Self-injurious behavior and attempted suicide in purging bulimia nervosa: associations with psychiatric comorbidity.
BACKGROUND
Few studies, to date, have investigated the relationship between self-damaging behavior and the presence of comorbid psychiatric diagnoses in eating disorders. The aim of the present study was to investigate the axis I and II comorbidity in subjects with bulimia nervosa who report self-injurious behavior and/or suicide attempt.


METHODS
The subjects were 95 patients with purging type bulimia nervosa who underwent a clinical evaluation assessing the presence of self-injurious behavior and suicide attempts, comorbidity for axis I and II psychiatric disorders and temperament.


RESULTS
No axis I diagnosis was associated with any type of self-injurious behavior, whereas social phobia and bipolar disorder were linked to attempted suicide. Significant independent predictors of impulsive self-injurious behavior were the presence of childhood sexual abuse, high harm avoidance scores, and high self-transcendence scores, whereas childhood sexual abuse, the presence of a cluster B personality disorder, and a low self-directedness were predictors of suicide attempts. Compulsive self-injurious behavior was significantly associated with harm avoidance and cluster C personality disorders. Harm avoidance was also associated with skin picking.


CONCLUSIONS
Personality disorders are a frequent correlate of the presence of SIB in purging bulimia nervosa. However, temperament seems to play a more important role. Further studies on larger samples are necessary to confirm our findings in bulimia nervosa and to extend them to other patient populations.
Favaro
Angela
A
Department of Neurosciences, University of Padova, Padova, Italy.
Santonastaso
Paolo
P
Monteleone
Palmiero
P
Bellodi
Laura
L
Mauri
Mauro
M
Rotondo
Alessandro
A
Erzegovesi
Stefano
S
Maj
Mario
M
D000328:Adult; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002400:Cathartics / Q000008:administration & dosage; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology*; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013694:Temperament
D002400:Cathartics