Psychosomatic Medicine
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Published online before print February 6, 2008, 10.1097/PSY.0b013e3181646765
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Psychosomatic Medicine 70:378-383 (2008)
© 2008 American Psychosomatic Society

ORIGINAL ARTICLES

Suicide Attempts in Anorexia Nervosa

Cynthia M. Bulik, PhD, Laura Thornton, PhD, Andréa Poyastro Pinheiro, MD, PhD, Katherine Plotnicov, PhD, Kelly L. Klump, PhD, Harry Brandt, MD, Steve Crawford, MD, Manfred M. Fichter, MD, Katherine A. Halmi, MD, Craig Johnson, PhD, Allan S. Kaplan, MD, James Mitchell, MD, Detlev Nutzinger, MD, Michael Strober, PhD, Janet Treasure, MD, D. Blake Woodside, MD, Wade H. Berrettini, MD, PhD and Walter H. Kaye, MD

From the Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina (C.M.B., L.T., A.P.P.); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania (K.P., W.H.K.); Department of Psychology, Michigan State University, East Lansing, Michigan (K.L.K.); Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland (H.B., S.C.); Klinik Roseneck, Hospital for Behavioral Medicine and University of Munich (LMU), Munich, Germany (M.M.F.); New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, New York (K.A.H.); Laureate Psychiatric Clinic and Hospital, Tulsa, Oklahoma, (C.J.); Department of Psychiatry, The Toronto Hospital, Toronto, Canada (A.S.K., D.B.W.); Department of Psychology, Neuropsychiatric Research Institute, Fargo, North Dakota (J.M.); Bad Bramstedt Hospital for Behavioral Medicine and University of Lübeck, Lübeck, Germany (D.N.); Neuropsychiatric Institute and Hospital, School of Medicine, University of California at Los Angeles, Los Angeles, California (M.S.); Department of Psychiatry, Institute of Psychiatry, Kings College, London, United Kingdom (J.T.); Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania (W.H.B.).

Address correspondence and reprint requests to Cynthia M. Bulik, PhD, Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160. E-mail: cbulik{at}med.unc.edu

Objective: To explore prevalence and patterns of suicidal attempts in persons with anorexia nervosa (AN).

Methods: Participants were the first 432 persons (22 male, 410 female) enrolled in the NIH funded Genetics of Anorexia Nervosa Collaborative Study. All participants had current or lifetime AN. The participants ranged in age from 16 to 76 (mean = 30.4, SD = 11.3). Suicidal behavior and intent was assessed via the Diagnostic Interview for Genetic Studies. We compared frequency and severity of attempts across diagnostic subtypes and comorbidity, and personality features associated with the presence of suicide attempts in persons with AN.

Results: About 16.9% of those with AN attempted suicide. Significantly fewer persons with the restricting subtype (7.4%) reported at least one attempt than those with purging AN (26.1%), AN with binge eating (29.3%), and a mixed picture of AN and bulimia nervosa (21.2%). After controlling for major depression, suicide attempts were associated with substance abuse, impulsive behaviors and traits, Cluster B personality disorders, panic disorder, and post-traumatic stress disorder as well as low self-directedness and eating disorder severity.

Conclusions: Suicide attempts in AN are not uncommon, are frequently associated with the intention to die, occur less frequently in persons with the restricting subtype of the illness, and after controlling for depression are associated with a constellation of behaviors and traits associated with behavioral and affective dyscontrol.

Key Words: anorexia nervosa • bulimia nervosa • eating disorders • suicide

Abbreviations: AN = anorexia nervosa; BN = bulimia nervosa; RAN = restricting anorexia nervosa; PAN = purging anorexia nervosa; AN(B) = binging anorexia nervosa; EDNOS = eating disorder not otherwise specified; ANBN = lifetime history of both AN and BN.




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