Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.

566 consecutively admitted BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN). Patients completed a comprehensive assessment battery.

Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.

Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.

The objective of this study was to analyze clinical and personality differences in three groups of patients with eating disorders: binge eating disorder (BED), bulimia nervosa- purging type (BN-P) and bulimia nervosa-non purging type (BN-NP).

The participants were 102 female patients (34 BED, 34 BN-P and 34 BN-NP), mean age 28.7. Assessment measures included the following tests: EDI-2, BITE, EAT-40, SCL-90-R and TCI-R, and other clinical and psychopathological indices that were collected via semi-structured interview.

When compared all three groups, BED were the oldest group, showed more frequent familial history of obesity and current or lifetime obesity. Regarding psychopathology, BN-P patients showed the most pathological scores, followed by BN-NP patients and BED patients showing the least pathological scores. Specifically, BN-P patients showed statistically higher scores than BED patients on SCL-90-R Paranoid Ideation, EAT-40 total score, EDI-2 Impulsivity subscale, and BITE Severity subscale. No statistically significant differences were observed among groups, on personality traits. A two-step cluster analysis procedure was conducted, to determine the clinical proximity among the three diagnostic groups. The relationship between cluster classification and diagnosis was statistically different (p<0.001), so we can assume that the present classification maybe does not classify accurately eating disorders.

Even when BED patients present differential characteristics with respect to family and personal antecedents when compared to BN patients, clinical and psychopathological overlapping with BN-NP makes them similar. Likewise, our results suggest deficiencies in the current nosological system, since it does not group patients’ subgroups which are homogeneous enough.

Given the clinical similarity and the frequent comorbidity between impulse control disorders and certain eating disorders (ED) such as bulimia nervosa, we aimed to compare personality and clinical profiles of individuals with and without substance use disorders (SUD) who had primary diagnoses of ED or impulse control disorders, namely pathological gambling (PG).

1096 ED [91.8% females] and 1120 PG [92.4% males] patients were assessed for the presence of SUD. All patients were consecutively admitted to our Psychiatry Department and diagnosed according to DSM-IV-TR criteria. We administered the Temperament and Character Inventory-Revised (TCI-R), the Symptom ChekList-90-Revised (SCL-90-R), and other clinical indices. Lifetime substance use included alcohol and other substances and was measured with the SCID-I. Student-Fisher t-tests were used to compare clinical features. Binary logistic regression models were used to analyse personality predictors of comorbidity with SUD. Adjustments for sex, age, and specific diagnosis were applied.

High Novelty Seeking, low Reward Dependence and low Self-Directedness were predictive of SUD in the whole sample independent of diagnosis (p<0.01). In the PG sample only, after adjustment for sex and age, Reward Dependence was no longer associated with SUD. Patients of both clinical samples with SUD showed higher SCL-90-R scores and severer eating and gambling symptoms (respectively).

Our results suggest that high Novelty Seeking, low Reward Dependence and low Self-Directedness are associated with lifetime SUD, which is also associated with a severer presentation of the primary disorder. This pattern holds across different populations such as ED and PG.

The course of an eating disorder is often prolonged and can lead to enduring disability for many years, with some patients requiring lengthy periods of in-patient care. Unfortunately, there is still little evidence concerning the optimal model of in-patient care for these patients.

Self-admission is a novel treatment tool, whereby patients who have high health care utilization are offered the possibility to self-admit to an inpatient ward for up to seven days, because of deteriorating mental health or any other reason. Purposes behind the model are to increase the availability of in-patient care, to promote autonomy and agency, and to decrease total inpatient care utilization.

To investigate whether self-admission can be beneficial for patients with severe eating disorders.

Two beds out of eleven at a specialist eating disorders inpatient unit were reserved for self-admission of well-known patients. All participants were interviewed about their experiences in the program at 6 months.

Participants described an increased sense of agency and safety in their everyday lives. Suggestions were also made, such as a more active outreach approach in promoting admission, providing a continual staff contact during the brief admission episode, and offering a similar self-admission model for day treatment.

Self-admission is a viable tool in the treatment of severe eating disorders and can increase quality of life by providing a safety net and promoting agency. However, logistical obstacles must be addressed in order to promote a constructive use.

The authors have not supplied their declaration of competing interest.