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BMC Psychiatry
Published in: BMC Psychiatry 1/2024

Open Access 01-12-2024 | Avoidant-Restrictive Food Intake Disorder | Research

The mediating effect of dysmorphic concern in the association between avoidant restrictive food intake disorder and suicidal ideation in adults

Authors: Gaelle Salameh, Nour El Khoury, Rabih Hallit, Diana Malaeb, Fouad Sakr, Mariam Dabbous, Feten Fekih-Romdhane, Sahar Obeid, Souheil Hallit

Published in: BMC Psychiatry | Issue 1/2024

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Abstract

Background

Reflecting on the existing literature on suicidal ideation and Avoidant/Restrictive Food Intake Disorder (ARFID), this article investigates the complex relationship between them, hypothesizing about the possibility of dysmorphic concerns, being a mediator linking ARFID to suicidal ideation.

Methods

Using a snowball sampling approach, a survey was created on Google Forms and circulated across messaging applications and social media networks (WhatsApp, Instagram, Messenger). The sample involved 515 participants recruited between February and March 2023. The questionnaire included the following scales: Nine-items Avoidant/Restrictive Food Intake Disorder screen (NIAS), Dysmorphic Concern Questionnaire (DCQ), and Columbia-Suicide Severity Rating Scale (C-SSRS). When filling the questionnaire, respondents were warned that they can experience distress when answering certain questions and received information about mental health services. Five hundred fifteen adults participated in this study, with a mean age of 27.55 ± 10.92 years and 60.1% females.

Results

After adjusting over potential confounders (i.e., age, education, marital status, and household crowding index), analyses showed that dysmorphic concerns fully mediated the association between avoidant restrictive eating and suicidal ideation. Higher avoidant restrictive eating was significantly associated with more dysmorphic concerns, and higher dysmorphic concerns were significantly associated with the presence of suicidal ideation. Finally, avoidant restrictive eating was not significantly associated with suicidal ideation.

Conclusion

This study highlights the potential indirect link between ARFID and suicidal ideation mediated by dysmorphic concerns. While no direct connection was observed between ARFID and suicidal ideation, the presence of dysmorphic concerns appeared to be a crucial factor in amplifying the risk of suicidal ideation in individuals with ARFID. This emphasizes the importance of addressing dysmorphic concerns alongside ARFID treatment to enhance mental health interventions and outcomes.
Literature
1.
GBD 2015. Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–544. https://​doi.​org/​10.​1016/​S0140-6736(16)31012-1. CrossRef
2.
Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, Andrade LH, Angermeyer MC, Beautrais A, Bromet E, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, Hu C, Karam EG, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Ormel J, Posada-Villa J, Sagar R, Tomov T, Uda H, Williams DR, Kessler RC. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry. 2010;71(12):1617–28.CrossRefPubMedPubMedCentral
3.
Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams D. Cross-National prevalence and risk factors for suicidal ideation, plans, and attempts. Br J Psychiatry. 2008;192(2):98–105.CrossRefPubMedPubMedCentral
4.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). Washington; 2013.
5.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Text Revision (DSM-5-TR), 5th edition. Amer Psychiatric Pub Inc. 2022.
6.
Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord. 2014;47(5):495–9.CrossRefPubMed
7.
Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord. 2017;5:21.CrossRefPubMedPubMedCentral
8.
Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry. 2015;24(7):779–85.CrossRefPubMed
9.
Sardahaee FS, Holmen TL, Micali N, Sund ER, Bjerkeset O, Kvaløy K. Suicidal ideation in relation to disordered eating, body size and weight perception: a cross-sectional study of a Norwegian adolescent population: the HUNT Study. BMJ Open. 2019;9(7):e029809.CrossRef
10.
Duncombe Lowe K, Barnes TL, Martell C, Keery H, Eckhardt S, Peterson CB, Lesser J, Le Grange D. Youth with Avoidant/restrictive food intake disorder: examining differences by age, weight status, and symptom duration. Nutrients. 2019;11(8):1955.CrossRefPubMedPubMedCentral
11.
Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2017.
12.
Milligan T, Middleman AB. Facing an eating disorder: a case of body dysmorphic disorder and avoidant/restrictive food intake disorder. SAGE Open Med Case Rep. 2022;10:2050313X221111679.PubMedPubMedCentral
13.
Kambanis PE, Kuhnle MC, Wons OB, Jo JH, Keshishian AC, Hauser K, Becker KR, Franko DL, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord. 2020;53(2):256–65.CrossRefPubMed
14.
15.
Krebs G, Fernández de la Cruz L, Rijsdijk FV, Rautio D, Enander J, Rück C, Lichtenstein P, Lundström S, Larsson H, Eley TC, Mataix-Cols D. The association between body dysmorphic symptoms and suicidality among adolescents and young adults: a genetically informative study. Psychol Med. 2022;52(7):1268–76.CrossRefPubMed
16.
Angelakis I, Gooding PA, Panagioti M. Suicidality in body dysmorphic disorder (BDD): a systematic review with meta-analysis. Clin Psychol Rev. 2016;49:55–66.CrossRefPubMed
17.
Fekih-Romdhane F, Hallit R, Malaeb D, Sakr F, Dabbous M, Sawma T, Obeid S, Hallit S. Psychometric Properties of an Arabic Translation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a community sample of Adults. J Eat Disord. 2023;11(1):143.CrossRefPubMedPubMedCentral
18.
Fritz MS, MacKinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18(3):233–9.CrossRefPubMed
19.
Melki IS, Beydoun H, Khogali M, Tamim H, Yunis K. Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health. 2004;58(6):476–80.CrossRefPubMedPubMedCentral
20.
21.
Zickgraf HF, Ellis JM. Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): a measure of three restrictive eating patterns. Appetite. 2018;123:32–42.CrossRefPubMed
22.
Jorgensen L, Castle D, Roberts C, Groth-Marnat G. A clinical validation of the dysmorphic concern questionnaire. Aust N Z J Psychiatry. 2001;35(1):124–8.CrossRefPubMed
23.
Rozzell KN, Carter C, Convertino AD, Gonzales M IV, Blashill AJ. The Dysmorphic Concern Questionnaire: Measurement invariance by gender and race/ethnicity among sexual minority adults - ScienceDirect. Body Image. 2020;35:201–6.CrossRefPubMed
24.
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ. Columbia-suicide severity rating scale (C-SSRS). Am J Psychiatry. 2011;168(12):1266–77.CrossRefPubMedPubMedCentral
25.
Chahine M, Salameh P, Haddad C, Sacre H, Soufia M, Akel M, Obeid S, Hallit R, Hallit S. Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry. 2020;20:304.CrossRefPubMedPubMedCentral
26.
27.
Barney A, Bruett LD, Forsberg S, Nagata JM. Avoidant Restrictive Food Intake Disorder (ARFID) and Body Image: a case report. J Eat Disord. 2022;10(1):61.CrossRefPubMedPubMedCentral
28.
Kollei I, Schieber K, de Zwaan M, Svitak M, Martin A. Body dysmorphic disorder and nonweight-related body image concerns in individuals with eating disorders. Int J Eat Disord. 2013;46(1):52–9.CrossRefPubMed
29.
Madsen SK, Bohon C, Feusner JD. Visual processing in anorexia nervosa and body dysmorphic disorder: similarities, differences, and future research directions. J Psychiatr Res. 2013;47(10):1483–91.CrossRefPubMedPubMedCentral
30.
Phillips KA, Coles ME, Menard W, Yen S, Fay C, Weisberg RB. Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry. 2005;66(6):717–25.CrossRefPubMed
31.
Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting. J Affect Disord. 2019;259:266–70.CrossRefPubMed
32.
Witte TK, Didie ER, Menard W, Phillips KA. The relationship between body dysmorphic disorder behaviors and the acquired capability for suicide. Suicide Life Threat Behav. 2012;42(3):318–31.CrossRefPubMed
33.
He J, Zickgraf HF, Ellis JM, Lin Z, Fan X. Chinese Version of the Nine Item ARFID Screen: psychometric properties and cross-cultural measurement invariance. Assessment. 2021;28(2):537–50.CrossRefPubMed
34.
Schermbrucker J, Kimber M, Johnson N, Kearney S, Couturier J. Avoidant/restrictive food intake disorder in an 11-year old south american boy: medical and cultural challenges. J Can Acad Child Adolesc Psychiatry. 2017;26(2):110–3.PubMedPubMedCentral
Metadata
Title
The mediating effect of dysmorphic concern in the association between avoidant restrictive food intake disorder and suicidal ideation in adults
Authors
Gaelle Salameh
Nour El Khoury
Rabih Hallit
Diana Malaeb
Fouad Sakr
Mariam Dabbous
Feten Fekih-Romdhane
Sahar Obeid
Souheil Hallit
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-05490-5

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