Body Attitudes and Experiences, Capability for Suicide, and Suicide Attempts in Individuals with Eating Disorders

Research evidences a link between eating disorders and suicidal behaviors, and capability for suicide has been proposed as a mechanism underlying this relationship. Negative body attitudes and experiences (BAE) are another promising set of explanatory variables, central to eating disorder pathology and theoretically aligned with capability for suicide. This study investigated direct pathways between BAE, particularly body protection, and lethality and frequency of past suicide attempts, as well as indirect pathways through capability for suicide (pain tolerance, fearlessness about death) and severity of eating pathology. The study also evaluated whether BAE differentiated among suicide attempt, ideation, and non-suicidal groups. Adults currently receiving eating disorder treatment (N = 352; 55.5% outpatient; 92.8% female; mean age 28.1 years) completed self-report measures of BAE, eating pathology, capability for suicide, and suicide-related variables. The PROCESS macro was utilized to test proposed direct and indirect pathways, and a Dunnett’s T3-corrected MANOVA evaluated differences in BAE across suicide groups. Results indicated low body protection was significantly directly associated with increased lethality and quantity of past suicide attempts. Only the indirect pathway through pain tolerance in predicting attempt frequency was significant. Further, body protection and lack of body familiarity differentiated among all suicide groups, while body attitudes and comfort with touch differentiated attempters from non-attempters, and body care differentiated non-suicidal participants from those with attempt or ideation history. Findings suggest BAE, particularly low body protection and lack of body familiarity, may merit consideration in studying the propensity of those with eating disorders to engage in suicidal behavior.