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Psychopathological distress predicts suicidal ideation and self-harm in Adolescent Eating Disorder outpatients

European Child & Adolescent Psychiatry volume 14, pages 276–281 (2005)Cite this article

Abstract

Objective

This study evaluated the differences in suicidal behaviour between adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, menarche timing, duration of eating disorder (ED), depression and general psychopathological symptoms (GSI) with suicidal behaviour in adolescent ED.

Methods

The study group comprised 57 adolescent outpatients (girls) attending for assessment because of eating disorders. Suicidal ideation, deliberate self-harm and suicidal attempts were assessed in self-report questionnaires.

Results

In both ED groups, one adolescent had attempted suicide before assessment. Suicidal ideation and/or deliberate self-harm were reported in over half of the cases. Bulimics had significantly more suicidal ideation and deliberate self-harm than anorectics. In multivariate analysis, BN and depression predicted suicidal ideation, but only GSI persisted as predicting deliberate self-harm.

Conclusions

Suicidal behaviour is common in adolescent ED. Type of ED (BN), depression and higher GSI are strongly associated with suicidal ideation and deliberate self-harm. Our results point to the need to evaluate psychopathological symptoms in adolescent ED, especially in BN, in the initial assessment to prevent severe suicidal behaviour.

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References

  1. APA (American Psychiatric Association: DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (1995). Fourth Edition, International Version. Washington, DC

  2. Beautrais AL (2003) Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry 160(6):1093–1099

    Article  PubMed  Google Scholar 

  3. Berg-Kelly K, Erdes L (1997) Self-assessment of sexual maturity by midadolescents based on a global question. Acta Paediatr 86(1):10–17

    CAS  PubMed  Google Scholar 

  4. Bulik CM, Sullivan PF, Joice PR (1999) Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatr Scand 100(1):27–32

    CAS  PubMed  Google Scholar 

  5. Corcos M, Taieb O, Benoit-Lamy S, Paterniti S, Jeammet P, Flament MF (2002) Suicide attempts in women with bulimia nervosa: frequency and characteristics. Acta Psychiatr Scand 106(5):381–186

    Article  CAS  PubMed  Google Scholar 

  6. Derogatis LR, Rickels K, Rock A (1976) The SCL-90 and the MMPI: A Step in the Validation of a New Self-Report Scale. Br J Psychiatry 128:280–289

    CAS  PubMed  Google Scholar 

  7. Eckert ED, Halmi KA, Marchi P, Grove W, Crosby R (1995) Ten-Year Follow-Up of Anorexia Nervosa: Clinical Course and Outcome. Psychol Med 25(1):143–156

    CAS  PubMed  Google Scholar 

  8. Erikson EH (1968) Identity, Youth and Crisis, Faber et Faber, London

  9. Fairburn CG, Cooper PJ (1984) The clinical features of bulimia nervosa. Br J Psychiatry 144:238–246

    CAS  PubMed  Google Scholar 

  10. Favaro A, Santonastaso P (1997) Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatr Scand 95(6):508–514

    CAS  PubMed  Google Scholar 

  11. Favaro A, Santonastaso P (1999) Different Types of Self-Injurious Behavior in Bulimia Nervosa. Compr Psychiatry 40(1):57–60

    Article  CAS  PubMed  Google Scholar 

  12. Favaro A, Santonastaso P (2000) Self-Injurious Behavior in Anorexia Nervosa. J Nerv Ment Dis 188(8):537–542

    CAS  PubMed  Google Scholar 

  13. Fergusson DM, Beautrais AL, Horwood LJ (2003) Vulnerability and resiliency to suicidal behaviours in young people. Psychol Med 33(1):61–73

    Article  CAS  PubMed  Google Scholar 

  14. Field T, Diego M, Sanders CE (2001) Adolescent Suicidal Ideation. Adolescence 36(142):241–248

    CAS  PubMed  Google Scholar 

  15. Finfgeld DL (2002) Anorexia nervosa: analysis of long-term outcomes and Implications. Arch Psychiatr Nurs 16(4):176–186

    Article  PubMed  Google Scholar 

  16. Fox C, Hawton K (2004). Introduction. In: Fox C, Hawton K (eds) Deliberate Self-Harm in Adolescence. Atheneum Press, Gateshead, Tyne and Wear, pp 11–16

  17. Haarasilta L, Marttunen M, Kaprio J, Aro H (2001) The 12-month prevalence and characteristics of major depressive episode in a representative nationwide sample of adolescents and young adults. Psychol Med 31(7):1169–1179

    Article  CAS  PubMed  Google Scholar 

  18. Hawton K, Rodham K, Evans E, Weatherall R (2002) Deliberate self harm in adolescents: self report survey in schools in England. BMJ 325(7374):1207–1211

    Article  PubMed  Google Scholar 

  19. Hayward C, Killen J, Wilson D, Hammer LD, Litt IF, Kraemer HC, Haydel F, Varady A, Taylor CB (1997) Psychiatric Risk Associated With Early Puberty in Adolescent Girls. J Am Acad Child Adolesc Psychiatry 36(2):255–262

    Article  CAS  PubMed  Google Scholar 

  20. Herpertz S (1995) Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of selfinjuries. Acta Psychiatr Scand 91(1):57–68

    CAS  PubMed  Google Scholar 

  21. Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB (2000) Mortality in Eating Disorders: A Descriptive Study. Int J Eat Disord 28 (1):20–26

    Article  CAS  PubMed  Google Scholar 

  22. Holi MM, Sammallahti PR, Aalberg VA (1998) A Finnish validation study of the SCL-90. Acta Psychiatr Scand 97(1):42–26

    CAS  PubMed  Google Scholar 

  23. Klonsky ED, Oltmanns TF, Turkheimer E (2003) Deliberate Self-Harm in a Nonclinical Population: Prevalence and Psychological Correlates. Am J Psychiatry 160 (8):1501–1508

    Article  PubMed  Google Scholar 

  24. Laufer M, Laufer ME (1984) Adolescence and Developmental Breakdown, Yale University Press

  25. Laufer M (1995) Understanding suicide: does it have a special meaning in adolescence? In: Laufer M (ed) The Suicidal Adolescent. Karnac (Books) Ltd, London, pp 69–82

  26. Laufer M (1997) Defining breakdown. In: Laufer M (ed) Adolescent breakdown and beyond. Karnac (Books) Ltd, London, pp 75–86

  27. Lewinsohn P, Rohde P, Seeley J (1996) Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clinical Psychology: Science and Practice 3:25–46

    Google Scholar 

  28. Lewinsohn P, Rohde P, Seeley JR, Baldwin C (2001) Gender Differences in Suicide Attempts from Adolescence to Young Adulthood. J Am Acad Child Adolesc Psychiatry 40(4):427–443

    Article  CAS  PubMed  Google Scholar 

  29. Nicholls D, Chater R, Lask B (2000) Children into DSM Don’t Go: A Comparison of Classification Systems for Eating Disorders in Childhood and Early Adolescence. Int J Eat Disord 28:317–324

    Article  CAS  PubMed  Google Scholar 

  30. Patton GC, Harris R, Carlin JB, Hibbert ME, Coffey C, Schwartz M, Bowes G (1997) Adolescent Suicidal Behaviours: A Population-based Study of Risk. Psychol Med 27(3):715–724

    Article  CAS  PubMed  Google Scholar 

  31. Paul T, Schroeter K, Dahme B, Nutzinger DO (2002) Self-injurious Behavior in Women With Eating Disorders. Am J Psychiatry 159(3):408–411

    Article  PubMed  Google Scholar 

  32. Pelkonen M, Marttunen M (2003) Child and adolescent suicide. Epidemiology, risk factors, and approaches to prevention. Paediatr Drugs 5(4):243–265

    PubMed  Google Scholar 

  33. Ruuska J, Kaltiala-Heino RK, Koivisto AM, Rantanen P (2003) Puberty, sexual development and eating disorders in adolescent outpatients. Eur Child Adolesc Psychiatry 12(5):214–220

    Article  PubMed  Google Scholar 

  34. Råstam M, Gillberg C, Wentz E (2003) Outcome of teenage-onset anorexia nervosa in a Swedish community-based sample. Eur Child Adolesc Psychiatry 12(Suppl 1):78–90

    Google Scholar 

  35. Stein D, Orbach I, Shani-Sela M, Har-Even D, Yaruslasky A, Roth D, Meged S, Apter A (2003) Suicidal Tendencies and Body Image and Experience in Anorexia Nervosa and Suicidal Female Adolescent Inpatients. Psychother Psychosom 72(1):16–25

    Article  PubMed  Google Scholar 

  36. Striegel-Moore R, Seeley JR, Lewinsohn P (2003) Psychosocial Adjustment in Young Adulthood of Women Who Experienced an Eating Disorder During Adolescence. J Am Acad Child Adolesc Psychiatry 42(5):587–593

    Article  PubMed  Google Scholar 

  37. Sullivan PF (1995) Mortality in AN. Am J Psychiatry 152(7):237–249

    Google Scholar 

  38. Welch SL, Fairburn CG (1996) Impulsivity or Comorbidity in Bulimia Nervosa: A Controlled Study of Deliberate Self-Harm and Alcohol and Drug Misuse in a Community Sample. Br J Psychiatry 169(4):451–458

    CAS  PubMed  Google Scholar 

  39. Wentz E, Gillberg C, Gillberg IC, Råstam M (2001) Ten-year Follow-up ofAdolescent-onset Anorexia Nervosa: Psychiatric Disorders and Overall Functioning Scales. J Child Psychol Psychiatry 42(5):613–622

    Article  CAS  PubMed  Google Scholar 

  40. WHO (1992) International Statistical Classification of Diseases and Related Health Problems (ICD-10) Vol 1. Geneva

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Authors and Affiliations

  1. Tampere School of Public Health, University of Tampere, Tampere, Finland

    Jaana Ruuska MD, Riittakerttu Kaltiala-Heino MD, DrMedSci, BSc & Anna-Maija Koivisto MD, DrMedSci

  2. Tampere Medical School, University of Tampere, 33014, Tampere, Finland

    Jaana Ruuska MD

  3. Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland

    Jaana Ruuska MD, Riittakerttu Kaltiala-Heino MD, DrMedSci, BSc & Päivi Rantanen MD, DrMedSci

  4. for Adolescent Intensive Care, Tampere University Hospital, Finland, Tampere, Finland

    Riittakerttu Kaltiala-Heino MD, DrMedSci, BSc

  5. Research Unit, Tampere University Hospital, Finland, Tampere, Finland

    Anna-Maija Koivisto MD, DrMedSci

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  1. Jaana Ruuska MD
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  2. Riittakerttu Kaltiala-Heino MD, DrMedSci, BSc
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  4. Anna-Maija Koivisto MD, DrMedSci
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Correspondence to Jaana Ruuska MD.

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Ruuska, J., Kaltiala-Heino, R., Rantanen, P. et al. Psychopathological distress predicts suicidal ideation and self-harm in Adolescent Eating Disorder outpatients. Europ.Child & Adolescent Psych 14, 276–281 (2005). https://doi.org/10.1007/s00787-005-0473-8

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  • DOI: https://doi.org/10.1007/s00787-005-0473-8

Key words

  • adolescent
  • eating disorder
  • suicidality
  • deliberate self-harm