Bridging Eating Disorder Psychopathology and Suicidality: A Network Comparison of Anorexia Nervosa and Bulimia Nervosa.

Objective

Although both anorexia nervosa (AN) and bulimia nervosa (BN) are associated with elevated suicide risk, whether the symptom-level associations between eating disorder psychopathology and suicidality differ across diagnoses remains poorly understood. This study aimed to estimate and compare the networks of eating disorder psychopathology and lifetime suicide attempt history in patients with AN and BN.

Method

Participants were 865 female patients diagnosed with AN (n = 257) or BN (n = 608). Eating disorder psychopathology was assessed using the Eating Disorder Inventory-2 (EDI-2), depressive symptoms using the Beck Depression Inventory (BDI), and lifetime suicide attempt history via a diagnostic interview. Separate networks were estimated for AN and BN patients. Network comparison procedures were applied to examine differences in overall network structure, global strength, and individual edge weights.

Results

In the AN network, the suicide attempt node was directly connected to depressive symptoms and multiple eating disorder psychopathological dimensions, with the suicide attempt-EDI-bulimia edge showing the largest estimate. In the BN network, suicide attempt history was directly connected to depressive symptoms, impulse regulation, and ineffectiveness, with the suicide attempt-impulse regulation edge showing the largest estimate. Network comparison tests showed significant differences in overall network structure. Among suicide-related edges, the suicide attempt-EDI-bulimia edge was significantly stronger in AN.

Discussion

Suicide attempt history showed diagnosis-specific network associations with eating disorder psychopathology. These findings highlight the importance of diagnosis-specific approaches to suicide risk assessment in eating disorders and suggest potential symptom-level targets for clinical intervention.