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1. Restrictive eating, but not binge eating or purging, predicts suicidal ideation in adolescents and young adults with low‐weight eating disorders

   https://doi.org/10.1002/eat.23210  

   Wang, Shirley B. ; Mancuso, Christopher J. ; Jo, Jenny ; Keshishian, Ani C. ; Becker, Kendra R. ; Plessow, Franziska ; Izquierdo, Alyssa M. ; Slattery, Meghan ; Franko, Debra L. ; Misra, Madhusmita ; et al ( December 2019 , International Journal of Eating Disorders)

   This study examined the relationship between eating‐disorder behaviors—including restrictive eating, binge eating, and purging—and suicidal ideation. We hypothesized that restrictive eating would significantly predict suicidal ideation, beyond the effects of binge eating/purging.

   Participants were 82 adolescents and young adults with low‐weight eating disorders. We conducted a hierarchical logistic regression, with binge eating and purging in Step 1 and restrictive eating in Step 2, to predict suicidal ideation.

   Step 1 was significant (p= .01) and explained 20% variance in suicidal ideation; neither binge eating nor purging significantly predicted suicidal ideation. Adding restrictive eating in Step 2 significantly improved the model (ΔR²= .07,p= .009). This final model explained 27% of the variance, and restrictive eating (but not binge eating/purging) significantly predicted suicidal ideation (p= .02).

   Restrictive eating is associated with suicidal ideation in youth with low‐weight eating disorders, beyond the effects of other eating‐disorder behaviors. Although healthcare providers may be more likely to screen for suicidality in patients with binge eating and purging, our findings indicate clinicians should regularly assess suicide and self‐injury in patients with restrictive eating. Future research examining how individuals progress from suicidal ideation to suicidal attempts can further enhance our understanding of suicide in eating disorders.

    

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2. Presence and severity of suicidal thoughts and behaviors across the eating disorder diagnostic spectrum: A pilot study

   https://doi.org/10.1002/jclp.23095  

   Duffy, Mary E. ; Siegfried, Nicole ; Bass, Garrett ; Joiner, Thomas E. ( December 2020 , Journal of Clinical Psychology)

   There is a dearth of research on suicidal thoughts and behaviors among eating disorder patients diagnosed with binge eating disorder (BED) or other specified feeding or eating disorder (OSFED). This pilot study evaluated presence and severity of suicidal thoughts and behaviors by eating disorder diagnosis in a transdiagnostic clinical eating disorder sample.

   Participants were individuals (N = 257; 91.1% female; 94.6% Caucasian) currently receiving eating disorder treatment for anorexia nervosa (AN), bulimia nervosa (BN), BED, or OSFED. Participants completed online measures of variables.

   Lifetime and current presence and severity of suicidal ideation and suicide attempts were statistically similar among diagnostic groups.

   Though largely overlooked, treatment‐utilizing individuals with BED and OSFED may experience elevated rates and severity of suicidal thoughts and behaviors, like those with AN and BN. Attention to suicide‐related risk assessment and management is needed when treating individuals with eating disorders, regardless of diagnosis.

    

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3. Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association online screening tool

   https://doi.org/10.1002/eat.23415  

   Flatt, Rachael E. ; Thornton, Laura M. ; Fitzsimmons‐Craft, Ellen E. ; Balantekin, Katherine N. ; Smolar, Lauren ; Mysko, Claire ; Wilfley, Denise E. ; Taylor, C. Barr ; DeFreese, J. D. ; Bardone‐Cone, Anna M. ; et al ( November 2020 , International Journal of Eating Disorders)

   We compared eating disorder (ED) characteristics and treatment seeking behaviors between self‐identified competitive athletes and non‐athletes in a large, community‐based sample.

   During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment.

   The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non‐athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge‐eating episodes compared with non‐athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non‐athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non‐athletes emerged on treatment history or intention to seek treatment post‐screen (less than 30%).

   Although the distribution of probable ED diagnoses was similar in athletes and non‐athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport‐specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

    

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4. Body Trust, agitation, and suicidal ideation in a clinical eating disorder sample

   https://doi.org/10.1002/eat.23352  

   Duffy, Mary E. ; Lieberman, Amy ; Siegfried, Nicole ; Henretty, Jennifer R. ; Bass, Garrett ; Cox, Shelbi A. ; Joiner, Thomas E. ( July 2020 , International Journal of Eating Disorders)

   Research has established pairwise relationships between suicidal ideation (SI), low Body Trust, elevated agitation, and eating disorders, but knowledge of how these aspects relate in a single model is lacking. This study tested an indirect pathway with low Body Trust relating to severity of SI via agitation in a clinical eating disorder sample.

   Participants (N= 319; 92.8% female; 93.4% Caucasian; mean age 21.8 years) were adults currently receiving specialized eating disorder treatment (44.3% intensive outpatient or higher level‐of‐care) who completed online self‐report measures of study variables. The PROCESS macro was utilized to test proposed pathways.

   Low Body Trust was significantly directly associated with increased severity of current SI, both before (B= −.89,p <.001) and after (B= −.51,p =.001) accounting for the indirect effect through agitation, also significant (B= −.37,SE= .06, CI −.52 to −.26).

   Perception of the body as unsafe may be related to agitation, and this intolerable sensation of trapped arousal could contribute to a desire to die. Future work should investigate these relationships prospectively to determine the relevance of Body Trust for assessment and treatment of suicide‐related factors among individuals with eating disorders.

    

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5. Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury : Replication and extension in adolescents

   https://doi.org/10.1002/eat.24043  

   Kline, Kiki M. ; Jorgensen, Saskia L. ; Lawson, W. Cole ; Ohashi, Yuri‐Grace B. ; Wang, Shirley B. ; Fox, Kathryn R. ( August 2023 , International Journal of Eating Disorders)

   Eating disorder (ED) behaviors are often characterized as indirect forms of self‐harm. However, recent research has found less clear demarcations between direct self‐harming behaviors (e.g., nonsuicidal self‐injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating.

   A total of 117 adolescents between ages 12–14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. Thet‐tests and linear effects models were conducted to compare self‐harming thoughts and intentions across behaviors.

   Participants reported at least some intent to hurt themselves physically in the moment and in the long‐term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self‐harming knowledge and intentions were most frequently reported with NSSI and longer‐term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors.

   This study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non‐zero self‐harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment.

   This study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self‐injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self‐harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self‐harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

    

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