Characteristics of Suicide Attempts in Anorexia and Bulimia Nervosa: a Case-control Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2011 Aug 23

PMID 21858173

Citations 12

Authors

Sebastien Guillaume

Isabelle Jaussent

Emilie Olie

Catherine Genty

Jacques Bringer

Philippe Courtet

Ulrike Schmidt

Affiliations

Soon will be listed here.

Abstract

Objective: Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED).

Method: Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.

Results: AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt.

Conclusion: There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.

Citing Articles

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References

Bulik C, Thornton L, Pinheiro A, Plotnicov K, Klump K, Brandt H . Suicide attempts in anorexia nervosa. Psychosom Med. 2008; 70(3):378-83. DOI: 10.1097/PSY.0b013e3181646765. View

WEISMAN A, Worden J . Risk-rescue rating in suicide assessment. Arch Gen Psychiatry. 1972; 26(6):553-60. DOI: 10.1001/archpsyc.1972.01750240065010. View

Favaro A, Santonastaso P, Monteleone P, Bellodi L, Mauri M, Rotondo A . Self-injurious behavior and attempted suicide in purging bulimia nervosa: associations with psychiatric comorbidity. J Affect Disord. 2007; 105(1-3):285-9. DOI: 10.1016/j.jad.2007.05.010. View

Guillaume S, Jaussent I, Jollant F, Rihmer Z, Malafosse A, Courtet P . Suicide attempt characteristics may orientate toward a bipolar disorder in attempters with recurrent depression. J Affect Disord. 2009; 122(1-2):53-9. DOI: 10.1016/j.jad.2009.06.006. View

Mann J . Neurobiology of suicidal behaviour. Nat Rev Neurosci. 2003; 4(10):819-28. DOI: 10.1038/nrn1220. View

Welch S, Fairburn C . 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. 1996; 169(4):451-8. DOI: 10.1192/bjp.169.4.451. View

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

Bulik C, Sullivan P, Joyce P . Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatr Scand. 1999; 100(1):27-32. DOI: 10.1111/j.1600-0447.1999.tb10910.x. View

Franko D, Keel P . Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev. 2006; 26(6):769-82. DOI: 10.1016/j.cpr.2006.04.001. View

10.

Holm-Denoma J, Witte T, Gordon K, Herzog D, Franko D, Fichter M . Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link. J Affect Disord. 2007; 107(1-3):231-6. DOI: 10.1016/j.jad.2007.07.029. View

11.

Corcos M, Taieb O, Paterniti S, Jeammet P, Flament M . Suicide attempts in women with bulimia nervosa: frequency and characteristics. Acta Psychiatr Scand. 2002; 106(5):381-6. DOI: 10.1034/j.1600-0447.2002.02318.x. View

12.

Preti A, Rocchi M, Sisti D, Camboni M, Miotto P . A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand. 2010; 124(1):6-17. DOI: 10.1111/j.1600-0447.2010.01641.x. View

13.

Simon J, Schmidt U, Pilling S . The health service use and cost of eating disorders. Psychol Med. 2005; 35(11):1543-51. DOI: 10.1017/S0033291705004708. View

14.

Blasco-Fontecilla H, Baca-Garcia E, Dervic K, Perez-Rodriguez M, Lopez-Castroman J, Saiz-Ruiz J . Specific features of suicidal behavior in patients with narcissistic personality disorder. J Clin Psychiatry. 2009; 70(11):1583-7. DOI: 10.4088/JCP.08m04899. View

15.

Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Langstrom N . Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ. 2010; 341:c3222. PMC: 2903664. DOI: 10.1136/bmj.c3222. View

16.

Beck R, Morris J, Beck A . Cross-validation of the Suicidal Intent Scale. Psychol Rep. 1974; 34(2):445-6. DOI: 10.2466/pr0.1974.34.2.445. View

17.

Crow S, Peterson C, Swanson S, Raymond N, Specker S, Eckert E . Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009; 166(12):1342-6. DOI: 10.1176/appi.ajp.2009.09020247. View

18.

Klump K, Bulik C, Kaye W, Treasure J, Tyson E . Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord. 2008; 42(2):97-103. DOI: 10.1002/eat.20589. View

19.

Asberg M, Traskman L, Thoren P . 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor?. Arch Gen Psychiatry. 1976; 33(10):1193-7. DOI: 10.1001/archpsyc.1976.01770100055005. View

20.

Keel P, Dorer D, Eddy K, Franko D, Charatan D, Herzog D . Predictors of mortality in eating disorders. Arch Gen Psychiatry. 2003; 60(2):179-83. DOI: 10.1001/archpsyc.60.2.179. View