Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Center for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy.
Int J Eat Disord. 2021 Mar;54(3):313-325. doi: 10.1002/eat.23410. Epub 2020 Nov 18.
Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of considerable clinical importance. We examined overall and ED subtype-specific associations among suicidal ideation, suicide attempts, and general and specific aspects of emotion dysregulation in a large sample of individuals with ED, at presentation for treatment and 1-year follow-up.
Using registry data from 2,406 patients, scores on the Difficulties in Emotion Dysregulation Scale (DERS) at initial registration were examined as predictors of recent suicidal ideation and self-report lifetime suicide attempts. Associations were examined in the full sample and in each ED subtype. In 406 patients, initial DERS scores were examined as predictors of suicidality at 1-year follow-up.
Overall DERS was associated with suicidal ideation and suicide attempts, even when adjusting for ED psychopathology and current depression. Perceived lack of emotion regulation strategies showed unique associations with suicidal ideation and suicide attempts, both in the full sample and in most ED subtypes. Initial DERS was also associated with follow-up suicidal ideation and suicide attempts, although this association did not remain when adjusting for past suicidality.
Results suggest that emotion dysregulation may be a potential mechanism contributing to suicidality in EDs, beyond the effects of ED psychopathology and current depression. Although the prevalence of suicidality differs across ED subtypes, emotion dysregulation may represent a risk trait for future suicidality that applies transdiagnostically. Results support addressing emotion dysregulation in treatment in order to reduce suicidality.
饮食失调（ED）患者的自杀率较高，确定与过去、现在和未来自杀相关的、具有治疗靶向性的特征具有重要的临床意义。我们在一个大型 ED 患者样本中，在就诊时和 1 年随访时，检查了自杀意念、自杀尝试以及情绪调节障碍的一般和特定方面与自杀意念、自杀尝试之间的整体和 ED 亚型特异性关联。
使用来自 2406 名患者的登记数据，在初始登记时，使用情绪调节困难量表（DERS）的得分，来预测近期的自杀意念和自我报告的终生自杀尝试。在全样本和每个 ED 亚型中检查了关联。在 406 名患者中，初始 DERS 评分被用来预测 1 年随访时的自杀意念。
总体 DERS 与自杀意念和自杀尝试相关，即使在调整 ED 精神病理学和当前抑郁时也是如此。感知到缺乏情绪调节策略与自杀意念和自杀尝试均具有独特的关联，无论是在全样本还是在大多数 ED 亚型中。初始 DERS 也与随访时的自杀意念和自杀尝试相关，但在调整过去的自杀意念后，这种关联不再存在。
结果表明，情绪调节障碍可能是 ED 中自杀的潜在机制，超出了 ED 精神病理学和当前抑郁的影响。尽管 ED 亚型之间的自杀率不同，但情绪调节障碍可能代表一种适用于跨诊断的未来自杀风险特征。结果支持在治疗中解决情绪调节障碍，以降低自杀率。
