Research on Eating Disorders and Suicidality Lab

Interface between eating disorders and suicidality

• Interpersonal psychological theory of suicide: Much of our previous work tested the Interpersonal Theory of Suicide (IPTS; Joiner, 2005) among people with eating disorders (Smith et al., 2017). The theory holds that suicide results when an individual desires death and has developed the capability to enact lethal self-harm; this capability develops through experience with pain and provocation. Early work by Joiner (2005) suggested that suicidal behavior is elevated in eating disorders, and anorexia nervosa in particular, because those with eating disorders have extremely elevated capability for suicide due to their frequent engagement in painful eating disorder behaviors. However, support for this supposition is mixed, as our research finds that some eating disorder behaviors, like vomiting, laxative use, and over-exercise, are associated with elements of capability for suicide, while other eating disorder factors, like restriction and anorexia diagnosis, are not (Smith et al., 2013; Witte, Zuromski, Gautheir, Smith et al., 2016). Additionally, we failed to find elevations in capability for suicide among an eating disorder sample relative to controls or a psychiatric comparison group (Smith, et al., 2017). However, our work does support that the eating disorder-suicide relationship may be driven by associations between eating disorder symptoms and the desire for suicide; specifically, low belongingness, perceived burdensomeness, and suicidal ideation (*Dodd, Smith, & Bodell, 2014; *Forrest…Smith, 2016; Smith et al., 2016). Taken together, our work suggests that the IPTS provides a useful, though perhaps incomplete, explanation of the elevated suicide risk among eating disorder samples. As such we have begun considering other biological, sociocultural, and psychological factors that may contribute to suicide risk among individuals with eating disorders. 

​

• Interoception: Interoception refers to being aware of emotional and physical sensations in the body (e.g., hunger, cold, heart rate, anxiety). People with impaired interoception, or interoceptive deficits, are literally “out of touch” with their bodies. Research has long supported interoception in the etiology of eating disorders, with the idea being that individuals who are out of touch with hunger and/or satiety sensations are more vulnerable to restrictive and binge eating behaviors, respectively. However, our lab began testing whether interoceptive deficits relate self-injurious behaviors more broadly. Our lab group conducted the first study examining interoceptive deficits in suicide ideators, planners, and attempters. Across two studies, interoceptive deficits were elevated in all suicide groups compared to controls, and significantly higher in suicide attempters compared to ideators and planners. Additionally, interoceptive deficits varied as a function of suicide attempt recency, with the most recent attempters having the greatest deficits, suggesting interoceptive deficits may be an important factor to consider in the identification of individuals capable of engaging in lethal self-injury (*Forrest, Smith, **White, Joiner, 2015). We have since replicated these findings in two independent eating disorder samples (Smith, *Forrest, *Velkoff, 2018; *Dodd, Smith, et al., 2018), a military sample (Smith et al., in press), and a sample of individuals engaging in non-suicidal self-injury (*Forrest & Smith, in press). Additionally, our work has identified that multiple attempters have greater interoceptive deficits than single attempters, that interoceptive deficits are positively associated with the lethality of the attempt, and that interoceptive deficits related to suicide attempts over and above risk factors such as hopelessness, gender, age, and post-traumatic stress symptoms. 

​

• Disgust sensitivity: Recent studies have found relationships between disgust and mental illnesses, such as posttraumatic stress disorder, borderline personality disorder, and obsessive-compulsive symptoms. Previous research in the lab has identified disgust sensitivity for death-related stimuli as a potential indicator of fearlessness about death (Velkoff, Forrest, Dodd, & Smith, 2016).

​​​

​

Eating Disorders

• Psychophysiological markers: We have used facial EMG to examine the role of disgust response in the perception of emaciated and overweight bodies (Dodd, Velkoff, Forrest, Fussner, & Smith, 2017). Additionally, we are investigating cardiac impedance (i.e., challenge vs. threat responses) in relation to a lab based stressor among highly perfectionistic individuals.

​

• Biological markers: Past work from our lab has tested the relationship between prenatal testosterone exposure and the development of disordered eating in women (Quinton, Smith, & Joiner, 2011) and men (Smith, et al., 2009). 

​

• Cognitive bias modification: In conjunction with the Clerkin Lab, we are currently working to develop an interpretation retraining intervention for maladaptive perfectionism.

​

• Over-exercise: We have a number of projects examining the effects of over-exercise on mental health outcomes (Smith, Yeager, & Dodd, 2015; Forrest, Smith, Fussner, Dodd, & Clerkin, 2016).

​

• Web-based treatment for eating disorders: In collaboration with Dr. Joseph Franklin, we are testing a web app that uses therapeutic evaluative conditioning (TEC) to reduce eating disordered behaviors. 

​

 

Suicide

• Implicit cognition: We are currently working on developing a novel implicit association task to measure suicidality and predict suicidal ideation and behavior.

​

• Genetic markers: The first study to examine the influence of genetics and environment on the factors of Joiner’s (2005) theory of suicide found that environmental influences appear to play an important role in the etiology of belongingness and burdensomeness, whereas acquired capability for suicide appears to be influenced by a combination of both genetic and non-shared environmental factors (Smith, et al., 2012).

​

• Prevention: We have conducted a set of studies (Smith, et al., 2014; Silva, Smith, Dodd, et al., 2016) investigating gatekeeper training among mental health care workers across the United States.​

​

• Individual Networks: We are currently applying network theory to known correlates and precedents fo suicide and assessing these symptoms using ecological momentary assessments. 

​

• Stigma: In collaboration with Dr. Jeff Hunger, we are investigating the role of weight stigma in suicide-related outcomes. In collaboration with Dr. Jonathan Kunstman, we are testing the role of discrimination and social pain minimization on suicidality. 

​

​

Cultural contexts

We strongly value understanding the cultural contexts that affect eating behavior and suicidality. To that end, we are conducting work in the following areas:

• Cross-cultural work: In the past, we collected data on Japanese women to test how perfectionism and body dissatisfaction interact to produce disordered eating (Smith & Joiner, 2008). Upcoming research projects will examine experiences of burdensomeness and belongingness, along with collegiate stressors such as exclusion and academic stress, as predictors of suicide risk among Chinese international college students. Additionally, in collaboration with Dr. Vaishali Raval, we collected data from college students in India examining constructs related to suicidality and academic stressors to better understand suicidality in this population. We have several in prep projects stemming from these data.

​

• Sexual minority populations: We found that body fat dissatisfaction was a better predictor of disordered eating behaviors than muscularity dissatisfaction in both gay and heterosexual men (Smith, et al., 2011). Previous work in the lab examined suicide risk factors among sexual minority women (Velkoff, Forrest, Dodd, & Smith, 2016), and ongoing research projects are investigating eating disorder symptoms among both sexual minority men and women.

​

• Weight stigma: In collaboration with Dr. Jeff Hunger, we are conducting work examining relations between weight stigma and both disordered eating and suicidality.