Abstract
PurposeRisk 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.MethodsAn 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.ResultsA 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.ConclusionsResults 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 evidenceLevel V, cross-sectional descriptive study.
Highlights
A well-established relationship exists between non-suicidal self-injury (NSSI) and bulimia, where prevalence rates of self-harm among individuals with bulimia behaviors range from 26 to 61% [1, 2]
Negative affect had a direct effect on body dissatisfaction, which had a direct effect on bulimia
Negative affect had an indirect effect on NSSI via body dissatisfaction and bulimia
Summary
A well-established relationship exists between non-suicidal self-injury (NSSI) and bulimia, where prevalence rates of self-harm among individuals with bulimia behaviors range from 26 to 61% [1, 2]. With comorbid presentations, including increased suicide attempts, substance use, and other externalizing behaviors [3, 4] These impairments contribute to increased clinical costs and medical burden [3], and understate the importance of understanding mechanisms that contribute to the development of comorbid presentations of bulimia symptoms and NSSI. While self-harm behaviors are often studied among pre-adolescents, high prevalence rates of NSSI are observed among college-aged populations, ranging from 12 to 38% [3, 7, 8]. These rates suggest college-aged populations are an at-risk group for comorbid bulimia and NSSI behaviors
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