What is Bulimia Nervosa? Are bulimic patients easy preys to depression?
By Debarati Choudhury and Sukant Khurana
Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Several studies have investigated the association between personality and suicide attempts and psychiatric comorbidities and suicide attempts separately in samples of people suffering from Bulimia Nervosa (BN). However, a major criticism that has emerged in the personality literature has been the examination of personality traits without controlling for psychiatric disorders as covariates. Personality traits may be related to suicidal behaviors directly as they may increase the likelihood of maladaptive responses, but personality traits may also predispose individuals to psychiatric disorders that increase risk for suicidal behaviors.
Therefore, the aims of the current study (https://www.ncbi.nlm.nih.gov/pubmed/26315489) were to: (a) determine the extent to which personality characteristics are associated with a lifetime history of a suicide attempt; (b) examine which psychiatric comorbidities, including mood, substance use, and anxiety disorders, are associated with a lifetime history of a suicide attempt; and © identify the unique effects of both personality and psychiatric comorbidity on a lifetime history of a suicide attempt among individuals with BN. These aims were examined in 2 samples to determine if the findings were robust to methodological differences.
The lifetime prevalence estimates of self-reported suicide attempts in our two samples of women with BN (27.5% in Study 1 with a lifetime suicide attempt and 20.3% with a lifetime suicide attempt or gesture in Study 2) were comparable to several previous studies. The relatively high prevalence estimate in Study 1 is particularly notable as this was a sample which assessed only suicide attempts and included individuals with sub-threshold BN.
Although not a main aim of the study, there were demographic differences between those with a lifetime suicide attempt and those without. In Study 1, participants with a lifetime suicide attempt had a higher mean current BMI than participants without a suicide attempt. A higher percentage of the lifetime suicide attempt or gesture group were non-Caucasian than those without a suicide attempt in Study 2. This finding was particularly surprising, as previous research has found either that Caucasian have a significantly higher risk of a suicide attempt than other ethnic groups, or failed to find any associations between race/ethnicity and suicide attempts.
Cognitive dysregulation, anxiousness, and insecure attachment were each associated with suicide attempts in one but not both of the samples. Systematic review of personality traits and suicide attempts found substantial evidence for the association between emotion dysregulation and its related traits with a lifetime suicide attempt history.
The third aim of the current study was to assess the unique effects of both personality and psychiatric comorbidity on suicide attempts. Although four personality traits were significantly associated with lifetime history of a suicide attempt across the two studies in the univariate models, the multivariate models for both of the two studies revealed that none of these traits were uniquely associated with suicide attempts. In both Study 1 and Study 2, depressive symptoms were significantly associated with suicide attempts in the multivariate model. Therefore, while both personality traits and comorbid psychopathology were associated with suicide attempts, depression was the most salient factor.
The lifetime prevalence of suicide attempts in women with BN is high, with more than 1 out of 5 individuals with BN attempting suicide throughout their life. Lifetime suicide attempts are associated with personality factors relating to emotion dysregulation and comorbid depression and anxiety. Prospective studies are needed to identify predictors of suicide attempts. Future studies should continue to disentangle the effect of personality and comorbid psychopathology on risk for suicide in order to inform treatment and prevention efforts.
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About:
Debarati Choudhury is a student who worked extensively as a researcher with Dr. Khurana’s group on mental health awareness and evaluated seminal work in the field to help laypeople understand the scientific literature on depression.
Dr. Sukant Khurana runs an academic research lab and several tech companies. He is also a known artist, author, and speaker. You can learn more about Sukant at www.brainnart.com or www.dataisnotjustdata.com and if you wish to work on biomedical research, neuroscience, sustainable development, artificial intelligence or data science projects for public good, you can contact him at skgroup.iiserk@gmail.com or by reaching out to him on linkedin https://www.linkedin.com/in/sukant-khurana-755a2343/.
Here are two small documentaries on Sukant and a TEDx video on his citizen science effort.