اقدام به خودکشی در انواع فرعی بی اشتهایی عصبی

Objective The risk for suicide attempts is elevated in anorexia nervosa (AN), yet we know little about the relation between suicide and personality in this group. We explored the prevalence of lifetime suicide attempts in women with AN and compared those who had and had not attempted suicide on eating disorder symptoms, general psychopathology, and personality both relative to a healthy control group and then across AN subtypes. Method One hundred four outpatients with restricting AN, 68 outpatients with purging AN, and 146 comparison individuals participated in the study. Results The prevalence of suicide attempts differed significantly across the 3 groups (P = .003), with 0% in the controls, 8.65% in the restricting AN group, and 25.0% in the purging AN group. Depression measures were elevated in those with suicide attempts. Within the restricting AN group, those who attempted suicide scored significantly higher on Phobic Anxiety, measured by means of the Symptom Checklist–Revised, than those who did not (P = .001). Conclusion The presence of purging and depressive symptoms in individuals with AN should increase vigilance for suicidality; and among restrictors, greater anxiety may index greater suicide risk.

1.1. Suicide and suicide attempts in individuals with eating disorders Eating disorders have one of the highest excessive mortality rates of all psychiatric disorders [1]. Suicide is a major cause of mortality for those with eating disorders [2], [3], [4] and [5]. Rates of suicide attempts are also elevated in individuals with eating disorders relative to the general population [2], [3], [4], [5], [6], [7] and [8]. Reports are mixed regarding differential rates of suicide attempts between anorexia nervosa (AN) and bulimia nervosa (BN), with some studies reporting no significant differences [9] and [10], another reporting higher rates of suicide attempts in BN than AN [11], and another reporting higher rates of suicide attempts in AN than BN [12]. These discrepant results may be accounted for by differences in recruitment strategies (eg, inpatient or outpatient services) [12] and differences across AN subtypes including restricting AN (RAN) and purging or binging/purging AN (BPAN) [13]. In support of this latter possibility, several studies have found higher rates of suicide attempts in BPAN than RAN [3], [14] and [15]. 1.2. Clinical profiles of individuals with AN who attempt suicide Suicide attempts in AN are associated with more frequent comorbid disorders (Axis I and II) including affective disorders [9] and [16], substance-related disorders [3], [12], [17] and [18], posttraumatic stress disorder [3], various impulse-control disturbances [3] and [19], and personality disorders [3], [14] and [20]. Clinical features associated with the presence of suicide attempts in AN patients include purging behavior [11] and [13], low body weight [11], longer duration of illness [11] and [20], age of onset [12], history of physical/sexual abuse [11], and poorer prognosis [2] and [21]. 1.3. Personality profile of individuals with AN who attempt suicide Suicidality in AN is associated with personality characteristics such as aggressive/impulsive traits, hopelessness, neuroticism, psychasthenia, and external locus of control [22] and [24]. Other traits associated with suicide attempts in AN include high persistence, low self-directedness, and high self-transcendence [9] and [3]. 1.4. Factors related to suicide attempts across AN subtypes Although differences in rates of suicide attempts across AN subtypes have been explored [3], [11], [15] and [23], typically reporting a lower rate of suicide attempts in RAN, there are scant data on potential differences in factors associated with suicide attempts across AN subtypes. A study using the MMPI-2 found that for individuals with RAN, those who attempted suicide scored higher than those who did not on the “Depression” and “Antisocial Practices” scales, whereas for individuals with BPAN, those who attempted suicide scored higher than those who did not on “Hysteria,” “Psychopathic Deviate,” “Shyness/Self-Consciousness,” “Antisocial Practices,” “Obsessiveness,” and “Low Self-Esteem” scales [15]. Given the lack of information on differential factors associated with suicide attempts across AN subtypes, the goals of the current study were (a) to examine differences between individuals with AN and matched controls on measures of personality, psychopathology, and rates of suicide attempts and (b) to evaluate differences in factors associated with suicide attempts between individuals with RAN and BPAN using measures of personality traits, psychopathology, and eating disorder symptoms.

In conclusion, individuals with AN differ from controls on measures of eating disorder symptomatology, psychopathology, and personality traits. The risk for suicide is elevated in AN, and those with the purging subtype are at more than 3 times greater risk than those with the restricting subtype. Depressive symptoms also characterize those who report at least one suicide attempt. Phobic anxiety appears to be a feature that distinguished between RAN and BPAN individuals in general, but was also higher in RAN individuals who did vs those who did not attempt suicide. These results suggest that presence of purging and depressive symptoms in individuals with AN should increase clinician vigilance for suicidality; and among restrictors, greater anxiety may also index greater suicide risk.