title: Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts.
abstract: OBJECTIVE
  Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap.
  
  
  METHODS
  Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable.
  
  
  RESULTS
  Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type.
  
  
  CONCLUSIONS
  Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.
authors.affiliation: CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674 Paris Cedex 14, France.
authors.forename: C
authors.initials: C
authors.lastname: Foulon
authors.forename: J D
authors.initials: JD
authors.lastname: Guelfi
authors.forename: A
authors.initials: A
authors.lastname: Kipman
authors.forename: J
authors.initials: J
authors.lastname: Adès
authors.forename: L
authors.initials: L
authors.lastname: Romo
authors.forename: K
authors.initials: K
authors.lastname: Houdeyer
authors.forename: S
authors.initials: S
authors.lastname: Marquez
authors.forename: M C
authors.initials: MC
authors.lastname: Mouren
authors.forename: F
authors.initials: F
authors.lastname: Rouillon
authors.forename: P
authors.initials: P
authors.lastname: Gorwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D015992:Body Mass Index; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D007406:Interview, Psychological; D008297:Male; D015999:Multivariate Analysis; D010297:Paris; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data; D016019:Survival Analysis