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#14 - Suicide et TROUBLES DES CONDUITES ALIMENTAIRES - 13 juin 2012

Les troubles de conduites alimentaires (TCA) – anorexie mentale et boulimie - émergent généralement à l’adolescence, une période de grands changements autant physiologiques que psychologiques où la définition de soi-même, la prise de contrôle de son être et de son image sont au premier-plan avant l’entrée dans l’âge adulte. Les TCA, qui prévalent principalement dans la population féminine, sont associés à une mortalité plus élevée notamment causée par des complications d’ordre somatique mais également par suicide. Ces comportements peuvent déjà être considérés comme autodestructeurs. La probabilité de décès par suicide chez les personnes anorexiques est nettement supérieure à celle de la population en général mais n’a pas la même envergure que chez les boulimiques. Avec l’augmentation de la pression sociale qu’amènent les médias en proposant des images stéréotypées de l’apparence physique, nous pouvons croire que les troubles de conduites alimentaires, associé à une hausse du risque suicidaire, nécessiteront plus d’attention dans les années à venir.

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Ngo Ton Sang, C., & Guillaume, S. (2010). Troubles des conduites alimentaires et risque suicidaire, In P. Courtet (Ed.) Suicides et tentatives de suicide (133-137). Paris : Médecine-Sciences, Flammarion.
Résumé : Prévalence des conduites suicidaires dans les TCA; Facteurs de risque suicidaire modulant la vulnérabilité suicidaire dans les TCA; Implications cliniques.

Lamas, C., Nicolas, I., & Corcos, M. (2010). Addictions comportementales (troubles des conduites alimentaires) et suicide. Annales Medico-Psychologiques, 168(7), 528-532.
Résumé: Le concept d’addiction, retenu par différents auteurs, paraît particulièrement fécond pour rendre compte des manifestations symptomatiques et de l’organisation psychopathologique rencontrées dans les troubles des conduites alimentaires (TCA). Dans les conduites addictives, le symptôme a pour fonction de lutter contre des affects dépressifs non structurés, irreprésentables, et menaçant l’intégrité du moi. Le fonctionnement psychopathologique de ces patients, la dépressivité, l’impulsivité, peuvent les mener à des passages à l’acte suicidaire. Si les tentatives de suicide sont plus fréquentes chez les sujets boulimiques, il y a plus de suicides chez les patientes suivies pour anorexie mentale.
http://dx.doi.org/10.1016/j.amp.2010.06.002

Preti, A., Rocchi, M. B. L., Sisti, D., Camboni, M. V., & Miotto, P. (2011). A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica, 124(1), 6-17.
Résumé: Objective: Past meta-analyses on suicide in eating disorders included few available studies. Method: PubMed/Medline search for papers including sample n ≥ 40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. Results: Of 16 342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate = 0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0; a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate = 0.030 per 100 person-years): SMR was 7.5. No suicide occurred among 246 patients with BED (mean follow-up = 5.3 years). Conclusion: AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated.
http://dx.doi.org/10.1111/j.1600-0447.2010.01641.x

Forcano, L., Alvarez, E., Santamaria, J. J., Jimenez-Murcia, S., Granero, R., Penelo, E., et al. (2011). Suicide attempts in anorexia nervosa subtypes. Comprehensive Psychiatry, 52(4), 352-358.
Résumé: OBJECTIVE: The risk for suicide attempts is elevated in anorexia nervosa (AN), yet we know little about the relation between suicide and personality in this group. We explored the prevalence of lifetime suicide attempts in women with AN and compared those who had and had not attempted suicide on eating disorder symptoms, general psychopathology, and personality both relative to a healthy control group and then across AN subtypes. METHOD: One hundred four outpatients with restricting AN, 68 outpatients with purging AN, and 146 comparison individuals participated in the study. RESULTS: The prevalence of suicide attempts differed significantly across the 3 groups, with 0% in the controls, 8.65% in the restricting AN group, and 25.0% in the purging AN group. Depression measures were elevated in those with suicide attempts. Within the restricting AN group, those who attempted suicide scored significantly higher on Phobic Anxiety, measured by means of the Symptom Checklist-Revised, than those who did not . CONCLUSION: The presence of purging and depressive symptoms in individuals with AN should increase vigilance for suicidality; and among restrictors, greater anxiety may index greater suicide risk.
http://dx.doi.org/10.1016/j.comppsych.2010.09.003

Guillaume, S., Jaussent, I., Olié, E., Genty, C., Bringer, J., Courtet, P., et al. (2011). Characteristics of suicide attempts in anorexia and bulimia nervosa: A case–control study. PLoS ONE, 6(8)
Résumé: Objective: Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED). Method: Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. Results: AN patients were more likely to have made a serious attempt, with a higher expectation of dying, and an increased risk of severity. BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. Conclusion: There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients’ higher desire to die and their more severe and lethal attempts.
http://dx.doi.org/10.1371/journal.pone.0023578

Selby, E. A., Smith, A. R., Bulik, C. M., Olmsted, M. P., Thornton, L., McFarlane, T. L., et al. (2010). Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa. Behaviour Research and Therapy, 48(7), 634-645.
Résumé: 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.
http://dx.doi.org/10.1016/j.brat.2010.03.016

Hoste, R. R., Labuschagne, Z., & Le Grange, D. (2012). Adolescent Bulimia Nervosa. Current Psychiatry Reports, (prepub).
Résumé: Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.
http://dx.doi.org/10.1007/s11920-012-0280-0

Ahrén-Moonga, J., Holmgren, S., von Knorring, L., & Af Klinteberg, B. (2008). Personality traits and self-injurious behaviour in patients with eating disorders. European Eating Disorders Review, 16(4), 268-275.
Résumé: The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self-injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N = 38) and age-matched controls (N = 67) were examined concerning self-reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety-related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self-injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients.
http://dx.doi.org/10.1002/erv.860

Carano, A., De Berardis, D., Campanella, D., Serroni, N., Ferri, F., Di Iorio, G., et al. (2012). Alexithymia and suicide ideation in a sample of patients with binge eating disorder. Journal of Psychiatric Practice, 18(1), 5-11.
Résumé: Objective. The goal of this cross-sectional study was to evaluate the relationships between alexithymia and suicide ideation in 80 adult outpatients with a DSM-IV diagnosis of binge eating disorder (BED). Methods. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20); suicide ideation was assessed with the Scale of Suicide Ideation (SSI); severity of BED was assessed with the Binge Eating Scale (BES); and depressive and anxiety symptoms were evaluated, respectively, with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (Ham-A). Results. Prevalence of current suicide ideation was 27.5% (n=22) in this sample and 10 subjects (12.5%) had attempted suicide at some time in their lives. Subjects with alexithymia had more significant suicide ideation, a higher prevalence of current suicide ideation, and more previous suicide attempts than those without alexithymia. In a linear regression model, higher MADRS scores and higher scores on the Difficulty in Identifying Feelings/Difficulty in Describing Feelings dimensions of the TAS-20 were associated with increased suicide ideation. Discussion. Suicidal behavior is no less common in BED than in other eating disorders. Individuals with BED may show increased suicide ideation, especially in the presence of alexithymia and depressive symptoms, even if these symptoms are subclinical. The authors also discuss limitations of this study and future research needs.
http://dx.doi.org/10.1097/01.pra.0000410982.08229.99

Unikel, C., Von Holle, A., Bulik, C.M., &, Ocampo, R. (2011). Disordered eating and suicidal intent: The role of thin ideal internalisation, shame and family criticism. European Eating Disorders Review, 20(1), 39-48.
Résumé: OBJECTIVE: We explored the effect of thin ideal internalisation, shame proneness and family criticism on disordered eating and suicidal intent in female Mexican adolescents. METHOD:  We studied a probabilistic sample of 2537 high school students in central Mexico, stratified by marginalisation status and migratory intensity. We […] estimate the odds of disordered eating and suicidal intent across scores for three predictors: Internalisation of the thin ideal, shame and family criticism. RESULTS:  Disordered eating was reported by 4.2% and suicidal intent by 13.2% of girls. The unadjusted odds ratios of any disordered eating for thin ideal internalisation, shame proneness and familial criticism were 1.2, 1.1 and 3.2, respectively. The positive association between thin ideal internalisation and disordered eating remained even after controlling for shame proneness and familial criticism. The association of these variables with suicidal intent was weaker. DISCUSSION:  Results support stronger effects for disordered eating than suicidal intent across the three unadjusted predictors. It also highlights the presence of the relationship of criticism and disordered eating in female adolescents from low and middle socio-economic backgrounds.
http://dx.doi.org/10.1002/erv.1070

Claes, L., Jimenez-Murcia, S., Aguera, Z., Castro, R., Sanchez, I., Menchon, J. M., et al. (2011). Male eating disorder patients with and without non-suicidal self-injury: A comparison of psychopathological and personality features. European Eating Disorders Review, [prepub].
Résumé: In the present study, we investigated the prevalence and comorbidity of non-suicidal self-injury (NSSI) in male eating disorder (ED) patients. In total, 130 male ED patients completed a list of 10 impulse-control problems (including NSSI), the Eating Disorder Inventory-2, the Symptom Checklist-90-Revised and the Temperament and Character Inventory. Overall, 21% of the male ED patients (n = 27) engaged in at least one type of NSSI, and we did not find significant differences between the ED subtypes. Self-injurious male ED patients showed significantly more severe ED symptoms and more affective, interpersonal and impulse-control problems than ED patients without NSSI. As previously described in female ED, our data confirm the affect regulation and impulse regulation functions of NSSI in male ED patients.
http://dx.doi.org/10.1002/erv.1161

Greydanus, D. E., & Apple, R. W. (2011). The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts. Journal of Multidisciplinary Healthcare, 4, 183-189.
Résumé: Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide.
http://dx.doi.org/10.2147/jmdh.s11569

Huas, C., Caille, A., Godart, N., Foulon, C., Pham-Scottez, A., Divac, S., et al. (2011). Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatrica Scandinavica, 123(1), 62-70.
Résumé: Objective: Little is known concerning mortality and predictive factors for anorexia nervosa in-patients. This study aimed to establish mortality rates and identify predictors in a large sample of adults through a 10-year post in-patient treatment follow-up. Method: Vital status was established for 601 anorexia nervosa (DSM-IV) consecutive in-patients with initial evaluation at admission. Standardized mortality ratio (SMR) was calculated. Cox analyses for hypothesized predictors of mortality were performed. Results: Forty deaths were recorded. SMR was 10.6. Six factors at admission were associated with death: older age, longer eating disorder duration, history of suicide attempt, diuretic use, intensity of eating disorder symptoms, and desired body mass index at admission. Conclusion: Anorexia nervosa in-patients are at high risk of death. This risk can be predicted by both chronicity and seriousness of illness at hospitalization. These elements should be considered as warnings to adapt care provision and could be targeted by treatment.
http://dx.doi.org/10.1111/j.1600-0447.2010.01627.x


Rosling, A. M., Sparen, P., Norring, C., & von Knorring, A. L. (2011). Mortality of eating disorders: A follow-up study of treatment in a specialist unit 1974-2000. International Journal of Eating Disorders, 44(4), 304-310.
Résumé: OBJECTIVE: To study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility. METHOD: A retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time. RESULTS: In the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes. DISCUSSION: SMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.
http://dx.doi.org/10.1002/eat.2082

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