavior. The aim of the present study was to investigate factors associated with suicidal behavior in ED patients. One hundred fifty patients at an outpatient ED clinic were included in the study. Data were gathered by retrospective chart analysis. We found that 48 patients (32%) had a history of parasuicide (i.e., suicide attempts, self-injury, or both). A significantly greater percentage of parasuicidal patients than nonparasuicidal patients had EDs with bingeing/pursing symptomatology, used more than one type of purging method, and had a lifetime history of a drug use disorder, impulse control problems, and bipolar disorder, as well as a more extensive outpatient and inpatient treatment history. The findings of this study support an increased tendency toward impulsivity among parasuicidal ED outpatients.     

Biases in a Swedish social register of alcoholics

Summary A sample of 153 men with alcohol abuse drawn from a population census study was divided in one group of men whose abuse was officially registered (0-group) and another where the abuse was known from other sources (A-group). The two groups have been compared in respect of a number of social and medical variables. There were significantly more psychotic and probably fewer asthenic persons in the 0-group. In other respects the 0-group was representative for all alcohol abusers in the sample. The implications of the findings are discussed.

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Zusammenfassung Eine Stichprobe von 153 Männern mit Alkoholmißbrauch, die aus einem Populationscensus herausgezogen worden war, wurde aufgeteilt in eine Gruppe von Männern, deren Mißbrauch offiziell registriert war (0-Gruppe) und in eine andere, wo der Mißbrauch aus anderen Informationsquellen bekannt war (A-Gruppe). Die beiden Gruppen sind in bezug auf eine Anzahl von sozialen und medizinischen Variablen verglichen worden. Es gab signifikant mehr psychotische und wahrscheinlich weniger asthenische Personen in der 0-Gruppe. In anderen Hinsichten war die 0-Gruppe repräsentativ für alle Alkoholiker in der Stichprobe. Die Folgerungen aus den Ergebnissen werden diskutiert.

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Résumé Un échantillon de 153 hommes abusant de l'alcool, établi d'après un recensement de population, a été divisé en un groupe d'hommes dont les abus étaient officiellement enregistrés (groupe 0) et un groupe dont les abus étaient connus par d'autres sources (groupe A). On a comparé les deux groupes selon un certain nombre de variables sociales et médicales. Il y avait, de façon significative, plus de malades psychotiques et, probablement, moins de personnes asthéniques dans le groupe 0. A d'autres égards, le groupe 0 était représentatif de tous les alcooliques de l'échantillon. Les implications de ces résultats sont discutées.

     

A comprehensive meta-analysis of the risk of suicide in eating disorders

Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta‐analysis of the risk of suicide in eating disorders. Objective: Past meta‐analyses on suicide in eating disorders included few available studies. Method: PubMed/Medline search for papers including sample n ≥ 40 and follow‐up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. Results: Of 16 342 patients with AN, 245 suicides occurred over a mean follow‐up of 11.1 years (suicide rate = 0.124 per 100 person‐years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI = 21.0–44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow‐up of 7.5 years (suicide rate = 0.030 per 100 person‐years): SMR was 7.5 (1.6–11.6). No suicide occurred among 246 patients with BED (mean follow‐up = 5.3 years). Conclusion: AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person‐year in BN compared to AN should be investigated.     

Impulse control disorders in eating disorders: clinical and therapeutic implications

OBJECTIVE: Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. METHOD: A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. EVALUATION: Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices. RESULTS: In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01). CONCLUSIONS: Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.     

Suicidality in eating disorders: clinical and psychological correlates

Although many authors have described eating disorders as often being associated with suicidal feelings and behaviour, few studies to date have evaluated the prevalence and characteristics of suicidal behaviour in eating disordered patients. In the present study, in which a consecutive series of 495 out-patients was studied, 13% of the patients reported at least one suicide attempt and 29% reported current suicidal ideation; 26% of attempters reported multiple attempts. A history of suicide attempt was more prevalent among binge-eating/purging anorexics and among purging bulimics than in the other subgroups. In cases with anorexia nervosa, suicide attempters were older, had a longer illness duration, weighed less, had more often used drugs and/or alcohol and tended to be more obsessive than non-attempters. In cases with bulimia nervosa, attempters presented with more psychiatric symptoms and had more frequently been sexually abused.     

Prevalence and clinical impact of eating disorders in bipolar patients

ObjectivesTo study the impact of eating disorders (EDs) on the severity of bipolar disorder (BD).MethodsThe Structured Clinical Interview for DSM-IV Axis I (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were used. Clinical and sociodemographic data were also collected.ResultsAmong the 356 bipolar patients included in this study, 19 (5.3%) were also diagnosed with ED. Of these, 57.9% had bulimia nervosa (BN) and 42.1% had anorexia nervosa (AN). Among ED patients, 94.7% were female. Bipolar patients with EDs presented with lower scores in the mental health domain of the WHOQOL-BREF, higher scores of depressive symptoms, and more psychiatric comorbidities.ConclusionsED comorbidities imposed important negative outcomes in bipolar patients. This finding suggests that attention should be given to the presence of EDs in BD patients and that better treatments focused on this population should be developed.     

Adverse sexual experience in childhood and clinical eating disorders: a preliminary description

Seventy-eight eating disordered patients were asked systematically about any history of adverse sexual experience. About two thirds gave such a history. The events reported were often distressing and significant to the subject. It is unclear what role such events play in the causation of later eating disorder.     

Characterizing eating disorders in a personality disorders sample

The presence of a comorbid eating disorder (ED) and personality disorder (PD) is associated with greater problems and poorer functioning than having an ED alone or PD alone. This pattern is also found for non-ED axis I disorders and PDs. This study aims to examine if an ED, compared to other non-ED axis I disorders, in a PD sample confers greater risks for: number and type of non-ED axis I and axis II disorders, suicide attempts and non-suicidal self-injury, and poorer psychosocial functioning. Standardized interviews were conducted on 166 females and 166 males with PDs. In females with PDs, EDs, as compared to other axis I disorders, were associated with more non-ED axis I and II disorders (particularly borderline and avoidant PD) and poorer global functioning, but not with suicide attempts or non-suicidal self-injury. In males with PDs, EDs were associated with more axis II disorders, particularly borderline PD. Given the small group of males with EDs, these results require replication. Males and females with PDs and EDs may have multiple comorbid disorders, particularly borderline PD and for females, avoidant PD that may warrant targeting in treatment.     

Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects

Symptoms of the upper and lower gastrointestinal (gastrointestinal) tract have been described in anorexia nervosa and bulimia nervosa. Studies focusing on general outcome and medical comorbidity describe a worse outcome in the binge eating/purging subtype of anorexia nervosa compared to the restricting subtype. Both anorexia nervosa subtypes experience substantial delays in gastric emptying as well as constipation. These gastrointestinal disturbances may play a role in anorexia nervosa patients' difficulties with refeeding and weight restoration. Bulimia nervosa patients showed increased gastric emptying capacity, with delayed gastric emptying and diminished gastric relaxation. In addition, diminished release of cholecystokinin and abnormalities in enteric autonomic function were found in bulimia nervosa patients. These factors may play a role in the perpetuation of the disease. Gastrointestinal disturbances develop secondary to the disordered eating behaviour and the concomitant malnutrition and subside mostly with the resumption of normal food intake and body weight. Knowledge of these changes may be of critical importance in avoiding misdiagnosis and successful therapy.     

Pathological gambling in eating disorders: Prevalence and clinical implications

Objective

Pathological gambling (PG) and eating disorders (ED) rarely co-occur. We explored the prevalence of lifetime PG in ED, compared severity of ED symptoms, personality traits, and psychopathological profiles across individuals with ED and PG (ED + PG) and without PG (ED-PG). Finally, we assessed the incremental predictive value of gender on the presentation of a comorbid PG.

Method

A total sample of 1681 consecutively admitted ED patients (1576 females and 105 males), participated in the current study (25 ED + PG and 1656 ED-PG). All participants were diagnosed according to DSM-IV criteria. Assessment measures included the Symptom Checklist and the Temperament and Character Inventory-Revised, as well as other clinical and psychopathological indices.

Results

The observed lifetime prevalence of PG was 1.49%. ED subtype was associated with lifetime PG (p = .003), with PG being more frequent in binge eating disorder (5.7%). ED + PG was more prevalent in males than in females (16% vs. 1.26%, respectively). Additionally, ED + PG patients exhibited more impulsive behaviours, lower impulse regulation and higher novelty seeking. Best predictors of ED + PG were novelty seeking (OR 1.030, p = .035), sex (OR 3.295, p = .048) and BMI (OR 1.081, p = .005).

Conclusions

Some personality traits (novelty seeking), being male and higher BMI are strongly related to the presence of lifetime PG in specific ED subtypes (namely binge eating disorder).     

Out of touch: Interoceptive deficits are elevated in suicide attempters with eating disorders

ABSTRACT

People with eating disorders have elevated interoceptive deficits and risk for self-injurious behaviors (SIBs). Across two eating disorder samples, the relationship between interoceptive deficits (IDs) and SIBs was tested. Study 1 (n = 100) found that suicide attempters and those engaging in non-suicidal self-injury (NSSI) had greater IDs than those with no self-injury history. Lack of access to emotion regulation strategies accounted for the link between IDs and SIBs. In Study 2 (n = 92) multiple suicide attempters had greater IDs than single attempters and those engaging in NSSI; however, the latter two groups did not differ from one another. Interoceptive deficits may differentiate those who engage in severe SIBs from those who do not, and thus be a useful determinant of suicide risk severity among patients with eating disorders. Lack of access to emotion regulation strategies appears to be one pathway linking interoceptive deficits and self-injury.     

Electroconvulsive therapy and suicide among the mentally ill in England: a national clinical survey

We aimed to determine the number and characteristics of psychiatric patients receiving electroconvulsive therapy (ECT) who had subsequently died by suicide. Data were collected on an 8-year (1999-2006) sample of suicide cases in England who had been in recent contact with mental health services. Of 9752 suicides, 71 (1%) were being treated with ECT at the time of death. Although the number of patients who received ECT had fallen substantially over time, the rate of suicide in these individuals showed no clear decrease and averaged 9 deaths per year, or a rate of 10.8 per 10,000 patients treated. These suicide cases were typically older, with high rates of affective disorder and previous self-harm. They were more likely to be an in-patient at the time of death than other suicide cases. Nearly half of the community cases who had received ECT had died within 3 months of discharge. Our results demonstrated that the fall in the use of ECT has not affected suicide rates in patients receiving this treatment. Services appear to acknowledge the high risk of suicide in those receiving ECT. Improvements in care of these severely ill patients may include careful discharge planning and improved observation of in-patients in receipt of ECT.     

Medical providers' self perceived knowledge and skills for working with eating disorders: a national survey

Research indicates that individuals suffering from an eating disorder (ED) consult their general practitioners more frequently than those without an eating disorder (Mond, Myers, Crosby, Hay, & Mitchell, 2010). However, little is known about medical providers' existing knowledge of and training in ED detection, intervention, and treatment. This study aimed to examine national medical providers' self-perceived knowledge, skills, and needs around eating disorder screening and intervention strategies. Utilizing survey design, a randomized sample of national medical providers responded to a 23-question survey. Sixty-eight percent of respondents indicated that they did not think to screen for an eating disorder because it was not the presenting concern and nearly 59% of providers did not feel like they had the skills necessary to intervene with eating disorders. Training implications and future research directions are discussed.     

Relation of clinical variables to dissociative phenomena in eating disorders

In this study 30 female patients with eating disorders were compared with 30 age-matched normal female subjects. The patients demonstrated significantly higher levels of dissociative psychopathology than the comparison subjects. Furthermore, the presence of severe dissociative experience appeared to be specifically related to a propensity for self-mutilation and suicidal behavior. These findings are discussed in light of recent data which suggest that neurochemical systems shown to be abnormal in patients with eating disorders may be key pathophysiologic substrates for dissociative experience.