EDs and the IPTS
Previous research regarding the IPTS and eating behaviors has typically focused on populations with clinically diagnosed EDs. Perceived burdensomeness has been associated with body dissatisfaction, binge eating, restricting, and laxative misuse in inpatient samples (Forrest et al., 2016). Furthermore, body dissatisfaction and restricting are related to suicidal ideation through higher perceived burdensomeness (Forrest et al., 2016). Thwarted belongingness has been positively associated with body dissatisfaction and restricting behaviors (Forrest et al., 2016). When looking specifically at a population of women diagnosed with bulimia, Lieberman and colleagues (2021) found perceived burdensomeness had a stronger effect on suicidal ideation than thwarted belongingness did, and that the interaction between perceived burdensomeness and thwarted belongingness was significantly associated with suicidal ideation. Similar results were found among a heterogenous ED sample, where the combination of thwarted belongingness and perceived burdensomeness was associated with lifetime suicidal ideation (Pisetsky et al., 2017).
Studies on capability for suicide have not provided entirely consistent results. For instance, Pisetsky and colleagues (2017) found that the pain tolerance facet of acquired capability was significantly associated with suicide attempts among those diagnosed with EDs, but it was not associated with fearlessness about death. A study among a college student sample examined pain tolerance and fearlessness about death among individuals who restricted calories and did not find an association (Zuromski & Witte, 2015). Similar results were demonstrated in a clinical sample which indicated that restricting was not associated with capability after controlling for other maladaptive eating behaviors (Witte et al., 2016). This finding is interesting considering research does indicate that restricting is associated with suicide attempts (Zuromski & Witte, 2015; Witte et al., 2016). Other maladaptive eating behaviors, such as vomiting and laxative misuse, have demonstrated strong associations with capability even when controlling for restricting behaviors (Witte et al., 2016). Additionally, vomiting was significantly associated with both facets of capability (i.e., pain tolerance and fearlessness about death; Witte et al., 2016).
Individuals diagnosed with EDs and individuals in psychiatric care have been found to demonstrate higher levels of thwarted belongingness, perceived burdensomeness, and suicidal ideation than a general college student population (Smith et al., 2016). However, college student populations in themselves constitute an important group for maladaptive eating behaviors and suicide risk research (Lipson & Sonneville, 2020). Studies examining the IPTS in college student samples have found that greater numbers of maladaptive eating symptoms as measured by the Eating Disorder Examination- Questionnaire were associated with greater thwarted belongingness and perceived burdensomeness, both of which were associated with a greater suicide risk (Kwan et al., 2017). Overall, research indicates that suicide risk is higher among those who engage in maladaptive eating behaviors and is influenced by severity and specific symptom presentations (Lipson & Sonneville, 2020).