Background: The aim of this study was to assess the relationship between body image and suicidal tendencies in anorexia nervosa (AN). Methods: Three groups of hospitalized female adolescents – nonsuicidal AN, suicidal psychiatric and nonsuicidal psychiatric patients, as well as a community control group with no psychiatric disturbances were compared with regard to suicidal tendencies (in the form of attitudes to life and death), body image and experience, depression and anxiety. Results: The AN and suicidal patients showed less attraction to but more repulsion by life, and more attraction to and less repulsion by death compared with the other two groups. The AN and suicidal patients were also different from either one or both control groups in showing more negative attitudes and feelings towards their bodies, lower sensitivity to body clues, less body control, and elevated depression and anxiety. These between-group differences in suicidal tendencies were retained after controlling for age, body mass index, the different body image dimensions, anxiety and depression. Conclusions: Our findings suggest that female AN inpatients with no evidence of overt suicidal behavior demonstrate elevated suicidal tendencies that are similar to those of suicidal psychiatric inpatients. These self-destructive tendencies are highly associated with a pervasive sense of disturbance of body image and experience.

Bruch H: Eating Disorders: Obesity, AN, and the Person Within. New York, Basic Books, 1973.
Thompson JK: Introduction; in Thompson JK (ed): Body Image, Eating Disorders, and Obesity. Washington, American Psychological Association, 1997, pp 1–20.
Cash TF, Deagle EA: The nature and assessment of body-image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. Int J Eat Disord 1997;22:107–125.
Leon GR, Fulkerson JA, Perry CL, Early-Zald MB: Prospective analysis of personality and behavioral vulnerabilities and gender influences in later development of disordered eating. J Abnorm Psychol 1995;104:140–149.
Striegel-Moore RH, Silberstein LR, Frensch P, Rodin J: A prospective study of disordered eating among college students. Int J Eat Disord 1989;8:499–509.
Slade PD: A review of body-image studies in anorexia nervosa and bulimia nervosa. J Psychiatr Res 1985;19:255–265.
Smith C, Feldman S, Nasserbakht A, Steiner H: Psychological characteristics and DSM-III-R diagnoses at 6-year follow-up of adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 1993;32:1237–1245.
Srinivasagam NM, Kaye WH, Plotnicov KH, Greeno CG, Weltzin TE, Rao R: Persistent perfectionism, symmetry, and exactness in anorexia nervosa after long-term recovery from anorexia nervosa. Am J Psychiatry 1995;152:1630–1634.
Buddeberg-Fischer B, Klaghofer R, Reed V: Associations between body weight, psychiatric disorders and body image in female adolescents. Psychother Psychosom 1999;68:325–332.
Heinberg LJ: Theories of body image disturbance: Perceptual, developmental, and sociocultural factors; in Thompson JK (ed): Body Image, Eating Disorders, and Obesity. Washington, American Psychological Association, 1997, pp 27–47.
Probst M, Vandereycken W, Van Coppenolle H, Pieters G: Body experiences in eating disorders before and after treatment: A follow-up study. Eur Psychiatry 1999;14:333–340.
Slade PD, Russell GFM: Awareness of body dimensions in anorexia nervosa: Cross-sectional and longitudinal studies. Psychol Med 1973;3:188–199.
Thompson JK, Spana RE: Visuospatial ability, accuracy of size estimation and bulimic disturbance in a noneating-disordered college sample: A neuropsychological analysis. Percept Mot Skills 1991;73:335–338.
Berry EM, Fried S, Edelstein EL: Abnormal oral sensory perception in patients with a history of anorexia nervosa and the relationship between physiological and psychological improvement in this disease. Psychother Psychosom 1995;63:32–37.
Brooks-Gunn J, Warren MP: Effects of delayed menarche in different contexts: Dance and non-dance students. J Youth Adolesc 1985;14:285–300.
Cattarin J, Thompson JK: A three-year longitudinal study of body image and eating disturbance in adolescent females. Eat Disord: J Treat Prevent 1994;2:114–125.
Nagel KL, Jones KH: Sociocultural factors in the development of eating disorders. Adolescence 1992;27:107–113.
Orbach I: The role of body experience in self-destruction. Clin Child Psychol Psychiatry 1996;1:607–619.
Orbach I, Lotem-Peleg M, Kedem P: Attitudes towards the body in suicidal, depressed and normal adolescents. Suicide Life Threat Behav 1995;25:211–221.
Orbach I, Mikulincer M: The Body Investment Scale: Construction and validation of a body experience scale. Psychol Assess 1998;10:415–425.
Petrie K, Chamberlain K, Clarke A: Psychological predictions of future suicidal behavior in hospitalized suicide attempters. Br J Clin Psychol 1998;27:247–257.
Russ MJ, Shearin EN, Clarkin JF, Harrison K, Hull WJ: Subtypes of self-injurious patients with borderline personality disorder. Am J Psychiatry 1993;150:1869–1871.
Orbach I, Mikulincer M, King R, Cohen D, Stein D: Thresholds and tolerance of physical pain in suicidal and nonsuicidal adolescents. J Consult Clin Psychology 1997;65:646–652.
Orbach I, Stein D, Shani-Sela M, Har-Even D: Body attitudes and body experiences in suicidal adolescents. Suicide Life Threat Behav 2001;31:237–249.
Sullivan PF: Mortality in AN. Am J Psychiatry 1995;152:1073–1074.
Bulik CM, Sullivan PF, Joice PR: Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatr Scand 1999;100:27–32.
Apter A, Gothelf D, Orbach I, Weizman R, Ratzoni G, Har-Even D, Tyano S: Correlation of suicidal and violent behavior in different categories in hospitalized adolescent patients. J Am Acad Child Adolesc Psychiatry 1995;34:912–918.
Favaro A, Santonastaso P: Suicidality in eating disorders: Clinical and psychological correlates. Acta Psychiatr Scand 1997;95:508–514.
Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB: Mortality in eating disorders: A descriptive study. Int J Eat Disord 2000;28:20–26.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
Walsh WB, Rosen PM: Self-Mutilation. New York, Guilford, 1988.
Goodsitt A: Eating disorders: A self-psychological perspective; in Garner DM, Garfinkel PE (eds): Handbook of Treatment for Eating Disorders. New York, The Guilford Press, 1997, pp 208–228.
Bray GA: An approach to the classification and evaluation of obesity; in Bjorntorp P, Brodoff BN (eds): Obesity. Philadelphia, Lippincott, 1992, pp 294–308.
Kaufman J, Birmaher B, Brent D, Rau U, Flynn C, Moreci P, Williamson D, Ryan N: Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36:980–988.
Strober M: The Eating Disorders Family History Interview. Los Angeles, University of California, 1987.
Lilenfeld LR, Kaye WH, Greeno CG, Merikangas KR, Plotnicov KH, Pollice C, Rao R, Strober M, Bulik CM, Nagy L: A controlled family study of AN and bulimia nervosa: Psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry 1998;55:603–610.
Orbach I, Milstein I, Har-Even D, Apter A, Tyano S, Elizur A: A Multi-Attitude Suicide Tendency scale for adolescents. Psychol Assess: J Consult Clin Psychol 1991;3:398–404.
Osman A, Barrios FX, Panak WF, Osman JR, Hoffman J, Hammer R: Validation of the Multi-Attitude Suicide Tendency scale in adolescent samples. J Clin Psychol 1994;50:847–855.
Kreitler S, Kreitler H: Body image: The dimension of size. Genetic Soc Gen Psychol Monogr 1988;114:5–32.
Chapman LJ, Chapman JP, Raulen ML: Body-image aberration in schizophrenia. J Abnorm Psychol 1978;87:399–407.
Nordstrom P, Schalling M, Asberg M: Temperamental vulnerability in attempted suicide. Acta Psychiatr Scand 1995;92:155–160.
Beck AT, Brown G, Steer RA, Eidelson JI: Differentiating anxiety and depression: A test of cognitive content specificity hypothesis. J Abnorm Psychol 1987;96:179–183.
Jackson CC, Davidson GP: The anorectic patient as a survivor: The denial of death and death themes in the literature on anorexia nervosa. Int J Eat Disord 1986;5:821–835.
Tyano S, Vincent M: L’adolescent, la vie et la mort, le quatrième organisateur (in French). Psychiatr Fr 1997;4:131–150.
Strober M: Disorders of the self in anorexia nervosa: An organismic-developmental paradigm; in Johnson CL (ed): Psychodynamic Treatment of Anorexia nervosa and Bulimia. New York, Guilford, 1991, pp 354–373.
Garner DM: Eating Disorder Inventory-2 (EDI-2). Odessa, Psychological Assessment Resources, 1991.
Casper RC: Personality features of women with good outcome from restricting anorexia nervosa. Psychosom Med 1990;52:156–170.
Strober M, Freeman R, Morrell W: The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 1997;22:339–360.
Crisp AH: Anorexia nervosa: Let me be. London, Academic Press, 1980.
Klein DF, Gittleman R, Quitkin F, Rifkin A: Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children. Baltimore, Williams & Wilkins, 1980.
Gleaves DH, Eberenz KP: Correlates of dissociative symptoms among women with eating disorders. J Psychiatr Res 1995;29:417–426.
Cash TF: The treatment of body image disturbance; in Thompson JK (ed): Body Image, Eating Disorders, and Obesity. Washington, American Psychological Association, 1997, pp 83–107.
Kanayama G, Pope HG, Hudson JI: ‘Body image’ drugs: A growing psychosomatic problem. Psychother Psychosom 2001;70:61–65.
Ricca V, Mannucci E, Zucchi T, Rotella CM, Faravelli C: Cognitive-behavioral therapy for bulimia nervosa and binge-eating disorders. Psychother Psychosom 2000;69:287–295.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.