Nonsuicidal self-injury in youth inpatients with eating disorders ; lifetime prevalence, methods, clinical correlates, and suicidality ; Nicht-suizidales selbstverletzendes Verhalten bei stationär behandelten Kindern und Jugendlichen mit Essstörung: Lebenszeitprävalenz, Methoden, klinische Korrelate und Suizidalität

This dissertation adresses nonsuicidal self-injury (NSSI) in youth inpatients with eating disorders (EDs). Even though EDs and NSSI both represent self-harming behaviors that are associated with an increased risk of mortality and suicide, epidemiological data on NSSI have been lacking for this vulnerable patient population. The present work first provides an overview of relevant clinical concepts and the current state of research on NSSI in EDs. An empirical study is then presented that was conducted as part of this dissertation to address an existing research gap by providing data on lifetime prevalence, methods used, clinical correlates, and suicidality associated with NSSI in youth inpatients with EDs. This empirical study is a retrospective chart review, which analyzed data from patients ≤ 18 years consecutively admitted between 1990–2015 to the Child and Adolescent Psychiatry Unit of the Charité University Hospital in Berlin, Germany, with a diagnosis of anorexia nervosa, restrictive type (AN-R), anorexia nervosa, binge-purge type (AN-BP), or bulimia nervosa (BN), according to the International Statistical Classification of Diseases and Related Health Problems. The sample consisted of 382 patients, was predominantly female (97.1%), and had a median age of 15.6 years (age range 9–18 years). Overall, a high lifetime prevalence of NSSI was found, with 47.6% in BN, 39.3% in AN-BP, and 8.3% in AN-R. Cutting was the most common NSSI method, followed by scratching, hitting, and burning. Multivariable regression analyses showed that NSSI independently correlated with a significantly higher number of psychiatric comorbidities in each ED subgroup and, in addition, with a lower weight gain during hospitalization in AN-R and with a longer duration of treatment in BN. Furthermore, NSSI was associated with more suicidal ideation in all ED subgroups, and additionally with more suicide attempts in AN-BP. In this dissertation, the obtained empirical findings are discussed against the background of the current state of ...