by Scott Crow, MD
University of Minnesota
The Emily Program
Scott Crow is psychiatrist at the University of Minnesota and at The Emily Program. His
research focuses on the causes and course of eating disorders, including suicide.
One of the main rationales for providing eating disorder treatment is that having an eating disorder increases one’s chances of medical problems, and even of dying. And, one of the common causes of death in those with an eating disorder is suicide.
There are several key things families should know about this issue. The first is simply to be aware that suicidal thinking is common for those with eating disorders and suicide is a risk. In popular culture, we think of suicide as being linked to depression, and of course it can be. But some research has shown the likelihood of suicidal thinking and of suicide may be higher in those with eating disorders than in any other mental illness, depression included. Moreover, some clinicians are also not well informed of this link, so if it is an issue for your family member, it is important to raise with their clinician.
Second, the risk of suicidal thoughts may be higher in people with both an eating disorder and another condition (for example, depression or an anxiety disorder). However, suicidal thoughts and suicide often occur in those with an eating disorder but no other co-occurring disorders. Third, early research in this area focused on suicide risk in people with anorexia nervosa, and we have known for decades that this is an area of high risk. But more recent research highlights that the risk may be as high, or higher, in people who have bulimia nervosa, and elevated in those with binge eating disorder, as well. We know this best from two US-based studies, the Adult and Adolescent versions of the National Comorbidity Survey, or NCS and NCS-A. The NCS and NCS-A were nationwide, door to door surveys asking about a wide variety of illnesses, including eating disorders. These studies showed that rates of suicidal thoughts and suicide attempts were higher in those with eating disorders than with other mental illnesses.
Furthermore, rates appeared highest in those with bulimia nervosa as compared to those with other eating disorders. And, the risk appeared similar for those with anorexia nervosa and those with binge eating disorder.
Finally, asking about suicide does not beget suicide attempts, “give people ideas”, or increase risk. In fact, some research suggests the opposite may be true; asking does not increase risk and may actually decrease it. It offers a chance to be supportive, it may be a window into treatment and can make a tremendously important difference.
In summary, suicide is an important risk for those with eating disorders. This risk spans across eating disorder diagnoses but may be highest for those with bulimia nervosa. Asking about suicidal thoughts may actually lower risk and can be lifesaving.