Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk

References

• Centers for Disease Control and Prevention. Healthy People 2000. U.S. Department of Health and Human Services. Available at: https://www.cdc.gov/nchs/healthy_people/hp2000.htm. Published July 8, 1999. Accessed June 6, 2021.
   Google Scholar
• Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008; 30(1):133–154. doi:10.1093/epirev/mxn002.
   PubMed Web of Science ®Google Scholar
• Hedegaard H, Curtin SC, Warner M. Suicide mortality in the United States, 1999–2017. NCHS Data Brief, no 330. National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/products/databriefs/db330.htm. Published November, 2018. Accessed June 6, 2021.
   Google Scholar
• Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Available at: https://www.samhsa.gov/data/. Published September 2020. Accessed June 6, 2021
   Google Scholar
• White S, Reynolds-Maler JB, Cordero E. Disordered eating and the use of unhealthy weight control methods in college students: 1995, 2002, 2008. Eat Disord. 2011;19(4):323–334. doi:10.1080/10640266.2011.584805.
   PubMed Web of Science ®Google Scholar
• Whitlock J, Muehlenkamp JJ, Purington A, et al. Nonsuicidal self-injury in a college population: General trends and sex differences. J Am Coll Health. 2011;59(8):691–698. doi:10.1080/07448481.2010.529626.
   PubMed Web of Science ®Google Scholar
• Dodd DR, Smith AR, Forrest LN, et al. Interoceptive deficits, nonsuicidal self-injury, and suicide attempts among women with eating disorders. Suicide Life Threat Behav. 2018; 48(4):438–448. doi:10.1111/sltb.12383.
   PubMed Web of Science ®Google Scholar
• Schwitzer A, Rodriguez L. Understanding and responding to eating disorders among college women during the first-college year. J First-Year Exper Stud Trans. 2002; 14(1):41–63.
   Google Scholar
• Lipson SK, Sonneville KR. Understanding suicide risk and eating disorders in college student populations: Results from a National Study. Int J Eat Disord. 2020; 53(2):229–238. doi:10.1002/eat.23188.
   PubMed Web of Science ®Google Scholar
• Nascimento VSD, Santos AVD, Arruda SB, et al. Association between eating disorders, suicide and depressive symptoms in undergraduate students of health-related courses. Einstein. 2020; 18:1–7.
   Web of Science ®Google Scholar
• Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002; 3(8):655–666. doi:10.1038/nrn894.
   PubMed Web of Science ®Google Scholar
• Hielscher E, Whitford TJ, Scott JG, Zopf R. When the body is the target—Representations of one’s own body and bodily sensations in self-harm: A systematic review. Neurosci Biobehav Rev. 2019; 101:85–112. doi:10.1016/j.neubiorev.2019.03.007.
   PubMed Web of Science ®Google Scholar
• Lattimore P, Mead BR, Irwin L, Grice L, Carson R, Malinowski P. ‘I can’t accept that feeling’: Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder. Psychiatry Res. 2017; 247:163–171. doi:10.1016/j.psychres.2016.11.022.
   PubMed Web of Science ®Google Scholar
• Brausch A, Perkins N. Nonsuicidal self-injury and disordered eating: Differences in acquired capability and suicide attempt severity. Psychiatry Res. 2018; 266:72–78. doi:10.1016/j.psychres.2018.05.021.
   PubMed Web of Science ®Google Scholar
• Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014; 13(2):153–160. doi:10.1002/wps.20128.
   PubMed Web of Science ®Google Scholar
• Wang SB, Mancuso CJ, Jo J, et al. Restrictive eating, but not binge eating or purging, predicts suicidal ideation in adolescents and young adults with low-weight eating disorders. Int J Eat Disord. 2020; 53(3):472–477. doi:10.1002/eat.23210.
   PubMed Web of Science ®Google Scholar
• Goel NJ, Sadeh-Sharvit S, Flatt RE, et al. Correlates of suicidal ideation in college women with eating disorders. Int J Eat Disord. 2018; 51(6):579–584. doi:10.1002/eat.22865.
   PubMed Web of Science ®Google Scholar
• Forrest LN, Smith AR, White RD, Joiner TE. (Dis)connected: An examination of interoception in individuals with suicidality. J Abnorm Psychol. 2015; 124(3):754–763. doi:10.1037/abn0000074.
   PubMed Web of Science ®Google Scholar
• Forcano L, Fernández-Aranda F, Alvarez-Moya E, et al. Suicide attempts in bulimia nervosa: personality and psychopathological correlates. Eur Psychiatr. 2009; 24(2):91–97. doi:10.1016/j.eurpsy.2008.10.002.
   PubMed Web of Science ®Google Scholar
• Peat CM, Muehlenkamp JJ. Self-objectification, disordered eating, and depression: A test of mediational pathways. Psychol Women Q. 2011;35(3):441–450. doi:10.1177/0361684311400389.
   Web of Science ®Google Scholar
• Tylka T, Kroon Van Diest A. The intuitive eating scale-2: Item refinement and psychometric evaluation with college women and men. J Couns Psychol. 2013;60(1):137–153. doi:10.1037/a0030893.
   PubMed Web of Science ®Google Scholar
• Witte TK, Didie ER, Menard W, Phillips KA. The relationship between body dysmorphic disorder behaviors and the acquired capability for suicide. Suicide Life Threat Behav. 2012; 42(3):318–331. doi:10.1111/j.1943-278X.2012.00093.x.
   PubMed Web of Science ®Google Scholar
• Franklin JC, Aaron RV, Arthur MS, Shorkey SP, Prinstein MJ. Nonsuicidal self-injury and diminished pain perception: The role of emotion dysregulation. Compr Psychiatry. 2012; 53(6):691–700. doi:10.1016/j.comppsych.2011.11.008.
   PubMed Web of Science ®Google Scholar
• Bernatova T, Svetlak M. Emotional and interoceptive awareness and its relationship to restriction in young women with eating disorders and healthy controls: A cascade from emotional to behavioral dysregulation. Act Nerv Super. 2017; 59(2):78–86. doi:10.1007/s41470-017-0006-z.
   Google Scholar
• Abaied JL, Wagner C, Breslend NL, Flynn M. Respiratory sinus arrhythmia as a predictor of eating disorder symptoms in college students: Moderation by responses to stress and parent psychological control. Eat Behav. 2016; 21:109–115. doi:10.1016/j.eatbeh.2016.01.006.
   PubMed Web of Science ®Google Scholar
• Laquatra TA, Clopton JR. Characteristics of alexithymia and eating disorders in college women. Addict Behav. 1994; 19(4):373–380. doi:10.1016/0306-4603(94)90060-4.
   PubMed Web of Science ®Google Scholar
• Rabasco A, Andover MS. The interaction of dissociation, pain tolerance, and suicidal ideation in predicting suicide attempts. Psychiatry Res. 2020; 284:112661. doi:10.1016/j.psychres.2019.112661.
   PubMed Web of Science ®Google Scholar
• Rogers ML, Hagan CR, Joiner TE. Examination of interoception along the suicidality continuum. J Clin Psychol. 2018; 74(6):1004–1016. doi:10.1002/jclp.22564.
   PubMed Web of Science ®Google Scholar
• Rogers ML, Duffy ME, Dougherty SP, Joiner TE. Interoception, pain tolerance, and self-injurious behaviors: A multidimensional assessment. Behav Ther. 2021.doi:10.1016/j.beth.2021.02.011.
   Web of Science ®Google Scholar
• Brausch AM, Nichols P, Laves E, Clapham R. Body investment as a protective factor in the relationship between acquired capability for suicide and suicide attempts. Behav Ther. 2021.doi:10.1016/j.beth.2021.02.008.
   Web of Science ®Google Scholar
• Orbach I, Stein D, Shan-Sela M, Har-Even D. Body attitudes and body experiences in suicidal adolescents. Suicide Life Threat Behav. 2001; 31(3):237–249. doi:10.1521/suli.31.3.237.24250.
   PubMed Web of Science ®Google Scholar
• Orbach I. The body-mind of the suicidal person. In Ellis TE, ed. Cognition and Suicide: Theory, Research, and Therapy. Washington, DC: American Psychological Association; 2006:193–214. doi:10.1037/11377-009.
   Google Scholar
• Joiner TE, Ribeiro JD, Silva C. Nonsuicidal self-injury, suicidal behavior, and their co-occurrence as viewed through the lens of the interpersonal theory of suicide. Curr Dir Psychol Sci. 2012; 21(5):342–347. doi:10.1177/0963721412454873.
   Web of Science ®Google Scholar
• Muehlenkamp JJ, Bagge CL, Tull MT, Gratz KL. Body regard as a moderator of the relation between emotion dysregulation and nonsuicidal self-injury. Suicide Life-Threat Behav. 2013; 4:479–493. doi:10.1111/sltb.12032.
   Google Scholar
• Joiner T. Why People Die by Suicide. Cambridge, MA: Harvard University Press; 2005.
   Google Scholar
• Ainley V, Tsakiris M. Body conscious? Interoceptive awareness, measured by heartbeat perception, is negatively correlated with self-objectification. PLoS One. 2013; 8(2):e55568. doi:10.1371/journal.pone.0055568.
   PubMed Web of Science ®Google Scholar
• Muehlenkamp JJ. Body regard in nonsuicidal self-injury: Theoretical explanations and treatment directions. J Cogn Psychother. 2012; 26(4):331–347. doi:10.1891/0889-8391.26.4.331.
   Google Scholar
• Kisch J, Leino EV, Silverman MM. Aspects of suicidal behavior, depression, and treatment in college students: Results from the Spring 2000 National College Health Assessment Survey. Suicide Life Threat Behav. 2005; 35(1):3–13. doi:10.1521/suli.35.1.3.59263.
   PubMed Web of Science ®Google Scholar
• Lackner RJ, Fresco DM. Interaction effect of brooding rumination and interoceptive awareness on depression and anxiety symptoms. Behav Res Ther. 2016; 85:43–52. doi:10.1016/j.brat.2016.08.007.
   PubMed Web of Science ®Google Scholar
• Gan WY, Nasir MM, Zalilah MS, Hazizi AS. Disordered eating behaviors, depression, anxiety and stress among Malaysian university students. Coll Stud J. 2011; 45(2):296–310.
   Google Scholar
• Hagan CR, Rogers ML, Brausch AM, Muehlenkamp JJ, Joiner TE.Jr Interoceptive deficits, non-suicidal self-injury, and suicide risk: a multi-sample study of indirect effects. Psychol Med. 2019;49(16):2789–2800. doi:10.1017/S0033291718003872.
   PubMed Web of Science ®Google Scholar
• Rogers ML, Stanley IH, Hom MA, Chiurliza B, Podlogar MC, Joiner TE. Conceptual and empirical scrutiny of covarying depression out of suicidal ideation. Assessment. 2018; 25(2):159–172. doi:10.1177/1073191116645907.
   PubMed Web of Science ®Google Scholar
• Campos RC, Holden RR, Laranjeira P, et al. Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk. Death Stud. 2016; 40(6):335–349. doi:10.1080/07481187.2016.1150920.
   PubMed Web of Science ®Google Scholar
• American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2019. https://www.acha.org/NCHA/ACHANCHA_Data/Publications_and_Reports/NCHA/Data/Reports_ACHA-NCHAIIc.aspx. Published Spring, 2019. Accessed June 6, 2021.
   Google Scholar
• Franko DL, Keel PK, Dorer DJ, et al. What predicts suicide attempts in women with eating disorders?Psychol Med. 2004; 34(5):843–853. doi:10.1017/s0033291703001545.
   PubMed Web of Science ®Google Scholar
• Smith A, Forrest L, Velkoff E. Out of touch: Interoceptive deficits are elevated in suicide attempters with eating disorders. Eat Disord. 2018; 26(1):52–65. doi:10.1080/10640266.2018.1418243.
   PubMed Web of Science ®Google Scholar
• Perkins NM, Ortiz SN, Smith AR, Brausch AM. Suicidal ideation and eating disorder symptoms in adolescents: The role of interoceptive deficits. Behav Ther. 2021.doi:10.1016/j.beth.2021.03.005.
   Web of Science ®Google Scholar
• Wright F, Bewick BM, Barkham M, House AO, Hill AJ. Co-occurrence of self-reported disordered eating and self-harm in UK university students. Br J Clin Psychol. 2009; 48(Pt 4):397–410. doi:10.1348/014466509X410343.
   PubMedGoogle Scholar
• Eisenberg D, Nicklett EJ, Roeder K, Kirz NE. Eating disorder symptoms among college students: Prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health. 2011; 59(8):700–707. doi:10.1080/07448481.2010.546461.
   PubMed Web of Science ®Google Scholar
• Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982; 12(4):871–878. doi:10.1017/S0033291700049163.
   PubMed Web of Science ®Google Scholar
• Dotti A, Lazzari R. Validation and reliability of the Italian EAT-26. Eat Weight Disord. 1998; 3(4):188–194. doi:10.1007/BF03340009.
   PubMedGoogle Scholar
• Patton GC, Johnson-Sabine E, Wood K, Mann AH, Wakeling A. Abnormal eating attitudes in London schoolgirls-a prospective epidemiological study: outcome at twelve month follow-up. Psychol Med. 1990; 20(2):383–394. doi:10.1017/s0033291700017700.
   PubMed Web of Science ®Google Scholar
• Gleaves DH, Pearson CA, Ambwani S, Morey LC. Measuring eating disorder attitudes and behaviors: a reliability generalization study. J Eat Disord. 2014; 2(1):6. doi:10.1186/2050-2974-2-6.
   PubMedGoogle Scholar
• Lee S, Kwok K, Liau C, Leung T. Screening Chinese patients with eating disorders using the Eating Attitudes Test in Hong Kong. Int J Eat Disord. 2002; 32(1):91–97. doi:10.1002/eat.10064.
   PubMed Web of Science ®Google Scholar
• Garner DM. Eating Disorder Inventory-3 (EDI-3) (Professional Manual). Odessa, FL: Psychological Assessment Resources. ; 2004.
   Google Scholar
• Nyman-Carlsson E, Engström I, Norring C, Nevonen L. Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample. Nord J Psychiatry. 2015; 69(2):142–151. doi:10.3109/08039488.2014.949305.
   PubMed Web of Science ®Google Scholar
• Gutierrez PM, Osman A, Barrios FX, Kopper BA. Development and initial validation of the Self-Harm Behavior Questionnaire. J Pers Assess. 2001; 77(3):475–490. doi:10.1207/S15327752JPA7703_08.
   PubMed Web of Science ®Google Scholar
• Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (Methodology in the Social Sciences). New York: Guilford Press; 2013.
   Google Scholar
• Abraham SF, Beumont PJV. How patients describe bulimia or binge eating. Psychol Med. 1982; 12(3):625–635. doi:10.1017/s0033291700055732.
   PubMed Web of Science ®Google Scholar
• Serpell L, Treasure J, Teasdale J, Sullivan V. Anorexia nervosa: Friend or foe?Int J Eat Disord. 1999; 25(2):177–186. doi:10.1002/(SICI)1098-108X(199903)25:2<177::AID-EAT7>3.0.CO;2-D.
   PubMed Web of Science ®Google Scholar
• Beumont PJ. Clinical presentation of anorexia nervosa and bulimia nervosa. Eat Disord Obesity: Comp Handbook. 2002; 2:162–170.
   Google Scholar
• Rockett IR, Wang S, Stack S, et al. Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?BMC Psychiatry. 2010; 10(1):1–8. doi:10.1186/1471-244X-10-35.
   PubMedGoogle Scholar
• Gordon KH, Castro Y, Sitnikov L, Holm-Denoma JM. Cultural body shape ideals and eating disorder symptoms among White, Latina, and Black college women. Cultur Divers Ethnic Minor Psychol. 2010; 16(2):135–143. doi:10.1037/a0018671.
   PubMed Web of Science ®Google Scholar
• Rodgers RF, Watts AW, Austin SB, Haines J, Neumark-Sztainer D. Disordered eating in ethnic minority adolescents with overweight. Int J Eat Disord. 2017; 50(6):665–671. doi:10.1002/eat.22652.
   PubMed Web of Science ®Google Scholar
• McKenzie K, Serfaty M, Crawford M. Suicide in ethnic minority groups. Br J Psychiatry. 2003;183(2):100–101. 2003; doi:10.1192/bjp.183.2.100.
   PubMedGoogle Scholar
• Matthews-Ewald MR, Zullig KJ, Ward RM. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav. 2014; 15(3):441–444. doi:10.1016/j.eatbeh.2014.05.002.
   PubMed Web of Science ®Google Scholar
• Silva C, Chu C, Monahan KR, Joiner TE. Suicide risk among sexual minority college students: A mediated moderation model of sex and perceived burdensomeness. Psychol Sex Orientat Gend Divers. 2015; 2(1):22–33. doi:10.1037/sgd0000086.
   Google Scholar
• Martinez-Gonzalez MA, Gual P, Lahortiga F, Alonso Y, de Irala-Estévez J, Cervera S. Parental factors, mass media influences, and the onset of eating disorders in a prospective population-based cohort. Pediatrics. 2003; 111(2):315–320. doi:10.1542/peds.111.2.315.
   PubMed Web of Science ®Google Scholar
• Rajalin M, Hirvikoski T, Jokinen J. Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters. J Affect Disord. 2013; 148(1):92–97. doi:10.1016/j.jad.2012.11.055.
   PubMed Web of Science ®Google Scholar
• American College Health Association. Healthy Campus 2020. Healthy Campus Coalition. Available at: https://www.acha.org/documents/ncha/ACHA-NCHA-III_Codebook_revised_12-11-2019.pdf. Published December, 2019. Accessed June 6, 2021.
   Google Scholar
• Boswell JF, Anderson LM, Oswald JM, Reilly EE, Gorrell S, Anderson DA. A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders. Behav Res Ther. 2019; 117:54–64. doi:10.1016/j.brat.2019.02.004.
   PubMed Web of Science ®Google Scholar
• Chesin MS, Sonmez CC, Benjamin-Phillips CA, Beeler B, Brodsky BS, Stanley B. Preliminary effectiveness of adjunct mindfulness-based cognitive therapy to prevent suicidal behavior in outpatients who are at elevated suicide risk. Mindfulness. 2015;6(6):1345–1355. doi:10.1007/s12671-015-0405-8.
   Web of Science ®Google Scholar