Within the conversation of suicide, there is often a great deal of information linking suicide to depression or substance abuse, but very little information on the link between eating disorders and suicide. For relevant information regarding features of mental health diagnoses, we often turn to the most recent Diagnostic and Statistical Manual of Mental Health Disorders. According to the current DSM, almost all diagnoses of eating disorders present clients with an increased risk for suicide attempts (2013). However, since Bing Eating Disorder has not been recognized as a formal diagnosis until the DSM-5, in order to get the most up to date information of suicide prevalence rates in eating disorders, I turned to recent research carried out by Tomoko Udo, Sarah Bitley, and Carlos M. Grilo wherein they evaluated lifetime prevalence of suicide attempts, psychosocial impairment, clinical profiles, and psychiatric comorbidity in adults with eating disorder. According to the study completed by Udo, Bitley, and Grilo regarding prevalence of suicidal attempts, there were findings of 24.9% prevalence rates for Anorexia Nervosa, 15.7% for Anorexia Nervosa Restricting Type, 44.1% for Anorexia Binge-Purge Type, 31.4% for Bulimia Nervosa, and 22.9% for Binge Eating Disorder (2019). See such prevalence rates of suicide within patients diagnosed with eating disorder, we then must look at underlying causes and contributing factors. For some of the patient’s that I see who have active suicidal ideation or a history of suicide attempts, the eating disorder can either develop or become a form of passive suicide. For other patients, suicide becomes more prevalent as we work on reducing eating disorder behaviors, even if they did not previously have a history of suicidal ideation or suicide attempts. Part of the reason why some patients may experience thoughts of suicide or urges to attempt suicide for he first time after addressing their disorder, is due to the patient having relied on their eating disorder in part as a form of coping for so long that if they do not have adequate internal or external resources throughout their recovery journey, as we reduce the eating disorder behaviors there become an increased need to apply other forms of coping as emotional dysregulation increases from reducing a form of coping, as unhealthy as it may have been. What I take from this is the insidious nature that all eating disorders have in common to mask underlying struggles and mask underlying feelings. For many, the eating disorder becomes a way of obtaining secondary gains such as a feeling of successfully punishing oneself for perceived misgivings or inadequacies, for some it can provide a sense of achievement when there is a struggle to see one’s successes, for others it can be a form of repression or psychic numbing without the substances to escape stressors around them, and many other underlying causes. Despite the variety of causes underlying the development of an eating disorder, there tends to be common threads that on some level the eating disorder provides the sufferer to mask many emotions beneath the disordered or the disorder behaviors. Much like depression or substance abuse, which we tend to hear more about, masking potentially highly distressing feelings leads to further struggles to process said feelings, which can ultimately lead to the patient feeling overwhelmed, helpless, hopeless, and out of alternative options of coping being attempting suicide. Whether the thoughts of suicide are present prior to treatment or come up during treatment, as a clinician we must prioritize assessing for suicide at each session, due to prevalence ratings and documented increased risk factors. For patients, there is a strong need to alter your treatment team if you develop thoughts or urges to attempt suicide, even if you never had the before. As a team, between the therapist and patient, there needs to be a united front from the beginning of services to explore and implement healthy forms of coping, self-soothing, and grounding to address emotional dysregulation that could lead to more frequent suicide thoughts, urges to complete suicide, or suicide attempts.
Author – Gabrielle Latorre, M.S., LMHC. Therapist at Turning Tides Eating Disorder Treatment Center.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Udo, B., Bitley, S., Grilo, C.M. (2019). Suicide attempts in US adults with lifetime DSM-5 eating disorders. BMC Medicine, 17(120). https://doi.org/10.1186/s12916-019-1352-3