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Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts

Published online by Cambridge University Press:  16 April 2020

C. Foulon ,
J.D. Guelfi ,
A. Kipman ,
J. Adès ,
L. Romo ,
K. Houdeyer ,
S. Marquez ,
M.C. Mouren ,
F. Rouillon  and
P. Gorwood
C. Foulon
Affiliation:
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674Paris Cedex 14, France
J.D. Guelfi
Affiliation:
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674Paris Cedex 14, France
A. Kipman
Affiliation:
AP-HP, CHU Louis Mourier, 178 rue des Renouillers, 92700Colombes, France
J. Adès
Affiliation:
AP-HP, CHU Louis Mourier, 178 rue des Renouillers, 92700Colombes, France
L. Romo
Affiliation:
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674Paris Cedex 14, France AP-HP, CHU Robert Debré, Child-Psychiatric Department, 48 boulevard Sérurier, 75019Paris, France
K. Houdeyer
Affiliation:
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674Paris Cedex 14, France AP-HP, CHU Louis Mourier, 178 rue des Renouillers, 92700Colombes, France
S. Marquez
Affiliation:
AP-HP, CHU Louis Mourier, 178 rue des Renouillers, 92700Colombes, France
M.C. Mouren
Affiliation:
AP-HP, CHU Robert Debré, Child-Psychiatric Department, 48 boulevard Sérurier, 75019Paris, France
F. Rouillon
Affiliation:
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674Paris Cedex 14, France
P. Gorwood*
Affiliation:
AP-HP, CHU Louis Mourier, 178 rue des Renouillers, 92700Colombes, France INSERM Unit 675, Faculty Xavier Bichat, 16 rue Henri Huchard, 75018Paris, France INSERM Unit 677, Faculty Pitié-Salpétriére, 91 boulevard de Hôpital, 75634Paris Cedex 13, France
*
*Corresponding author. INSERM Unit 675, Faculty Xavier Bichat, 16 rue Henri Huchard, 75018 Paris, France. Tel.: +33 (0)147 60 64 15; fax: +33 (0)147 60 67 40. E-mail address: philip.gorwood@lmr.aphp.fr (P. Gorwood).
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Abstract

Objective

Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap.

Method

Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable.

Results

Major depressive disorder (p < 0.001) and subtype switch from the restrictive to the bingeing/purging type (p < 0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR = 15) when compared to patients with neither major depressive disorder nor bingeing/purging type.

Conclusions

Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.

Keywords

SuicideImpulsivityDepressionEating disorderAddiction
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 8 , November 2007 , pp. 513 - 519
Copyright
Copyright © Elsevier Masson SAS 2007

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Footnotes

*

Supported in part by EC (“Factors in Healthy Eating”) and INRA/INSERM (4M406D) grants; The INSERM (RBM99003), France, promoted this work.

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