High Suicide Risk in the Eating Disorder Population

Girl struggling with eating disorders

Dr. Mark Gold’s Research You Can Use

The eating disorder population is exposed to a greater probability of suicide and attempted suicide. A recent study, conducted by the University of Bologna, Italy, executed a meta-analysis of previous studies in order to compare proportions of suicide attempts in eating disorder sub-groups.

Contrary to common belief, eating disorders are not a lifestyle choice. Eating disorders are serious psychiatric conditions encompassing severe disturbances in eating behaviors that negatively affect physical health, emotional stability and diminish the ability to function normally in pretty much all areas of life.

Obsession with food, body weight, and shape have proven to be significant indicators of an eating disorder. Common eating disorders include anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED).

Eating disorder and high suicide risk

Eating Disorders affect up to 30 million people of all ages and genders in the U.S. Eating disorders are accompanied by a high risk of mortality, stemming not just from the medical complications associated with disordered eating and the associated behaviors, but also due to its strong correlation with suicide.

Research has shown that individuals with anorexia nervosa have the highest rate of suicide, whereas those battling with bulimia nervosa and other eating disorders are associated with a higher incidence of suicide attempts. Bulimic patients also have a higher risk for non-suicidal self-harm, which is also related to a greater risk of suicide attempts.

Evidence suggests that the lower risk of suicide attempts in AN might be due to the restrictive AN subtype (AN-r), while the binge-purging AN subtype (AN-bp) would have the risk of suicide attempts similar to those in BN.

Furthermore, purging behaviors, such as vomiting, laxatives/diuretics use, and enemas, have been highlighted among the clinical correlates of suicide attempts in eating disorders, alongside depression, substance use, and history of childhood sexual/physical abuse.

Man dealing with Challenges in Anorexia Recovery

Literature regarding other eating disorders, especially binge eating disorder (BED), has remained mostly limited. Rates of attempted or completed suicides range between 2.3 percent and 34 percent in BED.

Present study

Despite reasonable evidential support, there exists no systematic exposition of an increased suicidal rate in specific subgroups of eating disorders.

Through a meta-analysis of data presented by previously published research, the present study aimed to categorically investigate the proportion of suicide attempts in the eating disorder subgroups, primarily focusing upon AN-r, AN-bp, BN, and BED.

Literature was gathered from two databases using a combination of keywords for eating disorders and suicide attempts. Studies reporting proportions of suicide attempters in at least two eating disorder groups, diagnosed as per the DSM-5 and ICD-10 diagnostic criteria were considered. Eating disorder subgroups were evaluated in pairs using binary random effect model. Arcsine Risk difference (RD) and 95 percent confidence intervals (CI) were calculated. Publication bias, meta-regression, and sensitivity analyses were also taken into account.

Results revealed that attempted suicide was found to be most frequent in bulimia nervosa population at 21 percent, compared to 12.5 percent in patients of anorexia nervosa. In BED, the proportion of suicide attempts was as high as in AN, that is 10 to 12 percent.
This meta-analysis of published studies confirms previous evidence of a higher proportion of suicide attempts in patients with AN-bp and BN compared with AN-r. Additionally, this analysis suggests that patients with BED have a risk of suicide attempts similar to AN-r patients.

Pooled lifetime proportion was calculated at 11.5 percent in BED to 25 percent AN-r, much higher than the reported lifetime rates of suicide attempts in the general population. ED patients were also found to be at high risk for non-suicidal self-injury at 27.3 percent, highly prevalent in the suicidal population, and especially in BN patients at 32.7 percent.

Paying attention to suicide risk factors in ED patients

Data extracted from this study strongly suggests that suicidal risk, given the previously known risk factors, should be routinely evaluated in patients with disordered eating.

The discovery of a higher proportion of suicide attempts in participants with BN and AN-bp depict that binge-purging behavioral tendencies might actually prove to be significant risk factors for suicidal behavior in eating disorder patients.

The association between binge-purging and suicide attempts is largely arbitrated by impulsivity and emotional instability, in combination with associated factors such as substance abuse and comorbid psychiatric disorders. This led the researchers to conclude that suicidal behavior is binge-purging disorders was more a result of adverse effects rather than a desire to die.

Teen girl staring out a window thinking about bulimiaThis meta-analysis confirms greater proportions of suicide attempts in patients with bulimia nervosa and binge-purging anorexia nervosa in comparison to patients with restrictive AN.

Additionally, even though prematurely, the indications that a young age in AN patients and Asian ethnicity may be protective factors for suicide attempts and may hold value for evaluations in further studies.

The authors concluded that suicidal behavior proves to be a major issue in patients with an eating disorder and must be taken into consideration during the evaluation, prevention, and treatment. Patients with binge/purging behavioral tendencies need to be monitored even more closely, with clinicians and healthcare providers being provided additional information and education to deal with such patients effectively and vigilantly.


References:

1. https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603
2. https://www.ncbi.nlm.nih.gov/pubmed/25231853
3. https://www.researchgate.net/publication/329279389_Suicide_attempts_in_eating_disorder_subtypes_A_meta-analysis_of_the_literature_employing_DSM-IV_DSM-5_or_ICD-10_diagnostic_criteria


About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014.

Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD


About the Transcript Editor:

Sana Ahmed photoSana Ahmed is a journalist and social media savvy content writer with extensive research, print and on-air interview skills. She has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.


The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 19, 2019.
Reviewed & Approved on February 19, 2019, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.