The Lifetime Prevalence of Non-Suicidal Self-Injury in Children and Adolescents With Eating Disorders-A Systematic Review and Meta-Analysis

OBJECTIVE

Eating disorders (EDs) and non-suicidal self-injury (NSSI) are both phenomena with onset in adolescence. Their co-occurrence is associated with higher symptom severity and an elevated risk of suicide. In this meta-analysis, we examine the lifetime prevalence of NSSI in youth with EDs.

METHODS

We searched PsycInfo, PubMed and previously published systematic reviews for studies reporting on lifetime NSSI prevalence among children and adolescents (19 years or younger) with an ED (anorexia nervosa, bulimia nervosa, binge eating or other specified feeding and EDs) published until June 2024. A generalized linear mixed model meta-analysis was performed to estimate the pooled prevalence. Meta-regressions and multivariate meta-analyses were conducted to estimate separate prevalence rates based on ED diagnosis and care frame (e.g., inpatient vs. outpatient), respectively.

RESULTS

Fifteen studies comprising 3311 children and adolescents were included. Pooled lifetime NSSI prevalence across all ED diagnoses was 34.2% [CI: 27.5%-41.7%]. Heterogeneity was large (I2 = 93.8%). Lifetime NSSI prevalence rates were significantly higher for participants with bulimia nervosa (53.6%) and those with anorexia nervosa binge-eating/purging type (51.9%) than for participants with anorexia nervosa restrictive type (15.8%).

DISCUSSION

The small number of studies and the large heterogeneity limit the conclusiveness of this meta-analysis. Results suggest an even higher prevalence of lifetime NSSI in adolescents with an ED than in adults with an ED. The results support previous findings indicating higher prevalence rates of NSSI for EDs associated with binge eating and purging behaviours than for restrictive EDs.

An investigation of associations between parenting and binge eating across pubertal development in pre-adolescent and adolescent female participants

OBJECTIVE

Puberty is a period of increased risk for the development of binge eating in female adolescents. Although developmental changes in autonomy-seeking behaviors and body weight and shape may influence both parenting styles and binge eating during puberty, studies have yet to examine how parenting practices may be differentially associated with youth outcomes depending on developmental stage. The current study examines whether interactions between puberty and parenting are associated with higher levels of binge-eating symptoms during/after puberty in female youth.

METHODS

Analyses used cross-sectional data from a previous study of disordered eating and puberty in 999 female youth (ages 8-16) and their parents from the Michigan State University Twin Registry. Youth self-reported binge eating, pubertal development, and perceived parental care and overprotection. Both parents and youth reported on parent-child conflict. Mixed linear models were used to examine whether pubertal development moderates the strength of associations between parenting (parent-child conflict, parental care, and parental overprotection) and offspring binge eating.

RESULTS

Although higher levels of parental overprotection and conflict, and lower levels of parental care were all significantly associated with binge eating, none of the associations were significantly moderated by pubertal development or age.

DISCUSSION

The quality of the parent-child relationship is significantly associated with binge eating in female youth regardless of developmental stage, highlighting the need for targeting harmful parenting strategies during adolescent eating disorder intervention.

PUBLIC SIGNIFICANCE

This is the first study to examine whether parenting/binge-eating associations in female participants differ across pubertal development. In a large population-based sample, we found lower parental care, higher parent-child conflict, and higher parental overprotection were all associated with higher levels of binge eating. Notably, associations did not differ across pubertal stage or age, suggesting that parenting is significantly associated with binge eating, regardless of developmental stage.

Parenting style and its effect on eating disorders and substance abuse across the young population

This article attempts to examine the occurrence of two behavioural changes, namely, substance abuse and eating disorders in order of onset mediated by ineffective parenting styles during young age. The four parenting styles and their consequential behavioural adverse effects are taken as the focal point of this study and are synthesized to provide an outlook on the status of ineffective parenting and deviant offspring behaviours. A review of literature was primarily undertaken to examine the characteristic features of ineffective parenting. A causal relationship was then drawn between the onset of behavioural disorders with an emphasis on substance abuse and eating disorders, along the parenting spectrum. We probed into the order and directionality of the offspring behavioural changes against ineffective parenting. The current available data shows the superimposition of the parenting style spectrum on a bell-shaped distribution of behavioural outcomes as exemplified by authoritarian, permissive and neglectful parenting as a prime determinant of several disorders among the young age; parenting styles being at the extremities of the parenting spectrum. The sweet spot of parenting, mainly associated to the authoritative approach, bears the most positive effect on the growing child. The extreme ends of parenting as per the varying degree of responsiveness and demandingness, generally observed in authoritarian and neglectful parenting precipitate concomitant deviant behaviours cascading from one another; intricately linking substance abuse and eating disorders. A number of studies describe the isolated effects of ineffective parenting on the development of substance abuse and eating disorders during the adolescent period. However, the relationship between both eating disorders and substance abuse is underplayed and need to be stressed upon to tailor behaviour-specific targeted therapies and restore the normalcy of these altered behaviours.

How the parenting style adopted can lead to a concurrent amalgam of disordered eating patterns and substance abuse.

How disordered eating behaviours and substance abuse are initiated as coping strategies to deal with the consequences of poor parenting.

Isolation of specific risk factors to deter the development of those deviant behaviours in addition to improvement of parenting methods.

Disordered eating among college students: The effects of parental attachment and the mediating role of emotion dysregulation

ObjectivesThe current study explored the relationship between parental attachment and disordered eating among college students. This study also explored the potential mediating role of factors associated with emotion regulation. Participants: One hundred sixty-seven undergraduates (M = 18.93 years, SD = 1.02) participated in the current study. Methods: Participants completed an anonymous questionnaire reporting their perceptions of their parental attachment relationships, emotional reactivity, difficulty regulating emotions, and disordered eating. Results: Analyses using structural equation modeling indicated that difficulty regulating emotions mediated the relationship between maternal attachment and disordered eating, but not between paternal attachment and disordered eating. Emotional reactivity did not emerge as a significant mediator. Conclusions: These findings suggest that maternal attachment relationships may be associated with difficulty regulating emotions in adulthood, which may in turn impact disordered eating attitudes and behaviors.

Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review

Non-suicidal self-injury (NSSI) is a worrying phenomenon that is prevalent among young people. Prior theorizing and empirical evidence suggest that parenting may play a role in the etiology of NSSI. Thus, we conducted a systematic review to examine the association between parenting behaviors and parenting styles with NSSI in young people.

METHODS

The following databases were searched for relevant articles in July 2020: PubMed, EMBASE, CINAHL Plus, and PsycINFO. Studies were included if they sampled young persons aged 10-25 years old with a history of NSSI, assessed parenting behavior or style, and tested associations between parenting and NSSI outcomes.

RESULTS

A total of 26 studies were included in this review. Among parenting behaviors, low parental support, high psychological control, and high reactive control were more consistently associated with NSSI. Conversely, the evidence for behavioral control is equivocal. There is some evidence that invalidating parenting is also associated with NSSI.

CONCLUSION

Consistent with the wider adolescent psychopathology literature, parenting that is perceived to be supportive, less psychologically controlling and reactive/punitive were less likely to be associated with NSSI. However, these results were largely based on child reports of parenting. Limitations and directions for future research are discussed.

Disordered eating behaviours and basic psychological need satisfaction: the mediating role of anxiety symptoms in preadolescents

Objective: According to self-determination theory, satisfied basic psychological needs can be a protective factor for psychopathology, including eating disorders and anxiety symptomatology. However, most research has focused on adolescent and adult populations, with less work examining perceived basic psychological need satisfaction from parents in younger samples who report anxiety and disordered eating. This cross-sectional study aimed to investigate whether basic psychological need satisfaction from parents was associated with disordered eating in preadolescents and whether anxiety mediated this relation.Method: A total of 211 preadolescents were recruited from primary schools across south Wales (mean age = 10.27 years, age range = 9-11 years; 49.3% female). Children completed self-report questionnaires on their basic psychological need satisfaction when with parents, as well as disordered eating and anxiety symptoms.Results: It was found that higher needs satisfaction was associated with lower disordered eating and anxiety, with stronger relations found in girls compared with boys. Furthermore, anxiety was found to mediate this relationship.Conclusions: Results suggest that basic psychological needs satisfaction may play an important role in the early emergence of co-occurring disordered eating and anxiety symptoms in boys and girls. The importance of considering anxiety symptoms in future work investigating needs satisfaction in the context of disordered eating and eating disorders is discussed.

The role of autonomy-supportive parenting in the competence, adherence and glycemic control of adolescents with type 1 diabetes

PURPOSE

To examine the relationships between autonomy support provided to adolescents with Type 1 Diabetes by their parents, and adolescents' competence, adherence to treatment, and glycemic control indicators.

METHOD

Thirty-seven adolescents, along with one of their parents, completed a set of questionnaires on the level of autonomy support provided by their parents. Adolescents' self-treatment competence and their level of adherence to treatment were also measured. A recent blood test assessing the adolescents' 3-month average glycemic level (HbA1c) was retrieved from their medical records as a glycemic control indicator.

RESULTS

Structural Equation Modeling suggested that parental autonomy support as reported by parents and adolescents was associated with higher adolescent self-treatment competence and higher adherence to treatment. These in turn were associated with better glycemic control.

CONCLUSION

Parental autonomy support is crucial and may contribute to the competence, adherence, and physical wellbeing of adolescents with Type 1 Diabetes. Parents should be instructed on ways to better support autonomy but still be involved in their child's life.

Indirekte und direkte nichtsuizidale Selbstverletzungen bei Mädchen und jungen Frauen mit Essstörungen

Zusammenfassung. Nichtsuizidales selbstverletzendes Verhalten (NSSV) tritt häufig bei Essstörungen auf. Die Befundlage zum Zusammenhang zwischen einem restriktiv-asketischen beziehungsweise bulimischen Essverhalten und NSSV ist jedoch nicht konsistent. Es wird geprüft, ob borderlinespezifische Gedanken die Beziehung zwischen asketischen beziehungsweise bulimischen Essverhalten auf der einen Seite und NSSV auf der anderen Seite mediieren. Eine Stichprobe von 74 Mädchen und jungen Frauen im Alter von 14 bis 21 Jahren ( M = 17.49; SD = 1.85), die eine Anorexie oder eine Bulimie aufweisen, bearbeiteten Fragebögen zu NSSV, borderlinespezifischen Gedanken sowie zu asketischen und bulimischen Verhaltensweisen. Borderline-Gedanken mediierten den Zusammenhang zwischen asketischem Verhalten auf der einen Seite und der Anzahl an bisher genutzten NSSV-Methoden und NSSI zur psychischen Regulation auf der anderen Seite. Bei Bulimie fand sich hingegen keine Mediation. Ein asketisches Verhalten ist bei Mädchen und jungen Frauen mit einer Essstörung über Borderline-Gedankenmuster mit der Anzahl an NSSV-Methoden und der Nutzung von NSSV zur psychischen Regulation verbunden. Ein primär durch Essattacken gekennzeichnetes Verhalten weist keinen Zusammenhang mit NSSV auf. Die verschiedenen Arten von gestörtem Essverhalten sollten separat auf einen Zusammenhang mit NSSV untersucht werden.

Putative Risk Factors for Non-Suicidal Self-Injury in Eating Disorders

Evidence suggests a common association between eating disorders (EDs) and non-suicidal self-injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self-evaluation, suicide attempts, substance abuse, parents' low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co-occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.