Suicidality in Adolescents With Onset of Anorexia Nervosa: From the Conceptualization of the Symptom to Clinical Practice

Abstract

Purpose: Anorexia nervosa (AN) is an eating disorder (ED) that is divided in a restrictive (R-AN) and atypical (A-AN) form depending on the body mass index (BMI). In 100 adolescents with AN, we reviewed the diagnosis (R-AN and A-AN) in relation to different diagnostic criteria (absolute BMI, DSM-5 criteria, European Guidelines and Cacciari percentile curves) and we studied the prevalence of suicidality (suicidal thoughts and behaviours). We also observed the association between suicidality and severity of AN symptoms and psychiatric comorbidities.Methods: We subdivided AN in R-AN and A-AN, considering the four diagnostic criteria previously described. We used the Fisher’s exact test and the Mann-Whitney test for categorical and continuous variables, and we applied multivariate analysis of variance and covariance. Results: Thirty-one % of patients changed diagnosis from R-AN to A-AN depending on which diagnostic criteria was used. Twenty-seven % of patients presented suicidality and they showed greater severity of specific AN psychopathology.Conclusions: Categorization of the AN in childhood can change depending on the diagnostic criteria used. Suicidality is independent from BMI, and seems to be related to specific ED psychopathology and psychiatric comorbidity. These data confirm the need to conceptualize the pathology in a different way and improve the therapeutic intervention. Our findings also highlight the importance of screening for suicidality among children and adolescents at onset of AN to prevent suicide.Level of evidence: level IV