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The relationship of suicide attempts and eating disorder symptoms : a mediating role for suicide capability? Shahnaz, Arezoo


Individuals with eating disorders (EDs) have an elevated risk for suicide compared to the general population. To date, research on EDs and suicide has mainly used ED diagnostic categories as the unit of analysis, for example, comparing Anorexia Nervosa and Bulimia Nervosa with regard to the frequency and lethality of suicide attempts. However, an increasing number of studies suggest that specific features of EDs (i.e., restrictive eating, fasting, binge-eating, and purging) may be most helpful in predicting suicide risk rather than the diagnostic categories, which can share similar features. Therefore, the present study examined a wide variety of specific ED features in relation to histories of suicidal ideation and attempts. In addition, the present study explored the role of capability in relation to ED features and suicide. Participants were 387 adults recruited via an online platform (MTurk) who completed questionnaires assessing eating disorder features, history of suicide ideation and attempts, suicide capability, and other relevant variables. A total of 70 participants with a lifetime history of suicide attempts, 114 participants with a lifetime history of suicide ideation but no history of attempts, and 203 participants with no history of either suicide ideation or attempts were obtained. Results revealed small to moderate differences on almost all ED features between ideators and nonsuicidal participants (d range = -.44 to .07, median = -.29), where ideators were more likely to endorse ED features than nonsuicidal participants. Smaller differences were observed between ideators and attempters for fewer ED features (d range = -.31 to .00, median = -.14), where attempters were more likely to endorse ED features than ideators. Specifically, cognitive restraint, restricting behaviours, excessive exercise, and muscle building were more associated with attempts than with ideation. Practical capability mediated the relationships of cognitive restraint and restricting behaviours to suicide attempts. Findings suggest that some ED features may be uniquely associated with suicidal ideation whereas others may be uniquely, albeit modestly, associated with suicide attempts among those with ideation. Future research, assessment, and treatment of individuals with certain ED features should consider the potential risk factor for suicidal thoughts and behaviours.

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