Predicting concurrent and short-term desire and intent to attempt suicide among people with body dysmorphic disorder using ecological momentary assessment of anxiety and shame.

Abstract

Anxiety and shame are central, elevated emotions in body dysmorphic disorder (BDD) that are implicated as risk factors for suicide in suicide theories and are associated with suicide risk in cross-sectional BDD studies. Given that emotions are transient and suicide risk can increase quickly, risk prediction in BDD may be enhanced by measuring momentary anxiety and shame. In 87 adults with moderate to severe, clinician-diagnosed BDD, we collected ecological momentary assessment-rated anxiety and shame 3 times daily for two 14-day periods (28 days). We used generalized linear mixed models to estimate associations of concurrent or next-observation ecological momentary assessment-rated (a) intensity of desire to die by suicide and (b) intention (absent/present) to attempt suicide, above baseline clinician-assessed suicide ideation (SI) severity (Columbia-Suicide Severity Rating Scale). Higher within-person deviations from one's average anxiety and shame were significantly related to greater concurrent and next-observation suicide desire and concurrent intent, above baseline clinician-assessed SI severity. Only baseline clinician-assessed SI predicted next-observation suicide intent. Altogether, results showed that our ability to detect and predict suicide risk in BDD was improved beyond baseline clinician assessment when a person's current anxiety and shame levels were also considered. When someone with BDD experiences elevated anxiety or shame compared to their own norm, these elevations are associated with concurrent and short-term increases in suicide desire and concurrent suicide intent. This is the first prospective study of shame and anxiety as risk factors for SI in BDD. Results underscore the importance of these emotions as assessment and intervention targets. (PsycInfo Database Record (c) 2025 APA, all rights reserved).