Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

Cristina Giner-Bartolome,Núria Mallorquí-Bagué,Iris Tolosa-Sola,Fernando Fernandez-Aranda,Trevor Steward,Susana Jimenez-Murcia,Roser Granero

doi:10.3389/fpsyg.2017.01163

Abstract

Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety.Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected.Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI.Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.

Highlights

There is growing evidence indicating that patients with eating disorders (EDs) present difficulties expressing and regulating emotions (Giner-Bartolomé et al, 2016)
The main aims of the present study were the following: (1) to compare state, trait anxiety and in-task heart rate variability (HRV) in three different groups: ED with Non-suicidal self-injury (NSSI) (ED+NSSI), ED without NSSI (ED-NSSI), and healthy controls (HC), and (2) to test statetrait anxiety and in-task HRV as independent predictors of NSSI in ED+NSSI patients in a cross-sectional study
The results of this study suggest that the NSSI behaviors in EDs are more associated with higher trait anxiety

Summary

Introduction

There is growing evidence indicating that patients with eating disorders (EDs) present difficulties expressing and regulating emotions (Giner-Bartolomé et al, 2016). Similar ER difficulties have been postulated for EDs and NSSI behaviors; namely, both reveal difficulties in thinking, planning, or implementing adaptive coping strategies (Solano et al, 2005; Claes et al, 2010; Muehlenkamp et al, 2012; Vansteelandt et al, 2013; Claes and Muehlenkamp, 2014; Kostro et al, 2014; Islam et al, 2015; Cucchi et al, 2016) Within this clinical population both maladaptive food intake and NSSI behaviors can be implemented as a maladaptive ER strategy that enables the individual to avoid, manage or lessen unpleasant emotions (Chapman et al, 2006; Andover and Morris, 2014; McKenzie and Gross, 2014). These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors

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