Dissociation and Suicidality in Eating Disorders: Mediating and Moderating Factors

Abstract

Elevated dissociation may increase the risk of suicide in patients suffering from eating disorders (EDs). The aims of the present study were: 1) To examine the relationship between dissociative symptoms and suicidality in female adolescents with EDs, and 2) To assess potential factors that would intervene in these relationships including body-related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Self-rating questionnaires were used to evaluate participants' levels of dissociation, suicidality, body-related characteristics, severity of ED symptoms, depression, and anxiety. Dissociation and suicidality were found to be closely related. Additionally, the mediating effect of body image factors in the relationship between higher dissociation and increased suicidality was modulated by despair and anxiety.  Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. These relationships were not moderated by ED-related parameters. Our findings show that in ED inpatients, increased dissociation is associated with increased suicidality, both directly and through the influence of body image, depression, and anxiety. In order to validate and extend the conclusions of our model in a prospective longitudinal assessment of ambulatory patients with EDs over the course of their illness, future studies should make an effort to incorporate data on actual suicidal behaviours and trauma history.