Restrictive eating, but not binge eating or purging, predicts suicidal ideation in adolescents and young adults with low‐weight eating disorders

Abstract

Objective This study examined the relationship between eating‐disorder behaviors—including restrictive eating, binge eating, and purging—and suicidal ideation. We hypothesized that restrictive eating would significantly predict suicidal ideation, beyond the effects of binge eating/purging. Methods Participants were 82 adolescents and young adults with low‐weight eating disorders. We conducted a hierarchical logistic regression, with binge eating and purging in Step 1 and restrictive eating in Step 2, to predict suicidal ideation. Results Step 1 was significant (p = .01) and explained 20% variance in suicidal ideation; neither binge eating nor purging significantly predicted suicidal ideation. Adding restrictive eating in Step 2 significantly improved the model (ΔR2 = .07, p = .009). This final model explained 27% of the variance, and restrictive eating (but not binge eating/purging) significantly predicted suicidal ideation (p = .02). Discussion Restrictive eating is associated with suicidal ideation in youth with low‐weight eating disorders, beyond the effects of other eating‐disorder behaviors. Although healthcare providers may be more likely to screen for suicidality in patients with binge eating and purging, our findings indicate clinicians should regularly assess suicide and self‐injury in patients with restrictive eating. Future research examining how individuals progress from suicidal ideation to suicidal attempts can further enhance our understanding of suicide in eating disorders.

Functional assessment of restrictive eating: A three-study clinically heterogeneous and transdiagnostic investigation

“…Given the importance of automatic negative reinforcement in other behaviors, these results suggest individuals might engage in multiple maladaptive behaviors to serve the same function. Future research examining this intriguing possibility could provide insight into whether high comorbidity between restrictive eating and other self-destructive behaviors (Wang et al, 2018(Wang et al, , 2019 reflect shared reinforcement processesand thus, potential shared treatment targets to simultaneously intervene on multiple behaviors. Consistent with this hypothesis, prior real-time monitoring research has found when individuals have thoughts of NSSI, they have simultaneous thoughts of binge eating or purging 10-20% of the time (Nock et al, 2009).…”

Clarifying the association of eating disorder features to suicide ideation and attempts

“…These mixed findings limit the theoretical and clinical understanding of suicide risk in EDs. There is preliminary evidence that focusing on specific features of EDs (e.g., binging, purging, restrictive eating), some of which can occur across many ED diagnoses, may be most informative for understanding suicide risk (Wang et al, 2020). Thus, determining which ED features (rather than diagnoses) most strongly relate to suicide attempts may be a fruitful avenue in helping address limitations and advance knowledge.…”

Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder

“…Mood disorders appear to be the next most common, affecting 17% (Duncombe Lowe et al, ) to 33% (Nicely et al, ) of individuals with ARFID. Despite evidence that suicidality is common among individuals with other eating disorders (Wang et al, n.d.; Franko et al, ), only one study (Duncombe Lowe et al, ) to date has assessed suicidality among individuals with ARFID and did not report the overall prevalence in the sample. Prevalence of neurodevelopmental disorders was 10% in one study (Lieberman et al, ).…”