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1. 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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2. 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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3. 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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4. Measuring cognitions during exercise: Associations between thoughts and eating disorder behaviors over a 3‐week ecological momentary assessment study

   https://doi.org/10.1002/eat.24011  

   Coniglio, Kathryn A. ; Kleiman, Evan M. ; Selby, Edward A. ( June 2023 , International Journal of Eating Disorders)

   Previous work has outlined cognitive beliefs about exercise in general, but very little is known about momentary cognitions while engaging in pathological exercise. The primary aim of this study was to explore thought content during exercise and to test whether these thoughts predicted later engagement in eating disorder behaviors. We also tested associations between thoughts and specific exercise activity.

   We monitored 31 women with clinically significant eating psychopathology for 3 weeks via ecological momentary assessment as they reported on their exercise and eating disorder behaviors, and thoughts about shape, weight, or calories during exercise. Thoughts were self‐reported upon cessation of each exercise session.

   Thinking about weight loss during exercise predicted later engagement in body‐checking behaviors. Weight‐bearing exercise was associated with a decreased likelihood of thinking about calories but an increased likelihood of thinking about shape during exercise.

   These findings show that shape and weight thoughts are present during exercise and that their influence on eating disorder behaviors may exist on a much briefer time scale (i.e., within a day) than previous studies show. Clinically, future studies may seek to test interventions aimed at changing or restructuring cognitions during exercise to help shape adaptive exercise behavior during and after treatment.

   This is the first study measuring thoughts during pathological exercise in real‐time among those with eating disorder psychopathology. The results show that thinking about weight loss during exercise might increase the likelihood of engaging in body‐checking behaviors. Findings will inform the development of treatment approaches to help those in recovery from eating disorders re‐engage with exercise.

    

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5. Emotion Recognition from Natural Phone Conversations in Individuals with and without Recent Suicidal Ideation

   https://doi.org/10.21437/interspeech.2019-1830  

   Gideon, John ; Schatten, Heather T. ; McInnis, Melvin G. ; Provost, Emily Mower ( September 2019 , Interspeech)

   Suicide is a serious public health concern in the U.S., taking the lives of over 47,000 people in 2017. Early detection of suicidal ideation is key to prevention. One promising approach to symptom monitoring is suicidal speech prediction, as speech can be passively collected and may indicate changes in risk. However, directly identifying suicidal speech is difficult, as characteristics of speech can vary rapidly compared with suicidal thoughts. Suicidal ideation is also associated with emotion dysregulation. Therefore, in this work, we focus on the detection of emotion from speech and its relation to suicide. We introduce the Ecological Measurement of Affect, Speech, and Suicide (EMASS) dataset, which contains phone call recordings of individuals recently discharged from the hospital following admission for suicidal ideation or behavior, along with controls. Participants self-report their emotion periodically throughout the study. However, the dataset is relatively small and has uncertain labels. Because of this, we find that most features traditionally used for emotion classification fail. We demonstrate how outside emotion datasets can be used to generate more relevant features, making this analysis possible. Finally, we use emotion predictions to differentiate healthy controls from those with suicidal ideation, providing evidence for suicidal speech detection using emotion. 

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