Abstract
Objective: The aim of this study was to examine the implication of personality, impulsivity, and emotion regulation difficulties in patients with a bulimic-spectrum disorder (BSD) and suicide attempts (SA), BSD patients with non-suicidal self-injury (NSSI), and BSD patients without these behaviors.Method: One hundred and twenty-two female adult BSD patients were assessed using self-report questionnaires. Patients were clustered post-hoc into three groups depending on whether they presented BSD without NSSI or SA (BSD), BSD with lifetime NSSI (BSD + NSSI) or BSD with lifetime SA (BSD + SA).Results: The BSD + NSSI and BSD + SA groups presented more emotion regulation difficulties, more eating and general psychopathology, and increased reward dependence in comparison with the BSD group. In addition, BSD + SA patients specifically showed problems with impulse control, while also presenting higher impulsivity than both the BSD and BSD + NSSI groups. No differences in impulsivity between the BSD and BSD + NSSI groups were found.Conclusions: The results show that BSD + NSSI and BSD + SA share a common profile characterized by difficulties in emotion regulation and low reward dependence, but differ in impulsivity and cooperativeness. This suggests that self-injury, in patients without a history of suicide attempts (i.e., BSD + NSSI), may have a regulatory role rather than being due to impulsivity.
Highlights
Both non-suicidal self-injuries (NSSI) and suicide attempts (SA) lie along a spectrum of self-destructive actions (Nock, 2014)
In accordance with our study aims, patients were clustered post-hoc into three mutually exclusive groups: bulimic-spectrum disorders (BSD) patients without current or lifetime NSSI or SA (BSD; n = 57), BSD patients who had engaged in NSSI at least once in their lifetime but never had attempted suicide (BSD + NSSI; n = 28), and BSD patients with at least one lifetime suicide attempt (BSD + SA; n = 37)
Regarding eating pathology as measured by the Eating Disorders Inventory-2 (EDI-2), we found that the BSD + NSSI and BSD + SA groups showed higher BSD psychopathology than the BSD group
Summary
Both non-suicidal self-injuries (NSSI) and suicide attempts (SA) lie along a spectrum of self-destructive actions (Nock, 2014). NSSI and SA share similarities in their risk factors (Andover et al, 2012), and a history of NSSI increases risk for suicide (Claes et al, 2010b), these two behaviors are distinct from each other in a number of ways. Patients who have a history of NSSI have more positive attitudes toward life than those who have had at least one SA (Muehlenkamp and Gutierrez, 2004); NSSI can be seen as being less severe than attempted suicide as the damage is not usually life threatening (In-Albon et al, 2013). NSSI refers to any socially unacceptable behavior involving the deliberate and direct destruction of one’s body tissue without suicidal intent (Muehlenkamp, 2005; Claes and Vandereycken, 2007b). SA are up to ten times more prevalent in ED compared to healthy populations, with prevalence being the highest in purging-type disorders (Pisetsky et al, 2013)
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