Self-Harm: Evaluating Patients with BED and BN

Researchers have tried to define differences and similarities between patients with bulimia nervosa (BN) and those with binge eating disorder (BED). Two recent studies have looked at both groups and their risk of self-harm.

Substance use and self-harm

Researchers using data from the New England Women’s Health Project evaluated whether there are differences in the likelihood of concomitant self-harm and substance use between women with BN and women with BED (Int J Eat Disord 2002;32;389). The New England Women’s Health Project is an ongoing community-based study of the risk factors associated with BED in women.

The researchers evaluated a history of self-harm and substance abuse (“impulsive behavior”) among women with BN-purging type and those with BED, to determine if women with BN had a greater likelihood of using such behavior than did women with BED. The final group included 71 Black and 144 White women 18 to 40 years of age. Fifty-three met the criteria for BN-purging type and 162 met the criteria for BED.

All the women had a brief telephone interview, and the diagnosis was confirmed in an in-person structured diagnostic interview. Eating disorders were established based on the Eating Disorders Examination (EDE, 12th ed.) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). Rates of substance dependence were also examined, and the presence of abuse and substance dependence were determined by the SCID. The group also assessed the rates of four combinations of harmful behaviors: 1) self-harm plus an alcohol problem; 2) self-harm plus a drug problem; 3) alcohol problem plus a drug problem; and 4) self-harm, an alcohol problem, and a drug problem (multiple impulsive behavior).

Most had a history of abuse

Of the 215 women in the study group, 152, or 70%, had a history of either sexual of physical abuse. There was no significant difference between the women with BED who reported a history of abuse and the women with BN who had a history of abuse. They could not be differentiated based on substance use, abuse, dependence, or self-harm. The only difference was in lifetime abuse of sedatives/hypnotics.

The authors’ data suggest that higher rates of self-harm and substance use may not be unique to BN patients but may be related to BED status or another as yet unidentified characteristic that is shared by women with BN and BED.

Differences by race

Overall, rates of substance use were lower for Black women than for White women, even though rates of physical/sexual abuse were higher in Black women than White women. Black women in the study were less likely than White women to report using at least one substance, substance problems, or self-harm. This finding underscored the importance of considering demographics in studies of psychopathology and of allowing for the possibility that there may be different pathways to development of psychological disorders or to resistance to the onset of psychological disorders among Black and White women.

Sexual orientation and self-harm

Researchers at the University of Otago School of Medicine, Dunedin, New Zealand, have uncovered a link between increasing degrees of same-sex attraction and self-harm in both men and women. The researchers evaluated a birth cohort of 1,019 New Zealand young adults; 946 participated in the final study.

Recent studies of homosexual populations have consistently shown higher rates of nonfatal suicidal behaviors than are found among heterosexual populations. A key question has been whether gender makes a difference. In this birth cohort of young adults, women as well as men who had experienced same-sex attraction had a higher risk of self-harm behaviors. Both sexes had a higher-than-normal risk of self-harm behaviors, and both men and women also had high odds for suicidal ideation and deliberate self-harm.

The association between sexual orientation and self-harm was slightly different among men and women. The odds ratios for suicidal ideation in the past year were 3.1 for men and 2.9 for women. Odds ratios for a history of self-harm were 5.5 for men and 1.9 for women. Men with any same-sex attraction were at a greater risk of deliberate self-harm than were women with same-sex attraction. This difference could have been due to chance but more likely is explained by differences between the sexes in readiness to admit to same-sex attraction. As a whole, the cohort was more accepting of same-sex relationships between women than between men.