Self-criticism longitudinally predicts nonsuicidal self-injury in eating disorders

A meta-analysis of disordered eating and its association with self-criticism and self-compassion

OBJECTIVE

Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE.

METHOD

Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted.

RESULTS

Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88).

DISCUSSION

Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE.

PUBLIC SIGNIFICANCE STATEMENT

Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.

Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021

OBJECTIVE

Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population.

METHOD

A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis.

RESULTS

We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH.

DISCUSSION

Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required.

PUBLIC SIGNIFICANCE

This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.

Testing a diathesis-stress model during the transition to university: Associations between self-criticism, stress, and internalizing problems

ObjectiveTo test a diathesis-stress model whereby self-criticism interacts with monthly perceived stress to predict same-month or next-month internalizing problems, including depression, anxiety, nonsuicidal self-injury (NSSI), and suicidal ideation, in students transitioning to university. Participants: 704 students (73% female, Mage = 17.97) were recruited during their first month of university in 2017 and 2018. Methods: Students completed surveys assessing self-criticism, perceived stress, and internalizing problems from September to April. Results: Self-criticism predicted higher depression and anxiety, as well as odds of NSSI and suicidal ideation, in students' first month on campus. Consistent with a diathesis-stress model, self-criticism strengthened the associations between stress and same-month depression and anxiety. Conclusions: Self-critical students are at elevated risk of internalizing problems during the transition to university, particularly when they feel more stressed than usual. These findings elucidate which students should be targeted in interventions and when interventions should be delivered to curtail internalizing problems.

Nonsuicidal Self-Injury Is Associated With Attenuated Interoceptive Responses to Self-Critical Rumination

Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior. Those with a history of NSSI often report high levels of self-critical rumination (SCR), a form of negatively valenced introspective self-referential processing. It is plausible that this overly analytical style of relating to the self might hinder the ability to process interoceptive signals, thereby increasing the capacity to engage in behaviors that cause bodily harm. Two studies investigated whether trait or state SCR influenced aspects of interoception in those with and without a history of NSSI. In Study 1 (N = 180), irrespective of NSSI history, trait SCR was associated with finding attending to the heartbeat unpleasant. However, no associations were observed for interoceptive confidence, or metacognitive insight into their interoceptive abilities (confidence-accuracy correspondence). Trait SCR was associated with having higher interoceptive accuracy, but only in those without a history of NSSI. In Study 2 (N = 98), irrespective of NSSI history, state self-criticism led to a more negative interoceptive valence, and reduced participants' metacognitive insight. In those without a history of NSSI, state self-criticism also increased interoceptive accuracy-an effect attenuated in those with NSSI. These findings suggest that those with NSSI are characterized by a blunted interoceptive response to negatively valenced self-focused attention.

Mediation analysis of social deficits between self-criticism and aggression in adolescents

This research aims to determine the mediating role of social deficits in self-criticism and aggression using a sample of 695 adolescents (girls = 49%, boys = 51%), aged 12 to 19 years (M = 14.97, SD = 1.30) from an urbanized city of Pakistan. Interpersonal Difficulties Scale, Self-Criticism Scale, and Aggressive Behavior Scale were used in the present study. Results indicated a significant positive association of social deficits with self-criticism and aggression (p < .001). Furthermore, findings also suggested a significant positive association between self-criticism and aggression. Mediation analysis revealed that self-criticism partially mediated the relationship between social deficits and aggression. Findings are discussed in terms of the expression and manifestation of self-criticism, social deficits, and aggression in adolescents in collectivistic cultures.

Updates in the treatment of eating disorders in 2020: a year in review in eating disorders: the journal of treatment & prevention

Several important studies advancing treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2020. This review summarizes the recent contributions to the literature on the treatment of eating disorders, including dialectical behavior therapy, yoga for positive embodiment, and treatment innovations in children and adolescents with eating disorders. Dialectical behavior therapy can be effectively used in complex eating disorder presentations, such as with comorbid substance use disorder and with suicidal behavior, and can be adapted for culturally-responsive treatments for binge eating and for guided self-help. Yoga may promote positive embodiment, which is supported by conceptual frameworks, studies evaluating yoga treatment interventions, and systematic reviews. Advances in eating disorder treatment for children and youth include the development of the Emotional Eating Scale adapted for children and adolescents, a review of primary care interventions for eating disorder treatment, and siblings' perspectives on eating disorder treatment. Research on novel methods including telementoring and innovative treatment modalities invoking feminism are promising areas of future research.

Assessing self-criticism and self-reassurance: Examining psychometric properties and clinical usefulness of the Short-Form of the Forms of Self-Criticizing/Attacking & Self-Reassuring Scale (FSCRS-SF) in Spanish sample

The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) was designed to measure self-criticism (SC) through Inadequate Self (IS) and Hated Self (HS) factors, as well as self-reassurance (RS). However, its long and short forms have yet to be validated in the Spanish Population. The present study examines the psychometric properties of the short form (FSCRS-SF) and its clinical usefulness in a sample of 576 adult individuals, 77 with psychiatric disorders and 499 without. Non-clinical participants were split according to their previous experience with meditation (active meditators, n = 133; non-active meditators, n = 41; and non-meditators, n = 325) and differences between these subgroups were explored. Additionally, a subsample of 20 non-clinical participants took part in a mindfulness- and compassion- based intervention (MCBI) to assess the usefulness of the scale as an outcome measure. Results confirmed the original three-factorial structure, good internal consistency, acceptable test-retest reliability, and a pattern of correlations consistent with previous literature. Regarding differences between groups, the clinical subsample showed significant higher SC and lower RS levels than non-clinical participants and active meditators had significant lower IS and higher RS levels than non-meditators. Participants who participated in the MCBI showed significant RS improvement and a decrease in IS and HS levels. Moreover, a hierarchical multiple regression showed that RS made a significant predictive contribution to distress at three months’ time. In conclusion, results show that the Spanish version of the FSCRS-SF is a reliable and valid measure of SC and RS in non-clinical populations and an adequate instrument to detect changes after MCBIs.

Emotion Reactivity and Suicide Risk in Patients With Depression: The Mediating Role of Non-Suicidal Self-Injury and Moderating Role of Childhood Neglect

Background: The association between emotion reactivity (ER) and suicide risk has been confirmed in recent studies, especially in patients with depression. However, there is a lack of understanding of the underlying mechanism of the relation from ER to suicide risk among patients with depression. This study planned to examine a model of how ER, non-suicidal self-injury (NSSI), and childhood neglect (CN) interact to affect suicide risk in depressed patients. Methods: Four hundred and ninety-six patients (64.5% female, mean age = 30.40 years, SD = 12.56) who have accomplished self-rating instruments of ER, NSSI, CN, and suicide risk were included. Results: Findings showed that ER was positively connected with suicide risk, and NSSI partially mediated the above connection. Besides, CN moderated the mediation model, that is, the mediation effect was more pronounced in depressed patients with CN compared to depressed patients without CN. Conclusions: It was concluded that there is a relationship among ER, NSSI, CN, and suicide risk in patients with depression, and it strengthens our knowledge of the mechanism behind suicide risk. Our findings emphasize that the identification of NSSI and CN should be considered when assessing the suicide risk of patients with depression, as well as the intervention focus on emotion regulation and support for patients.

Longitudinal relations of self-criticism with disordered eating behaviors and nonsuicidal self-injury

OBJECTIVE

Self-criticism has been proposed as a transdiagnostic predictor of disordered eating and nonsuicidal self-injury (NSSI). First, this study explored cross-sectional associations of multiple disordered eating behaviors, NSSI, and self-criticism. Second, it tested longitudinal relations of self-criticism with disordered eating and NSSI, adjusting for baseline levels of both behaviors.

METHODS

In Sub-study 1, undergraduates (N = 251, 79.5% female, M_age = 19.1 years) completed self-report measures of disordered eating, NSSI, and self-criticism at baseline and after 8 weeks. In Sub-study 2, community-based young adults with histories of disordered eating, NSSI, or both (N = 517, 88.8% female, M_age = 24.7 years) completed measures of disordered eating, NSSI, and self-criticism at baseline and after 4 weeks. All measures were completed online.

RESULTS

In Sub-study 1, both disordered eating and NSSI showed significant cross-sectional associations with self-criticism, and self-criticism was significantly related to binge eating, fasting, and NSSI at follow-up. In Sub-study 2, both behaviors again showed significant cross-sectional associations with self-criticism. Self-criticism showed significant longitudinal relations with fasting, purging, and excessive exercise. Longitudinal relations of self-criticism with NSSI varied across disordered eating behaviors.

DISCUSSION

NSSI showed cross-sectional associations with a range of disordered eating behaviors. Self-criticism reflects a common correlate of both disordered eating and NSSI. Evidence supported transdiagnostic longitudinal impact of self-criticism across multiple forms of disordered eating but provided more limited support for impacts on NSSI.

Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know

PURPOSE OF REVIEW

The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research.

RECENT FINDINGS

While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.