5 - (SYM 92) Restless Nights, Restless Appetites: Exploring the Links Between Sleep Dysfunction and Agitation on Suicidality Among Eating Disorder Patients

Individuals with eating disorders are particularly susceptible to experiencing suicidal thoughts and behaviors, with more than 40% of individuals with eating disorders endorsing suicidal ideation (Smith et al., 2018). However, the mechanisms underlying the association between suicide and disordered eating are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts. Dysfunction in sleep is one such risk factor that may confer increased suicide risk, particularly among individuals with eating disorders. Compared to individuals without suicidal ideation, individuals with suicidal ideation report a pattern of more severe and frequent sleep problems, including poor sleep quality, insomnia, and nightmares (Krakow et al., 2011). Indeed, sleep problems are self-reported at higher rates among individuals with eating disorders compared to healthy controls (Asaad Abdou et al., 2018). Furthermore, agitation in tandem with sleep problems could confer the highest risk for suicidal thoughts and behaviors among individuals with eating disorders, as this creates an internal state of psychic anxiety during the day without the brief respite of sleep at night. Hence, the purpose of the current study was to examine relations between sleep difficulties, agitation, and suicidal ideation among a residential eating disorder sample. Female eating disorder patients (N=97) completed weekly questionnaires across 12 weeks of treatment. General linear mixed (GLM) models examined whether sleep quality and/or agitation were concurrently or prospectively associated with suicidal ideation. Results revealed a significant interaction between within-person sleep quality and agitation on suicidal ideation [B(S.E.) = −0.02(0.01), p < 0.05], such that on weeks when an individual experienced both lower than their average sleep quality and higher than their average agitation, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. These results suggest that in order to manage suicidal ideation among individuals with eating disorders, ongoing assessment of sleep as well as overall overarousal symptoms, including agitation, may be warranted. Evidence-based treatments that target sleep problems, such as Cognitive Behavioral Therapy for Insomnia, and agitation and overarousal, such as Dialectical Behavioral Therapy, may be effective in reducing suicidality in treatment-seeking patients.