Abstract
This study aimed to examine (1) the presentation of binge eating and compensatory weight-control behaviors in a community sample of individuals who engage in non-suicidal self-injury (NSSI), (2) the relationship of NSSI features and ED symptoms, and (3) the relationship of psychopathology with ED symptoms. Participants with histories of NSSI (n = 118) were recruited from online self-injury forums and completed measures of ED, NSSI, general psychiatric symptoms and borderline personality (BP) symptoms through online questionnaires. Two thirds of the participants (66.1 %) engaged in compensatory weight-control behaviors at least once per week within the past 3 months, 57.6 % engaged in weekly fasting, and 57.6 % engaged in weekly binge eating. Greater versatility and medical severity of NSSI were positively associated with ED symptoms. Furthermore, BP symptoms were positively associated with increased ED symptoms, even after controlling for general psychiatric symptoms. These findings highlight NSSI versatility, NSSI medical severity and BP symptoms as important correlates of increased ED symptoms in individuals who engage in NSSI, and highlight a need to integrate assessment for ED among individuals who engage in NSSI.
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References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC.
Armey, M. F., Crowther, J. H., & Miller, I. W. (2011). Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury. Behavior Therapy, 42(4), 579–588. doi:10.1016/j.beth.2011.01.002.
Button, E. J., Chadalavada, B., & Palmer, R. L. (2010). Mortality and predictors of death in a cohort of patients presenting to an eating disorders service. The International Journal of Eating Disorders, 43(5), 387–392. doi:10.1002/eat.20715.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394. doi:10.1016/j.brat.2005.03.005.
Claes, L., & Vandereycken, W. (2007). Is there a link between traumatic experiences and self-injurious behaviors in eating-disordered patients? Eating Disorders, 15(4), 305–315. doi:10.1080/10640260701454329.
Claes, L., Vandereycken, W., & Vertommen, H. (2001). Self-injurious behaviors in eating-disordered patients. Eating Behaviors, 2(3), 263–272. doi:10.1016/S1471-0153(01)00033-2.
Claes, L., Vandereycken, W., & Vertommen, H. (2003). Eating-disordered patients with and without self-injurious behaviours: a comparison of psychopathological features. European Eating Disorders Review, 11(5), 379–396. doi:10.1002/erv.510.
Claes, L., Klonsky, E. D., Muehlenkamp, J., Kuppens, P., & Vandereycken, W. (2010). The affect-regulation function of nonsuicidal self-injury in eating-disordered patients: which affect states are regulated? Comprehensive Psychiatry, 51(4), 386–392. doi:10.1016/j.comppsych.2009.09.001.
Claes, L., Fernández-Aranda, F., Jimenez-Murcia, S., Botella, C., Casanueva, F. F., de la Torre, R., & Menchón, J. M. (2013). Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions. Personality and Individual Differences, 54(1), 137–140. doi:10.1016/j.paid.2012.07.035.
Derogatis, L. R. (1993). BSI brief symptom inventory. Administration, scoring, and procedures manual (4th ed.). Minneapolis: National Computer Systems.
Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behaviour Research and Therapy, 43(6), 691–701. doi:10.1016/j.brat.2004.06.011.
Favaro, A., & Santonastaso, P. (1999). Different types of self-injurious behavior in bulimia nervosa. Comprehensive Psychiatry, 40(1), 57–60.
Favaro, A., Santonastaso, P., Monteleone, P., Bellodi, L., Mauri, M., Rotondo, A., & Maj, M. (2008). Self-injurious behavior and attempted suicide in purging bulimia nervosa: associations with psychiatric comorbidity. Journal of Affective Disorders, 105(1–3), 285–289. doi:10.1016/j.jad.2007.05.010.
Favazza, A. R., & Conterio, K. (1989). Female habitual self-mutilators. Acta Psychiatrica Scandinavica, 79(3), 283–289.
Fichter, M. M., & Quadflieg, N. (2004). Twelve-year course and outcome of bulimia nervosa. Psychological Medicine, 34(08), 1395. doi:10.1017/S0033291704002673.
Garner, D. M. (2004). Eating disorder inventory -3 professional manual. Odessa: Psychological Assessment Resources.
Glenn, C. R., & Klonsky, E. D. (2009). Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders, 23(1), 20–28. doi:10.1521/pedi.2009.23.1.20.
Gratz, K. L. (2001). Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. doi:10.1023/A:1012779403943.
Hayes, J. A. (1997). What does the brief symptom inventory measure in college and university counseling center clients? Journal of Counseling Psychology, 44(4), 360–367. doi:10.1037/0022-0167.44.4.360.
Joiner, T. (2005). Why people die by suicide. Why people die by suicide. Cambridge: Harvard University Press.
Kline, P. (1998). The new psychometrics: Science, psychology and measurement. The new psychometrics: Science, psychology and measurement. Florence: Taylor & Frances/Routledge.
Klonsky, E. D. (2009). The functions of self-injury in young adults who cut themselves: clarifying the evidence for affect-regulation. Psychiatry Research, 166(2–3), 260–268. doi:10.1016/j.psychres.2008.02.008.
Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self-injury: a research review for the practitioner. Journal of Clinical Psychology, 63(11), 1045–1056. doi:10.1002/jclp.20412.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder (Guilford Press).
Mahadevan, S., Hawton, K., & Casey, D. (2010). Deliberate self-harm in Oxford University students, 1993–2005: a descriptive and case-control study. Social Psychiatry and Psychiatric Epidemiology, 45(2), 211–219. doi:10.1007/s00127-009-0057-x.
Morey, L. C. (1991). Personality assessment inventory: Professional manual. (P. A. Resources, Ed.). Odessa, FL.
xMuehlenkamp, J., Engel, S., Wadeson, A., Crosby, R., Wonderlich, S.,Simonich, H., & Mitchell, J. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47(1), 83–87. doi:10.1016/j.brat.2008.10.011
Muehlenkamp, J. J., Claes, L., Smits, D., Peat, C. M., & Vandereycken, W. (2011). Non-suicidal self-injury in eating disordered patients: a test of a conceptual model. Psychiatry Research, 188(1), 102–108. doi:10.1016/j.psychres.2010.12.023.
Muehlenkamp, J. J., Peat, C. M., Claes, L., & Smits, D. (2012). Self-injury and disordered eating: expressing emotion dysregulation through the body. Suicide & Life-Threatening Behavior, 42(4), 416–425. doi:10.1111/j.1943-278X.2012.00100.x.
Nixon, M. K., Cloutier, P. F., & Aggarwal, S. (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 41(11), 1333–1341. doi:10.1097/00004583-200211000-00015.
Nock, M. K., Joiner, T. E. J., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. doi:10.1016/j.psychres.2006.05.010.
Peterson, C. M., & Fischer, S. (2012). A prospective study of the influence of the UPPS model of impulsivity on the co-occurrence of bulimic symptoms and non-suicidal self-injury. Eating Behaviors, 13(4), 335–341. doi:10.1016/j.eatbeh.2012.05.007.
Ross, S., Heath, N. L., & Toste, J. R. (2009). Non-suicidal self-injury and eating pathology in high school students. The American Journal of Orthopsychiatry, 79(1), 83–92. doi:10.1037/a0014826.
Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. The American Journal of Psychiatry, 158(4), 632–634. doi:10.1176/appi.ajp.158.4.632.
Safer, D. L., Chen, E. Y., Eating, A., Pro-, W. D., Neurosci-, B., & Sciences, B. (2011). Anorexia nervosa as a disorder of emotion dysregulation: theory, evidence, and treatment implications. 203–207.
Sansone, R. A., Sansone, L. A., & Levitt, J. L. (2004). Borderline personality disorder: Self-Harm and eating disorders. In J. L. Levitt, R. A. Sansone, & L. Cohn (Eds.), Self-harm behaviour and eating disorders. New York: Brunner- Routledge.
Sansone, R. A., Chu, J. W., Wiederman, M. W., & Lam, C. (2011). Eating disorder symptoms and borderline presonality symptomatology. Eating and Weight Disorders, 16, 81–85.
Selby, E. A., Bulik, C. M., Thornton, L., Brandt, H. A., Crawford, S., Fichter, M. M., & Joiner, T. E. (2010). Refining behavioral dysregulation in borderline personality disorder using a sample of women with anorexia nervosa. Personality Disorders, 1(4), 250–257. doi:10.1037/a0019313.
Shingleton, R. M., Eddy, K. T., Keshaviah, A., Franko, D. L., Swanson, S. A., Yu, J. S., & Herzog, D. B. (2013). Binge/purge thoughts in nonsuicidal self‐injurious adolescents: an ecological momentary analysis. International Journal of Eating Disorders, 46(7), 684–689. doi:10.1002/eat.22142.
St Germain, S. A., & Hooley, J. M. (2012). Direct and indirect forms of non-suicidal self-injury: evidence for a distinction. Psychiatry Research, 197(1–2), 78–84. doi:10.1016/j.psychres.2011.12.050.
Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the eating disorder diagnostic scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12(2), 123–131. doi:10.1037/1040-3590.12.2.123.
Stice, E., Fisher, M., & Martinez, E. (2004). Eating disorder diagnostic scale: additional evidence of reliability and validity. Psychological Assessment, 16(1), 60–71. doi:10.1037/1040-3590.16.1.60.
Turner, B. J., Layden, B. K., Butler, S. M., & Chapman, A. L. (2013). How often, or How many ways: clarifying the relationship between Non-suicidal self-injury and Suicidality. Archives of Suicide Research, 17(4), 397–415. doi:10.1080/13811118.2013.802660.
Wade, T. D., Wilksch, S. M., & Lee, C. (2012). A longitudinal investigation of the impact of disordered eating on young women’s quality of life. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 31(3), 352–359. doi:10.1037/a0025956.
Wonderlich, S., Myers, T., Norton, M., & Crosby, R. (2002). Self-harm and bulimia nervosa: a complex connection. Eating Disorders: The Journal of Treatment & Prevention, 10(3), 257–267. doi:10.1080/10640260290081849.
Wright, F., Bewick, B. M., Barkham, M., House, A. O., & Hill, A. J. (2009). Co-occurrence of self-reported disordered eating and self-harm in UK university students. The British Journal of Clinical Psychology / The British Psychological Society, 48(Pt 4), 397–410. doi:10.1348/014466509X410343.
Acknowledgments
We would like to thank the Social Sciences and Humanities Research Council for providing financial support for this study. We would also like to acknowledge our appreciation of our research assistants who contributed to this project, and of the participants in this research.
Conflict of Interest
Angelina Yiu, Brianna J. Turner, Brianne K. Layden, Alexander L. Chapman, and Shannon L. Zaitsoff declare that they have no conflict of interest.
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This study was reviewed and approved by a University Institutional Review Board. Informed consent was obtained from all participants.
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Yiu, A., Turner, B.J., Layden, B.K. et al. Prevalence and Correlates of Eating Disorder Symptoms in a Community Sample with Non-Suicidal Self-Injury. J Psychopathol Behav Assess 37, 504–511 (2015). https://doi.org/10.1007/s10862-014-9470-x
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DOI: https://doi.org/10.1007/s10862-014-9470-x