Many people have heard about the dangers of dying from medical complications associated with eating disorders (e.g., organ failure). However, less people are aware that suicide is also a major cause of premature death among individuals with eating disorders.
Arcelus and colleagues (2011) conducted a study and found that individuals with anorexia nervosa had a much higher premature mortality rate than individuals with other types of mental disorders (e.g., schizophrenia, depression, bipolar disorder) and that approximately one in five of those deaths were due to suicide. Meanwhile, another recent large-scale study by Zerwas et al. (2015) found that individuals with eating disorders (anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified) had elevated risks for both death by suicide and suicide attempts, as compared to people without eating disorders. Finally, a new study (Fichter & Quadflieg, 2016) looked at early death rates in binge eating disorder in addition to the previously mentioned eating disorders and concluded that, “suicide is a major concern not only in anorexia nervosa, but in all eating disorders, calling for intensive attention of all clinicians.”
Warning Signs & Risk Factors
If you or someone you know is afflicted with an eating disorder, it is important to know how to recognize suicide risk. In 2010, Van Orden and colleagues identified some of the most powerful risk factors for suicide, which include: having a mental disorder, previous suicide attempts, social isolation, perceiving oneself as a burden to others, and a lack of fear about suicide. The American Association of Suicidology has also identified warning signs of suicide including: suicidal ideation (thoughts and planning about suicide), substance abuse, purposelessness, anxiety, feeling trapped, hopelessness, withdrawal from others, anger, recklessness, and mood changes. If you notice these risk factors and/or warning signs in yourself or people you know, it is important to do your best to get help immediately. Sometimes people worry that if they ask someone if they are thinking about suicide that it will plant the idea in their head, but the research suggests that does not happen (e.g., Gould et al., 2005). Rather, it can be a helpful way to express concern and figure out if someone needs help.
How You Can Help
It is important to understand that people who suffer from eating disorders may be thinking about suicide because they are having emotional, mental, and physical experiences that are incredibly painful. Many people misunderstand suicidal thinking as selfish or weak (Sand, Gordon, Bresin, 2013) rather than as a symptom of a mental disorder. You can be very helpful to people who feel suicidal by approaching them with warmth, support, and compassion for their suffering. It is important to simultaneously firmly express that suicide is not the solution and that seeking help for their mental health problems is a solution. If you are the one feeling suicidal, please have some compassion for yourself and don’t feel ashamed about seeking help.
In addition to approaching the person who is experiencing suicidal desire with kindness, it is important to try to keep them as safe as possible. The most effective strategies depend on the individual and the situation, but some commonly helpful immediate steps include 1) restricting their access to means for hurting themselves (e.g., taking away access to guns, medications, etc. while this person is at elevated suicide risk, arranging for them to be supervised by their parents or friends while they are at risk) and 2) developing a crisis plan for healthy coping strategies to engage in when thinking about suicide (e.g., calling emergency phone numbers such as 911, contacting supportive friends or family members, engaging in enjoyable activities such as going for a walk or playing games, looking at photos and/or quotes that instill hope, etc.). It is also really important that the person seeks out longer term care with a mental health professional and/or a physician.
Where to Get Help
Fortunately, there are many good resources available for help with suicidal thoughts. One useful first step is to reach out to services specifically available for suicide prevention. These services provide help immediately and can also link you up to local referrals for more long-term care (e.g., therapy). These include the following:
National Suicide Prevention Lifeline
Veterans Crisis Line
1-800-273-8255, Press 1.
The Trevor Project (for LGBTQ youth)
People with eating disorders appear to be at greater risk for suicide attempts and death by suicide. Importantly, there are good resources available and there are many good reasons to have hope. Please seek help – you are valuable and your life is important.
About The Author:
Dr. Kathryn Gordon is an Associate Professor in the Psychology Dept. at North Dakota State University. Her research focuses on disordered eating and suicidal behavior. She is the director of the Disordered Eating and Suicidal Behavior Lab.
Arcelus, J., Mitchell, A.J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry, 68, 724-731.
Fichter, M.M., & Quadflieg, N. (2016). Mortality in eating disorders – results of a large prospective clinical longitudinal study. International Journal of Eating Disorders.
Gould, M.S., Marrocoo, F.A., Kleinman, M., Thomas, J.G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of suicide youth screening programs. Journal of the American Medical Association, 293, 1635-1643.
Sand, E., Gordon, K.H., & Bresin, K. (2013). The impact of specifying suicide as the cause of death in an obituary. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, 63-66.
Van Orden, K.A., Witte, T.L., Cukrowicz, K.C., Braithwaite, S.R., Selby, E.A., & Joiner, Jr. T.E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600.
Zerwas, S., Larsen, J.T., Petersen, L., Thornton, L.M., Mortensen, P.B., & Bulik, C.M. (2015). The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality. Journal of Psychiatric Research, 65, 16-22.
Written – 2016