Suicidal Behavior in Eating Disorders

Abstract

Many studies have shown that people with eating disorders have higher rates of suicidal ideation, suicide attempts, and completed suicide than the general population. One of the diseases with the highest suicide rate among psychiatric disorders is anorexia nervosa. Some hypotheses have been proposed to explain possible causes of increased suicidal behavior in eating disorders. Some conditions common to eating disorders and suicidal behavior, such as dissatisfaction with the body and interoceptive deficits, have been cited. It has been conclusively shown that psychiatric comorbidity, especially the co-diagnosis of depression, increases the risk of suicide in patients with eating disorders. However, increased suicidal behavior in eating disorders cannot be explained by comorbidity alone. The interpersonal psychological theory of suicide (IPTS), developed by Joiner, aims to understand why people commit suicide and to explain the differences in individual suicidal behavior. Some researchers have thought that the increased suicidal behavior of people with eating disorders, especially anorexia nervosa patients, is expected from the perspective of IPTS. The compensatory behaviors of patients with eating disorders, such as vomiting or chronic restrictive food intake, are painful and challenging actions for the body. It can be considered that repeated encounters with painful and challenging experiences form a habit in the individual and reduce pain avoidance. When viewed from the IPTS perspective, decreased pain avoidance may explain the increased suicide attempts and completed suicides of individuals. Clinicians working with eating disorder patients must conduct regular and comprehensive assessments of suicide. Comorbidities such as major depression, anxiety disorder, and substance-use disorder should not be overlooked in patients with eating disorders and should be taken seriously.

Keywords

• Eating disorder
• suicide
• anorexia nervosa
• interoceptive deficit

Yeme Bozukluklarında İntihar Davranışı

Öz

Yeme bozukluğu olan kişilerin intihar düşüncesi, intihar girişimi ve tamamlanmış intihar oranlarının genel toplumdan yüksek olduğu pek çok araştırma sonucunda gösterilmiştir. Psikiyatrik bozukluklar arasında en yüksek intihar oranına sahip olan hastalıklardan biri anoreksiya nervozadır. Yeme bozukluklarında artmış intihar davranışlarının olası nedenlerini açıklamak için bazı hipotezler öne sürülmüştür. Hem yeme bozukluğu hem de intihar davranışında, bedenden memnun olmama ve interoseptif kusurlar gibi ortak olan bazı durumlara atıf yapılmıştır. Psikiyatrik komorbidite varlığının, özellikle de depresyon ek tanısının, yeme bozukluğu hastalarında intihar riskini artırdığı kesin olarak gösterilmiştir. Yine de yeme bozukluğunda artmış intihar davranışı sadece komorbidite ile açıklanamaz. Joiner tarafından geliştirilen kişilerarası psikolojik intihar kuramı (KPİK) insanların neden intihar davranışlarında bulunduklarını anlamaya ve bireysel intihar davranışlarındaki farklılıkları açıklamayı amaçlar. Yeme bozukluğu hastalarının kronik kısıtlayıcı besin alımı ve kusma gibi telafi davranışları acı verici ve vücut için zorlayıcı eylemlerdir. Acı verici ve zorlayıcı deneyimlerle tekrarlanan karşılaşmaların bireyde alışkanlık oluşturarak acıdan kaçınmayı azalttığı düşünülebilir. KPİK penceresinden bakıldığında; acıdan kaçınmanın azalması, bireylerin artmış intihar girişimleri ve tamamlanmış intiharlarını açıklayan bir faktör olabilir. Yeme bozukluğu hastalarıyla çalışan klinisyenlerin düzenli ve kapsamlı intihar değerlendirmeleri yapmaları çok önemlidir. Yeme bozukluğu hastalarında başta majör depresyon olmak üzere, eşlik eden anksiyete bozukluğu, madde kullanım bozukluğu gibi komorbiditelerin atlanmayıp agresif biçimde tedavi edilmesi gerekir.

Anahtar Kelimeler

• yeme bozukluğu
• intihar
• anoreksiya nervoza
• interoseptif defisit

Kaynakça

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