By Kirsten Book, PMHNP, FNP-BC

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Statistics show that suicide is one of the top causes of death for young people aged 10 to 24 years old.1 Suicide is also the second leading cause of death among individuals with anorexia nervosa, and suicidal behavior is elevated in bulimia nervosa and binge eating disorder relative to the general population. The eating disorder anorexia nervosa has the highest mortality rate of any other mental illness, with estimates of lifetime suicide attempts ranging from 3 to 29.7%.2

Approximately one-quarter to one-third of people with anorexia nervosa, bulimia nervosa, or binge eating disorder have thought about suicide, and one-quarter to one-third of people with anorexia and bulimia have attempted suicide. Individuals with anorexia are 18 times more likely to die by suicide and those struggling with bulimia are 7 more times likely to die by suicide.3

There is a complex and interconnected relationship between eating disorders and suicide, although it’s important to note that not everyone with an eating disorder will experience suicidal thoughts or behaviors.

Risk Factors

Many factors can contribute to an increased risk of suicide or attempted suicide among people with eating disorders. Some of these factors may include:4

  • A history of multiple mental health comorbidities (ie: depression, anxiety, mood disorders)
  • A history of previous suicide attempts
  • Social isolation
  • Family issues and conflicts
  • Family history of suicide
  • Substance misuse
  • Adverse or traumatic childhood experiences (e.g. abuse, bullying etc.)
  • A sense of being a burden on others. Feelings of excessive guilt and shame
  • Self harm behaviors
  • Hospitalization and treatment history
  • Tolerance for high risk and impulsive behaviors
  • Difficulty regulating emotions

Eating disorders may cause personality and neurobiological changes in individuals. Those who suffer from eating disorders may become malnourished as they establish and reinforce patterns of restriction and/or purging. Those who engage in eating disorder behaviors may also find themselves feeling shame, guilt, and low self-esteem. These negative emotions may lead to other mental health complications such as severe depression and/or anxiety.5,6

5 Warning Signs of Suicidal Thinking

Regardless of the reason, people who are considering suicide often show similar signs and behave in similar ways. People with eating disorders who are experiencing suicidal thoughts may:7

  • Talk about having no reason to live, or feeling hopeless and guilty about being a burden to others because of their disorder.
  • Increase their use of alcohol or drugs, or engage in other reckless behaviors.
  • Experience mood swings, display increased anxiety or anger, or suddenly display a sense of relief or improvement in symptoms.
  • Begin to withdraw from social activities, isolate themselves from others or start to give away their possessions.
  • Express thoughts about death or dying or not being around in the future, saying goodbye to family and friends, or creating a plan by searching online or elsewhere for ways to end their lives.

Treatment Considerations

If you or someone you know is struggling with an eating disorder or exhibiting signs of suicidal thoughts, it is essential to seek help immediately. Reach out to a mental health professional, therapist, or helpline such as the suicide prevention hotline. Early intervention and appropriate treatment can make a significant difference in improving the mental health and well being of individuals facing these challenges.

Resources

If you or your loved one is contemplating suicide please contact one of these resources below:

If you or your loved one is in immediate danger do not hesitate to call 911 for a welfare check.

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Sources

[1]Ahn, J., Lee, J. H., & Jung, Y. C. (2019). Predictors of Suicide Attempts in Individuals with Eating Disorders. Suicide and Life-Threatening Behavior, 49(3), 789–797. https://doi.org/10.1111/sltb.12477

[2]Pisetsky, E. M., Thornton, L. M., Lichtenstein, P., Pedersen, N. L., & Bulik, C. M. (2013). Suicide attempts in women with eating disorders. Journal of abnormal psychology, 122(4), 1042–1056. https://doi.org/10.1037/a0034902

[3] Smith, A. R., Zuromski, K. L., & Dodd, D. R. (2018). Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Current opinion in psychology, 22, 63–67. https://doi.org/10.1016/j.copsyc.2017.08.023

[4] Fazel, S., & Runeson, B. (2020). Suicide. The New England journal of medicine, 382(3), 266–274. https://doi.org/10.1056/NEJMra1902944

[5] Smith, A. R., Ortiz, S. N., Forrest, L. N., Velkoff, E. A., & Dodd, D. R. (2018). Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality. Current psychiatry reports, 20(9), 77. https://doi.org/10.1007/s11920-018-0931-x

[6] Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Touyz, S., & Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. Journal of eating disorders, 10(1), 132. https://doi.org/10.1186/s40337-022-00654-2

[7] National Institute of Mental Health (NIMH). (2023). Suicide prevention. Available at: https://www.nimh.nih.gov/health/topics/suicide-prevention