Self-injurious behavior in anorexia nervosa.
Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa
Favaro
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A
Department of Neurological and Psychiatric Sciences, University of Padua, Padova, Italy.
Santonastaso
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P
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D001294:Attitude to Health; D002032:Bulimia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002400:Cathartics / Q000009:adverse effects; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003192:Compulsive Behavior / Q000175:diagnosis / Q000453:epidemiology; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts; D010555:Personality Inventory / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D014839:Vomiting / Q000175:diagnosis / Q000523:psychology
D002400:Cathartics; D004232:Diuretics