Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-04-30T18:17:39.371Z Has data issue: false hasContentIssue false
  • English
  • Français

El cambio al subtipo atracón/purga de la anorexia nerviosa con frecuencia se asocia con intentos de suicidio

Published online by Cambridge University Press:  12 May 2020

C. Foulon ,
J. D. Guelfi ,
A. Kipmanc ,
J. Adès ,
L. Romo ,
K. Houdeyer ,
S. Marquez ,
M. C Mouren ,
F. Rouillon  and
P. Gorwood
C. Foulon
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
J. D. Guelfi
Affiliation:
AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
A. Kipmanc
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
J. Adès
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
L. Romo
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
K. Houdeyer
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
S. Marquez
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
M. C Mouren
Affiliation:
AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
F. Rouillon
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
P. Gorwood
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia INSERM Unidad 675, Facultad Xavier Bichat, 16 Rue Henri Huchard, 75018París, Francia INSERM Unidad 677, Facultad Pitié-Salpétrière, 91 bulevar del Hospital, 75634París Cedex 13, Francia
Get access

Resumen

Objetivo.

La anorexia nerviosa tiene la tasa de mortalidad por suicidio más alta de todos los trastornos psiquiátricos, asociándose el suicidio con muchos factores. Evaluamos la primera aparición de estos factores en la vida del paciente, teniendo en cuenta su posible solapamiento.

Método.

Trescientos cuatro pacientes ingresados y ambulatorios con anorexia nerviosa (DSM-IV) fueron seleccionados sistemáticamente en tres hospitales de las afueras de París, entre diciembre de 1999 y enero de 2003. Los pacientes fueron evaluados con una entrevista personal (DIGS). Se midieron las dimensiones del trastorno de la alimentación y los pacientes fueron entrevistados por un clínico entrenado para evaluar el IMC mínimo y determinar, retrospectivamente, la edad en que se produjeron por primera vez la anorexia nerviosa, el trastorno depresivo mayor, los trastornos de ansiedad y el cambio al tipo atracón/purga.

Resultados.

El trastorno depresivo mayor (p < 0,001) y el cambio desde el subtipo restrictivo al tipo atracón/purga (p < 0,001) fueron los dos factores que se produjeron significativamente con más frecuencia antes de los intentos de suicidio y siguieron estando implicados en un análisis multivariante, usando medidas sindrómicas o dimensionales. Teniendo en cuenta la incidencia a lo largo de la vida con un análisis de supervivencia, el cambio de la anorexia al tipo atracón/purga parece ser un factor predictivo fundamental, con un aumento grande de la frecuencia de intentos de suicidio (CP=15) comparados con los pacientes sin trastorno depresivo mayor ni anorexia del tipo atracón/purga.

Conclusiones.

La anorexia nerviosa de tipo atracón/purga se asocia significativamente con intentos de suicidio y podría merecer especial atención. Si se confirma en un estudio con diseño prospectivo, estos resultados abogarían por la necesidad de detección precoz y/o intervención terapéutica más intensiva y específica sobre la conducta de atracones y purgas.

Keywords

SuicidioImpulsividadDepresiónTrastorno alimentarioAdicción
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 15 , Issue 2 , March 2008 , pp. 90 - 97
Copyright
Copyright © European Psychiatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

American Psychiatric Association. Practice guideline for assessment and treatment of patients with suicidal behaviors. Am J Psychiatry 2003; 160(1 ls):1–60.Google Scholar
Askenazy, FL, Sorci, K, Benoit, M, Lestideau, K, Myquel, M, Lecrubier, Y. Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior. J Affect Disord 2003 May;74(3):219–27.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Moch, J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:53–62.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Joyce, PR. Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatr Scand 1999;100:27–32.CrossRefGoogle ScholarPubMed
Casper, RC, Eckert, ED, Halmi, KA, Goldberg, SC, Davis, JM. Bulimia: its incidence and clinical importance in patients with anorexia nervosa. Arch Gen Psychiatry 1980;37:1030–5.CrossRefGoogle ScholarPubMed
Claes, L, Vandereycken, W, Vertommen, H. Impulsive and compulsive traits in eating disordered patients compared with Controls. Pers Individ Dif 2002;32:707–14.CrossRefGoogle Scholar
Da Costa, M, Halmi, KA. Classifications of anorexia nervosa: questions of subtypes. Int J Eat Disord 1992; 11:305–13.3.0.CO;2-2>CrossRefGoogle Scholar
Dumais, A, Lesage, A, Alda, M, Rouleau, G, Dumont, M, Chawky, N, et al. Risk factors for suicide completion in major depression: a case—control study of impulsive and aggressive behaviors in men. Am J Psychiatry 2005;162:2116–24.CrossRefGoogle ScholarPubMed
Emborg, C. Mortality and causes of death in eating disorders in Denmark 1970-1993: a case register study. Int J Eat Disord 1999;25:243–55.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Fahy, T, Eisler, I. Impulsivity and eating disorders. Br J Psychiatry 1993;162:193–7.CrossRefGoogle ScholarPubMed
Favaro, A, Santonastaso, P. Purging behaviors, suicide attempts, and psychiatric symptoms in 398 eating disordered subjects. Int J Eat Disord 1996;20:99–103.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Favaro, A, Santonastaso, P. Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatr Scand 1997;95:508–14.CrossRefGoogle ScholarPubMed
Franko, DL, Keel, PK, Dorer, DJ, Blais, MA, Delinsky, SS, Eddy, KT, et al. What predicts suicide attempts in women with eating disorders? Psychol Med 2004;34:843–53.CrossRefGoogle ScholarPubMed
Garfinkel, PE, Moldofsky, H, Garner, DM. The heterogeneity of anorexia nervosa. Arch Gen Psychiatry 1980;37:1036–40.CrossRefGoogle ScholarPubMed
Garner, DM, Garner, MV, Rosen, LW. Anorexia nervosa “restricters” who purge: implications for subtyping anorexia nervosa. Int J Eat Disord 1993 Mar;13(2):171–85.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Garner, DM, Garfinkel, PE. The eating attitude test: an index of the symptoms of anorexia nervosa. Psychol Med 1979;9:273–9.CrossRefGoogle ScholarPubMed
Garner, DM, Olmsted, MP, Polivy, J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983;2:15–34.3.0.CO;2-6>CrossRefGoogle Scholar
Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997 Mar; 170:205–28.CrossRefGoogle ScholarPubMed
Herzog, DB, Greenwood, DN, Dorer, DJ, Flores, AT, Ekeblad, ER, Richards, A, et al. Mortality in eating disorders: a descriptive study. Int J Eat Disord 2000;28:20–6.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Herzog, W, Deter, HC, Fiehn, W, Petzold, E. Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective 12-year follow-up study. Psychol Med 1997;27:269–79.CrossRefGoogle ScholarPubMed
Hosmer, DW, Lemeshow, S. Applied logistic regression. In: Wiley, J., editor. New York; 1980.Google Scholar
Kaplan, EL, Meier, F. Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958;58:457–81.CrossRefGoogle Scholar
Keel, PK, Dorer, DJ, Eddy, KT, Franko, D, Charatan, DL, Herzog, DB. Predictors of mortality in eating disorders. Arch Gen Psychiatry 2003;60:179–83.CrossRefGoogle ScholarPubMed
Milos, G, Spindler, A, Hepp, U, Schnyder, U. Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. Gen Hosp Psychiatry 2004;26:129–35.CrossRefGoogle ScholarPubMed
Nagata, T, Kawarada, Y, Kiriike, N, Iketani, T. Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity. Psychiatry Res 2000;94:239–50.CrossRefGoogle ScholarPubMed
Nurnberger, JI Jr, Blehar, MC, Kaufmann, CA, York-Cooler, C, Simpson, SG, Harkavy-Friedman, J, et al. Diagnostic Interview for Genetic Studies: rational, unique features, and training. Arch Gen Psychiatry 1994;51:849–62.CrossRefGoogle Scholar
Oldbam, J. Borderline personality disorder and suicidality. Am J Psychiatry 2006;163:20–6.CrossRefGoogle Scholar
Orbach, I, Stein, D, Shan-Sela, M, Har-Even, D. Body attitudes and body experiences in suicidal adolescents. Suicide Life Threat Behav 2001;31(3):237–49. Fall.CrossRefGoogle ScholarPubMed
Patton, GC. Mortality in eating disorders. Psychol Med 1988;18:947–51.CrossRefGoogle ScholarPubMed
Pompili, M, Mancinelli, I, Girardi, P, Ruberto, A, Tatarelli, R. Suicide in anorexia nervosa: a meta-analysis. Int J Eat Disord 2004 Jul;36(1):99–103.CrossRefGoogle ScholarPubMed
Pompili, M, Girardi, P, Ruberto, A, Tatarelli, R. Suicide in borderline personality disorder: a meta-analysis. Nord J Psychiatry 2005;59(5):319–24.CrossRefGoogle ScholarPubMed
Pompili, M, Girardi, P, Tatarelli, G, Ruberto, A, Tatarelli, R. Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eat Behav 2006 Nov;7(4):384–94.CrossRefGoogle ScholarPubMed
Preisig, M, Fenton, BT, Matthey, ML, Berney, A, Ferrero, F. Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of the French version. Eur Arch Psychiatry Clin Neurosci 1999;249(4):174–9.CrossRefGoogle ScholarPubMed
Pryor, T, Wiederman, MW, McGilley, B. Clinical correlates of anorexia nervosa subtypes. Int J Eat Disord 1996 May;19(4):371–9.Google ScholarPubMed
Reba, L, Thornton, L, Tozzi, F, Klump, KL, Brandt, H, Crawford, S, et al. Relationships between features associated with vomiting in purgingtype eating disorders. Int J Eat Disord 2005 Dec;38(4):287–94.CrossRefGoogle ScholarPubMed
Rosval, L, Steiger, H, Bruce, K, Israel, M, Richardson, J, Aubut, M. Impulsivity in women with eating disorders: problem of response inhibition, planning, or attention? Int J Eat Disord 2006 Nov;39(7):590–3.CrossRefGoogle ScholarPubMed
Shearer, S, Peters, C, Quaytman, M, Wadman, BE. Intent and lethality of suicide attempts among female borderline inpatients. Am J Psychiatry 1988;145:1424–7.Google ScholarPubMed
Steiger, H. Eating disorders and the serotonin connection: state, trait and the developmental effects. J Psychiatry Neurosci 2004;29:20–9.Google ScholarPubMed
Stein, D, Lilenfeld, LR, Wildman, PC, Marcus, MD. Attempted suicide and self-injury in patients diagnosed with eating disorders. Compr Psychiatry 2004;45:447–51.CrossRefGoogle ScholarPubMed
Sullivan, PF. Mortality in anorexia nervosa. Am J Psychiatry 1995;152(7):1073–4.Google ScholarPubMed
Tozzi, F, Thornton, LM, Klump, KL, Fichter, MM, Halmi, KA, Kaplan, AS, et al. Symptom fluctuation in eating disorders: correlates of diagnostic crossover. Am J Psychiatry 2005;162:732–40.CrossRefGoogle ScholarPubMed
Vandereycken, W, Pierloot, R. The significance of subclassification in anorexia nervosa: a comparative study of clinical features in 141 patients. Psychol Med 1983 Aug;13(3):543–9.CrossRefGoogle ScholarPubMed
Viesselman, JO, Roig, M. Depression and suicidality in eating disorders. J Clin Psychiatry 1985;46:118–24.Google ScholarPubMed
Vitousek, K, Manke, F. Personality variables and disorders in anorexia nervosa and bulimia nervosa. J Abnorm Psychol 1994;103:137–47.CrossRefGoogle ScholarPubMed
Westen, D, Harnden-Fischer, J. Personality profiles in eating disorders: rethinking the distinction between axis I and axis II. Am J Psychiatry 2001;158:547–62.CrossRefGoogle ScholarPubMed
Wildman, P, Lilenfeld, LRR, Marcus, MD. Axis I comorbidity onset and parasuicide in women with eating disorders. Int J Eat Disord 2004;35:190–7.CrossRefGoogle ScholarPubMed
Woolf, B. On estimating the relation between blood group and disease. Ann Hum Genet 1955;19:251–3.CrossRefGoogle ScholarPubMed
Youssef, G, Plancheret, B, Laget, J, Corcos, M, Clament, MF, Halfon, O. Personality trait risk factors for attempted suicide among young women with eating disorders. Eur Psychiatry 2004;19:131–9.CrossRefGoogle ScholarPubMed