Self-harm or non-suicidal self-injury (SI) are common among adolescents, particularly among adolescents with eating disorders. Previous studies have shown that SI seems to be associated with sexual trauma, mood disorders, and substance abuse. The present study aimed to find out whether (1) SI is associated with any specific eating disorder symptoms, such as bingeing, or purging, and (2) how often clinicians screen for SI behaviours (and whether particular patients are more likely to be screened than others).
Dr. Rebecka Peebles and colleagues looked retrospectively at intake evaluations of 1,432 patients between the ages of 10-21 (mean age 15). Three quarters of the patients were Caucasian, and slightly over 9% were male. Sixty-three percent had an intake diagnosis of eating disorder not otherwise specified (EDNOS).
MAIN FINDINGS FOR AIM 1
- Of those screened for SI behaviours, 40.8% engaged in SI
- Cutting was the most common SI behaviour reported (85%)
- Bingeing/purging was highly associated with SI (see figure 1 below)
- History of abuse was also highly associated with SI (see figure 2 below)
- Patients who engaged in SI were also more likely to use antidepressants (though we can’t draw any conclusions about causation here)
MAIN FINDINGS FOR AIM 2
- Only 42.7% of patients were screened for SI behaviours
- Clinicians were more likely to screen for SI in patients who:
- were older
- had the ED for longer
- had a history of binge eating, purging, substance use, abuse
- were diagnosed with bulimia nervosa
These findings suggest that health care providers who do intake evaluations and screen for various behaviours might be biased as “they were more likely to screen patients who fit a profile of a self-injurer.” This means that the associations between bingeing/purging and history of abuse may or may not remain once providers screen all incoming patients for SI. This is because the associations above are based only on 42.7% of patients, we don’t know about the SI status of the other 57.3%.
This means that more effort must be made to ensure that all clinicians and intake nurses/staff screen every incoming patient for SI behaviours.
Effective and standardized provider screening is essential given the high rates of [SI behaviours] among both adolescents and patients with ED who are screened, and the increased risk for suicide in those who self-injure. Further prospective study is warranted to determine the true prevalence in ED adolescents, as these results could be biased by such selective screening.
Readers, what do you think of the findings in this study? Do you think the associations between bingeing/purging and history of abuse with SI make sense?
Out of curiosity, when you were evaluated for an ED, where you screened for SI?
Bias&rft.issn=1054139X&rft.date=2011&rft.volume=48&rft.issue=3&rft.spage=310&rft.epage=313&rft.artnum=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1054139X10003095&rft.au=Peebles%2C+R.&rft.au=Wilson%2C+J.&rft.au=Lock%2C+J.&rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CPsychology%2CHealth%2CPsychiatry%2C+Eating+Disorders%2C+Anorexia+Nervosa%2C+Bulimia+Nervosa%2C+Self-Harm%2C+Self-Injury%2C+Screening">Peebles, R., Wilson, J., & Lock, J. (2011). Self-Injury in Adolescents With Eating Disorders: Correlates and Provider Bias. Journal of Adolescent Health, 48 (3), 310-313 DOI: 10.1016/j.jadohealth.2010.06.017