Non-suicidal Self-injury and Bulimia: the Role of Emotion Dysregulation and Body Dissatisfaction

Overview

Journal Eat Weight Disord

Publisher Springer

Date 2019 Jul 12

PMID 31292855

Citations 6

Authors

Lindsey Hovrud

Raluca Simons

Jeffrey Simons

John Korkow

Affiliations

Soon will be listed here.

Abstract

Purpose: Risk factors of negative affect, body dissatisfaction, distress tolerance, and negative urgency are independently associated with bulimia symptoms and non-suicidal self-injury (NSSI). However, relationships of these risk factors within comorbid presentations are not fully understood. The current study examined specific roles of these risk factors within this relationship.

Methods: An at-risk community sample of young adults (N = 429) completed an online survey of negative affect, body dissatisfaction, distress tolerance, negative urgency, bulimia symptoms, and NSSI.

Results: A hypothesized path model was a good fit to the data. Results indicated direct paths from body dissatisfaction, negative urgency, and distress tolerance to bulimia symptoms. Negative urgency, distress tolerance, and bulimia symptoms were directly associated with NSSI. Consistent with hypotheses, distress tolerance and negative urgency acted as vulnerability factors, increasing the strength of associations between bulimia symptoms and NSSI. Distress tolerance also strengthened associations between negative urgency and NSSI. In addition to the direct effect, negative urgency was indirectly associated with NSSI via body dissatisfaction bulimia. Hypothesized indirect effects through distress tolerance were not supported.

Conclusions: Results support etiological models of bulimia and NSSI, and suggest deficits in emotion regulation strengthen risk of comorbid presentations. Furthermore, individuals with greater impulsivity and difficulty tolerating distress are at increased risk of engaging in both bulimia behaviors and NSSI, providing targets for clinical intervention.

Level Of Evidence: Level V, cross-sectional descriptive study.

Citing Articles

Cutting into the Mirror: Association of Body Image Concerns with Non-Suicidal Self-Injury in Adolescents and Young Adults with Eating Disorders.

Piarulli F, Margari A, Margari F, Matera E, Viola G, Maiorano C Eur J Investig Health Psychol Educ. 2025; 15(2).

PMID: 39997087 PMC: 11854202. DOI: 10.3390/ejihpe15020023.

Multi-family therapy for bulimia nervosa: a qualitative pilot study of adolescent and family members' experiences.

Escoffie A, Pretorius N, Baudinet J J Eat Disord. 2022; 10(1):91.

PMID: 35786421 PMC: 9250718. DOI: 10.1186/s40337-022-00606-w.

Lifetime prevalence and clinical correlates of nonsuicidal self-injury in youth inpatients with eating disorders: a retrospective chart review.

Arnold S, Wiese A, Zaid S, Correll C, Jaite C Child Adolesc Psychiatry Ment Health. 2022; 16(1):17.

PMID: 35227292 PMC: 8884089. DOI: 10.1186/s13034-022-00446-1.

Disordered eating as a repercussion of sexual assault: a consequence to consider.

Malet-Karas A, Bernard D, Piet E, Bertin E Eat Weight Disord. 2022; 27(6):2095-2106.

PMID: 35015284 DOI: 10.1007/s40519-021-01356-5.

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms.

Krug I, Arroyo M, Giles S, Dang A, Kiropoulos L, De Paoli T J Eat Disord. 2021; 9(1):153.

PMID: 34809723 PMC: 8607624. DOI: 10.1186/s40337-021-00508-3.

References

WATSON D, Clark L, Tellegen A . Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988; 54(6):1063-70. DOI: 10.1037//0022-3514.54.6.1063. View

Lavender J, Green D, Anestis M, Tull M, Gratz K . Negative affect, negative urgency, thought suppression, and bulimic symptoms: a moderated mediation analysis in a sample at-risk for bulimic symptoms. Eur Eat Disord Rev. 2015; 23(3):246-50. DOI: 10.1002/erv.2351. View

Claes L, Islam M, Fagundo A, Jimenez-Murcia S, Granero R, Aguera Z . The Relationship between Non-Suicidal Self-Injury and the UPPS-P Impulsivity Facets in Eating Disorders and Healthy Controls. PLoS One. 2015; 10(5):e0126083. PMC: 4439129. DOI: 10.1371/journal.pone.0126083. View

Eisenberg D, Nicklett E, Roeder K, Kirz N . Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health. 2011; 59(8):700-7. PMC: 3721327. DOI: 10.1080/07448481.2010.546461. View

Ross S, Heath N, Toste J . Non-suicidal self-injury and eating pathology in high school students. Am J Orthopsychiatry. 2009; 79(1):83-92. DOI: 10.1037/a0014826. View

Anestis M, Selby E, Fink E, Joiner T . The multifaceted role of distress tolerance in dysregulated eating behaviors. Int J Eat Disord. 2007; 40(8):718-26. DOI: 10.1002/eat.20471. View

Preacher K, Rucker D, Hayes A . Addressing Moderated Mediation Hypotheses: Theory, Methods, and Prescriptions. Multivariate Behav Res. 2016; 42(1):185-227. DOI: 10.1080/00273170701341316. View

Lundahl A, Wahlstrom L, Christ C, Stoltenberg S . Gender differences in the relationship between impulsivity and disordered eating behaviors and attitudes. Eat Behav. 2015; 18:120-4. DOI: 10.1016/j.eatbeh.2015.05.004. View

Whitlock J, Eckenrode J, Silverman D . Self-injurious behaviors in a college population. Pediatrics. 2006; 117(6):1939-48. DOI: 10.1542/peds.2005-2543. View

10.

Stice E . Interactive and Mediational Etiologic Models of Eating Disorder Onset: Evidence from Prospective Studies. Annu Rev Clin Psychol. 2015; 12:359-81. DOI: 10.1146/annurev-clinpsy-021815-093317. View

11.

Lavender J, Utzinger L, Cao L, Wonderlich S, Engel S, Mitchell J . Reciprocal associations between negative affect, binge eating, and purging in the natural environment in women with bulimia nervosa. J Abnorm Psychol. 2015; 125(3):381-6. PMC: 4821806. DOI: 10.1037/abn0000135. View

12.

Peterson C, Fischer S . A prospective study of the influence of the UPPS model of impulsivity on the co-occurrence of bulimic symptoms and non-suicidal self-injury. Eat Behav. 2012; 13(4):335-41. DOI: 10.1016/j.eatbeh.2012.05.007. View

13.

Kwan M, Gordon K, Eddy K, Thomas J, Franko D, Troop-Gordon W . Gender differences in coping responses and bulimic symptoms among undergraduate students. Eat Behav. 2014; 15(4):632-7. DOI: 10.1016/j.eatbeh.2014.08.020. View

14.

Peterson C, Davis-Becker K, Fischer S . Interactive role of depression, distress tolerance and negative urgency on non-suicidal self-injury. Personal Ment Health. 2014; 8(2):151-60. DOI: 10.1002/pmh.1256. View

15.

Bresin K, Carter D, Gordon K . The relationship between trait impulsivity, negative affective states, and urge for nonsuicidal self-injury: a daily diary study. Psychiatry Res. 2012; 205(3):227-31. DOI: 10.1016/j.psychres.2012.09.033. View

16.

Culbert K, Racine S, Klump K . Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry. 2015; 56(11):1141-64. DOI: 10.1111/jcpp.12441. View

17.

Vansteelandt K, Claes L, Muehlenkamp J, De Cuyper K, Lemmens J, Probst M . Variability in affective activation predicts non-suicidal self-injury in eating disorders. Eur Eat Disord Rev. 2012; 21(2):143-7. DOI: 10.1002/erv.2220. View

18.

Dir A, Karyadi K, Cyders M . The uniqueness of negative urgency as a common risk factor for self-harm behaviors, alcohol consumption, and eating problems. Addict Behav. 2013; 38(5):2158-62. DOI: 10.1016/j.addbeh.2013.01.025. View

19.

Muehlenkamp J, Brausch A . Body image as a mediator of non-suicidal self-injury in adolescents. J Adolesc. 2011; 35(1):1-9. DOI: 10.1016/j.adolescence.2011.06.010. View

20.

Wray T, Simons J, Dvorak R, Gaher R . Trait-based affective processes in alcohol-involved "risk behaviors". Addict Behav. 2012; 37(11):1230-9. PMC: 3401606. DOI: 10.1016/j.addbeh.2012.06.004. View