# The association of eating disorder specific and unspecific symptoms with suicidal ideation in patients with anorexia nervosa

## TL;DR

This study finds that suicidal thoughts in anorexia nervosa are more linked to general psychological symptoms like depression and anxiety than to eating disorder-specific symptoms.

## Contribution

The study uses network analysis to show that broader psychological symptoms, not eating disorder-specific ones, are most strongly associated with suicidal ideation in anorexia nervosa.

## Key findings

- Feelings of ineffectiveness, depressive, and anxiety symptoms were most strongly related to suicidal ideation.
- Eating disorder-specific symptoms were not significantly linked to suicidal ideation.
- The associations remained consistent before and after partial weight gain during treatment.

## Abstract

Anorexia nervosa is a serious eating disorder with a high mortality rate, ranking among the most lethal mental health conditions. This is not only due to sequelae of cachexia, but also due to suicidality. The present study employs a network analysis approach to determine whether there are unique associations between suicidal ideation and eating disorder-specific symptoms in anorexia nervosa, or if suicidal ideation is more influenced by other symptoms such as those more loosely related to eating disorders or general internalizing symptoms, as well as biological factors. Additionally, we examined the potentially changing impact of symptoms after intensive treatment. Methods: The study involved female patients with anorexia nervosa admitted to intensive inpatient treatment. Eating disorder-specific and -related symptoms, depressive, anxiety, obsessive-compulsive symptoms, nutritional data as well as suicidal ideation were assessed at two points: immediately after admission (n = 313) and following partial weight gain (n = 217) and were examined together in a network analysis model. Results: The nodes that were most strongly related to suicidal ideation at both timepoints were feelings of ineffectiveness, as well as depressive and anxiety symptoms. Eating disorder-specific symptoms were found to be not significantly related to suicidal ideation. Conclusions: The results indicate that suicidal ideation in anorexia nervosa is primarily related to broader psychological symptoms rather than eating disorder-specific symptoms. The prominence of feelings of ineffectiveness within the network highlights the need for clinical interventions that focus on the enhancement of self-efficacy in anorexia nervosa.