Increased Vigilance Urged When Purging, Depression Are Comorbid

Purging may be a warning sign of an impending suicide attempt in some individuals with anorexia nervosa, a new study suggests.

The researchers compared the prevalence of lifetime suicide attempts in 318 subjects—68 with anorexia nervosa who purged, 104 with anorexia nervosa who did not purge, and 146 matched controls. They found that none of the controls had attempted suicide, compared with 9 percent of the nonpurging anorexia subjects and 25 percent of the purging anorexia subjects. These were significant differences. Thus, individuals who had anorexia and who purged were about three times more likely to attempt suicide than individuals who had anorexia but did not purge.

The researchers also explored eating-disorder symptoms, general psychopathology, and personality traits in the three groups of subjects to obtain more insight into what distinguishes patients with anorexia who attempt suicide from patients with anorexia who do not.

They came up with two findings. One was, not surprisingly, that anorexia subjects who had attempted suicide were more depressed than those who had not attempted suicide. The other was that phobic anxiety distinguished nonpurging anorexia subjects who had attempted suicide from nonpurging anorexia subjects who had not attempted suicide.

Thus, "the presence of purging and depressive symptoms in individuals with anorexia nervosa should increase vigilance for suicidality," the researchers concluded, "and among [anorexia patients who do not purge], greater [phobic] anxiety may index greater suicide risk."

The senior investigator of the study was Fernando Fernández-Aranda, Ph.D., head of the Eating Disorders Unit at the Bellvitge University Hospital in Barcelona, Spain. The results were published in the July-August Comprehensive Psychiatry.

The study was financed by the European Union, the European Commission, and the Fondo de Investigacion Sanitaria-FIS.