Research on Eating Disorders and Suicidality Lab

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:

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• Mechanistic Dehumanization: Collaborator, Dr. Franki Kung, has proposed that Asians have historically been viewed in the U.S. as like machines or robots, indicating that they are subject to mechanistic dehumanization. Integrating this dehumanization perspective with clinical psychology research, we are working to test a model whereby mechanistic dehumanization and related constructs impact interoception and in turn, disordered eating and suicidality. We  collected data among 300 Asian Americans in the U.S. over 4 timepoints (1 month apart) to begin testing this model.

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• LGBTQ+ 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). Ongoing research projects are quantitatively and qualitatively investigating eating disorder symptoms, interoceptive dysfunction, and suicidality among LGBTQ+ individuals.

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• Older adults: We are currently collecting 3 waves of data among older adults to test how aging related factors may impact interoception, as well as disordered eating and suicidality.

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

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• Service Members: We have a number of projects and databases related to mental health issues particular to Service Members. We are also currently funded to develop prevention programs and interventions for suicidality for service members.

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• 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). 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. Additionally, with Dr. Raval, we are testing the delivery of online DBT programs to students in India.

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• Food-Insecure Populations: We are currently collecting data in collaboration with the Auburn University Hunger Solutions Institute to better understand body image, weight stigma, interoceptive dysfunction, eating pathology, and risk factors for suicide among individuals experiencing food insecurity on and around campus. 

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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 (e.g., 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. 

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• Interoception: Interoception is crucial for recognizing emotions and sensations (e.g., hunger, temperature, pain) and responding accordingly. People without interoceptive awareness are thus out of touch with their bodies—numb to their internal sensations. As such, interoceptive deficits may facilitate self-injury as it is easier to harm a body one is disconnected from than a body to which one is connected. Supporting this, we find interoceptive deficits are elevated in suicide groups compared to controls, and higher in suicide attempters compared to ideators and planners (e.g., *Forrest, Smith, et al., 2015; Smith et al., 2018; Smith et al., 2020; Smith et al., 2023). Interoceptive deficits are also greatest among those with the most recent and lethal attempts (Duffy, Smith, et al., 2021, *Forrest, Smith, et al., 2015; Smith et al., 2020). Notably, worse interoceptive awareness also longitudinally predicts self-injury (Gioia, Forrest, & Smith, 2022; *Velkoff & Smith, 2023). This work, which has been replicated by multiple independent lab groups, supports ideation-to-action frameworks as it suggests that as interoceptive awareness decreases, one becomes more capable of lethal action.

• Given that interoception is modifiable, over the past decade we developed a novel, computerized training program to improve interoceptive awareness, called Reconnecting to Internal Sensations and Experiences (RISE). This program of research has been continuously funded by the Department of Defense since 2019 (#R02106, MO23031). Our pilot tests (Smith et al., 2021; Smith et al., 2022) found RISE to be acceptable and feasible, as well as associated with improved interoceptive awareness and reduced suicidal ideation, disordered eating, depression, and anxiety scores at post-test. In a randomized trial conducted at two military bases, we found RISE was associated with greater improvements in interoceptive awareness relative to the comparator. These improvements largely persisted at 1 and 3-month follow-up (Smith et al., 2023). We are beginning another RCT to test whether RISE can prevent the onset of suicidal ideation among healthy service members (#MO23031).​

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• 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).

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