Impact of Eating Psychopathology, Obsessive-Compulsion and Depression on Self-Harm Behavior in Patients with Eating Disorders

섭식장애 환자의 섭식장애 증상, 우울, 강박성이 자해행동에 미치는 영향

  • 공성숙 (순천향대학교 간호학과)
  • Published : 2009.08.28

Abstract

Purpose: The purpose of the study was to investigate psychological factors such as eating psychopathology, depression, and obsessive-compulsion that might influence self-harm behavior in patients with eating disorders. Methods: Patients with eating disorders (n=135) who visited "M" clinic for eating disorders participated in the study. Data were collected from March to August 2007 using the Eating Disorder Inventory-2, Beck Depression Inventory, Maudsley Obsessional-Compulsive Inventory, and Self-Harm Inventory (SHI). Results: The participants scored high on self-harm as well as on depression and obsessive-compulsion. On the SHI, a high frequency of self harm behavior such as 'torturing self with self-defeating thoughts', 'abused alcohol', 'hit self', and 'suicide attempt' were found for the participants. There were significant correlations between most eating psychopathology variables, depression, obsessive-compulsion, and self-harm behavior. 'Interoceptive awareness' (eating psychopathology), depression, and 'checking' (obsessive-compulsion) were significant predictors of self-harm behavior. Conclusion: Future interventions for patients with eating disorders should focus on assessing the possibility of self-harm and suicidal attempts, especially in those patients with high levels of eating psychopathology, depression, or obsessive-compulsion. Early intervention for depression and obsessive-compulsion could contribute to preventing self-harm and suicide in patients with eating disorders.

Keywords

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: American Psychiatric Association
  2. Anderson, C. B., Carter, F. A., McIntosh, V. V., Joyce, P. R., & Bulik, C. M. (2002). Self-harm and suicide attempts in individuals with bulimia nervosa. Eating Disorders, 10, 227-243 https://doi.org/10.1002/erv.472
  3. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571 https://doi.org/10.1001/archpsyc.1961.01710120031004
  4. Borenstein, M., Rothstein, H., & Cohen, J. (1997). Power and precision. Mahwah, NJ: Lawrence Erlbaum
  5. Bulik, C. M., Sullivan, P. F., & Joyce, P. R. (1999). Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatrica Scandinavica, 100, 27-32 https://doi.org/10.1111/j.1600-0447.1999.tb10910.x
  6. Cho, D. K. (1985). The study of objective measurement for obsessional-compulsive behavior: The standardization of the list of obsessional-compulsive behavior in Maudsley obsessional-compulsive inventory. Seoul University Student Review, 20, 78-90
  7. Cho, S. J., Jeon, H. J., Kim, J. K., Suh, T. W., Kim, S. U., Hahm, B. J., et al. (2002). Prevalence of suicide behaviors (suicidal ideation and suicide attempt) and risk factors of suicide attempts in junior and high school adolescents. Journal of Korean Neuropsychiatric Association, 41, 1142-1155
  8. Claes, L., Vandereycken, W., & Vertommen, H. (2004). Family environment of eating disordered patients with and without selfinjurious behaviors. European Psychiatry, 19, 494-498 https://doi.org/10.1016/j.eurpsy.2004.09.001
  9. Croyle, K. L., & Waltz, J. (2007). Subclinical self-harm: Range of behaviors, extent, and associated characteristics. American Journal of Orthopsychiatry, 77, 332-342 https://doi.org/10.1037/0002-9432.77.2.332
  10. Favaro, A., & Santonastaso, P. (1998). Impulsive and compulsive self-injurious behavior in bulimia nervosa: Prevalence and psychological correlates. Journal of Nervous and Mental Disease, 186, 157-165 https://doi.org/10.1097/00005053-199803000-00004
  11. Favaro, A., & Santonastaso, P. (1999). Different types of self injurious behavior in bulimia nervosa. Comprehensive Psychiatry, 40, 57-60 https://doi.org/10.1016/S0010-440X(99)90078-0
  12. Favazza, A. R., & Simeon, D. (1995). Self-mutilation. In E. Hollander, & D. Stein (Eds.), Impulsivity and aggression (pp. 185-200). Sussex, England: John Whey & Sons
  13. Forcano, L., Fernaandez-Aranda, F., Alvarez-Moya, E., Bulik, C., Granero, R., Gratacos, M., et al. (2009). Suicide attempts in bulimia nervosa: Personality and psychopathological correlates. European Psychiatry, 24, 91-97 https://doi.org/10.1016/j.eurpsy.2008.10.002
  14. Franko, D. L., & Keel, P. K. (2006). Suicidality in eating disorders:Occurrence, correlates, and clinical implications. Clinical Psychology Review, 26, 769-782 https://doi.org/10.1016/j.cpr.2006.04.001
  15. Garner, D. M. (1991). Eating Disorders Inventory II. Odessa, FL: Psychological Assessment Resources
  16. Hahn, H. M., Yum, T. H., Shin, Y. W., Kim, K. H., Yoon, D. J., & Chung, K. J. (1986). A standardization study of Beck Depression Inventory in Korea. Journal of Korean Neuropsychiatric Association, 25, 487-502
  17. Hodgson, R. J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy, 15, 389-395 https://doi.org/10.1016/0005-7967(77)90042-0
  18. Ko, S. M. (1999). Under-diagnosed psychiatric syndrome. I: Trichotillomania. Annals of the Academy of Medicine, Singapore, 28, 279-281
  19. Laquatra, T. A., & Clopton, J. R. (1994). Characteristics of alexithymia and eating disorders in college women. Addictive Behaviors, 19, 373-380 https://doi.org/10.1016/0306-4603(94)90060-4
  20. Lyle, R. M. (1996). Translation of Eating Disorders Inventory II-Korean. Odessa, FL: Psychological Assessment Resources
  21. Matsunaga, H., Kiriike, N., Iwasaki, Y., Miyata, A., Matsui, T., Nagata, T., et al. (2000). Multi-impulsivity among bulimic patients in Japan. International Journal of Eating Disorders, 27, 348-352 https://doi.org/10.1002/(SICI)1098-108X(200004)27:3<348::AID-EAT13>3.0.CO;2-F
  22. Nagata, T., Kawarada, Y., Kiriike, N., & Iketani, T. (2000). Multiimpulsivity of Japanese patients with eating disorders: Primary and Secondary Impulsivity. Psychiatry Research, 94, 239-250 https://doi.org/10.1016/S0165-1781(00)00157-8
  23. Paul, T., Schroeter, K., Dahme, B., & Nutzinger, D. O. (2002). Selfinjurious behavior in women with eating disorders. American Journal of Psychiatry, 159, 408-411 https://doi.org/10.1176/appi.ajp.159.3.408
  24. Roberts, R. E., Roberts, C. R., & Chen, Y. R. (1998). Suicidal thinking among adolescents with a history of attempted suicide. Journal of American Academy of Child and Adolescent Psychiatry, 37, 1294-1300 https://doi.org/10.1097/00004583-199812000-00013
  25. Ruuska, J., Kaltiala-Heino, R., Rantanen, P., & Koivisto, A. M. (2005). Psychopathological distress predicts suicidal ideation and selfharm in adolescent eating disorder outpatients. European Child &Adolescent Psychiatry, 14, 276-281 https://doi.org/10.1007/s00787-005-0473-8
  26. Sansone, R. A., & Levitt, J. L. (2002). Self-harm behaviors among those with eating disorders: An overview. Eating Disorders, 10, 205-213 https://doi.org/10.1080/10640260290081786
  27. Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). The Self-Harm Inventory (SHI): Development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54, 973-983 https://doi.org/10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H
  28. Sullivan, P. F. (1995). Mortality in anorexia nervosa. American Journal of Psychiatry, 152, 1073-1074 https://doi.org/10.1176/ajp.152.7.1073
  29. Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disorders: The extent and nature of the association. Suicide &Life-Threatening Behavior, 37, 409-421 https://doi.org/10.1521/suli.2007.37.4.409
  30. Wildman, P., Lilenfeld, L. R., & Marcus, M. D. (2004). Axis I comorbidity onset and parasuicide in women with eating disorders. International Journal of Eating Disorders, 35, 190-197 https://doi.org/10.1002/eat.10213