@article{792b60f9dd1e44cc9626b8f93e7bd8ca,
title = "Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa",
abstract = "Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.",
keywords = "Anorexia, Purging, Restricting, Self-injury, Suicide",
author = "Selby, {Edward A.} and Smith, {April R.} and Bulik, {Cynthia M.} and Olmsted, {Marion P.} and Laura Thornton and McFarlane, {Traci L.} and Berrettini, {Wade H.} and Brandt, {Harry A.} and Steve Crawford and Fichter, {Manfred M.} and Halmi, {Katherine A.} and Jacoby, {Georg E.} and Johnson, {Craig L.} and Ian Jones and Kaplan, {Allan S.} and Mitchell, {James E.} and Nutzinger, {Detlev O.} and Michael Strober and Janet Treasure and Woodside, {D. Blake} and Kaye, {Walter H.} and Joiner, {Thomas E.}",
note = "Funding Information: This study was funded, in part, by National Institute of Mental Health grant F31MH081396 to E. A. Selby (under the sponsorship of T.E. Joiner) and by an NIMH grant F31MH083382 to A. R. Smith (under the sponsorship of T. E. Joiner), as well as the following National Institutes of Health Grants ( MH066122, MH066117, MH066145, MH066296, MH066147, MH066289, MH066193, MH066287, MH066288, MH066146 ). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The authors thank the study managers and clinical interviewers of the Genetics of Anorexia Nervosa Collaboration for their efforts in participant screening and clinical assessments. Genotyping services for the Genetics of Anorexia Nervosa Collaboration were provided by the Center for Inherited Disease Research (CIDR). CIDR is fully funded through a federal contract from the National Institutes of Health to The Johns Hopkins University, Contract Number HHSN268200782096C. Michael Strober receives support from the Franklin Mint Chair in Eating Disorders. The authors are indebted to the participating families for their contribution of time and effort in support of this study. ",
year = "2010",
month = jul,
doi = "10.1016/j.brat.2010.03.016",
language = "English (US)",
volume = "48",
pages = "634--645",
journal = "Behaviour Research and Therapy",
issn = "0005-7967",
publisher = "Elsevier Limited",
number = "7",
}