The Link Between Eating Disorders and Suicide

When you think about disorders associated with high rates of self-injurious thoughts and behaviors, including suicide, which disorders come to mind? It is likely you think of depression, bipolar disorder, or schizophrenia. It is perhaps less likely that you think of eating disorders. However, as I review below, research continues to demonstrate that all eating disorders are associated with extremely elevated rates of non-suicidal self-injury, suicidal ideation, suicide attempts, and death by suicide.

Non-Suicidal Self-Injury and Eating Disorders

Non-suicidal self-injury (NSSI) refers to the deliberate infliction of physical harm on oneself without suicidal intent. Individuals with eating disorders have significantly higher rates of NSSI than the general population. 
According to a systematic review and meta-analysis, on average, about one-third of individuals with eating disorders have engaged in NSSI.¹ However, rates are even higher in those anorexia binge/purge subtype, with about 42% engaging in NSSI.¹

Suicidal Ideation

Suicidal ideation involves thoughts about, considering, or planning suicide. Individuals with eating disorders report extremely elevated levels of suicidal ideation compared to those without eating disorders. In fact, a study found that over half (51%) of individuals with eating disorders experience suicidal thoughts at some point in their life,² which is much greater than the 9% average lifetime rate for adults cross-nationally.³

Suicide Attempts

A suicide attempt is defined as a self-inflicted, potentially injurious behavior with intent to die that does not result in death.⁴ Attempted suicide is one of the strongest predictors of future suicide death. Between 23-44% of individuals with anorexia, bulimia, and binge eating disorder report a history of suicide attempts,⁵ a rate that is drastically elevated compared to the general population. 

For reference, approximately 3% of adults cross-nationally report having attempted suicide in their lifetime,³ highlighting the severe risk faced by individuals with eating disorders. Notably, suicide attempt rates vary by eating disorder type, with anorexia nervosa (binge/purge subtype) having the highest rates (44%).⁵

Suicide Death

Among eating disorders, anorexia nervosa has the highest mortality rate, with suicide being the second leading cause of death. It is estimated that one in five individuals with anorexia who die do so from suicide. 

Additionally, research indicates that individuals with anorexia nervosa are 18-31 times more likely to die by suicide than their same-age peers.^6,7 Other eating disorders also carry significantly elevated suicide risks, with bulimia nervosa having a standardized mortality ratio (SMR) of 7.5, other specified feeding or eating disorders (OSFED) at four times the general population risk, and elevated suicide risk in binge eating disorder.^{6,7,8,9,10,11}

Why Are Eating Disorders Linked to Suicide?

Researchers are still trying to understand why eating disorders are associated with such elevated suicide risk. Our lab has tested whether a leading theoretical model explaining suicide risk, the Interpersonal Psychological Theory of Suicide (IPTS) developed by Joiner and colleagues, can help explain this risk. 

This theory posits that suicide occurs when an individual both desires and is capable of ending their life.²¹ Two critical components contribute to suicidal desire:²¹

• Thwarted Belongingness: Humans have a fundamental need to feel connected to others. When individuals with eating disorders experience secrecy, social isolation, and failure to achieve perceived appearance ideals, they may feel intensely disconnected from others.
• Perceived Burdensomeness: This occurs when individuals believe they are a burden to others. The high cost of eating disorder treatment, caregiving burdens, and physical complications of the disorder may contribute to these feelings.

However, the theory also states that suicidal desire alone is not sufficient for an attempt. The individual must also have the capability for suicide, which is comprised of high pain tolerance and fearlessness about death. 

The idea behind capability for suicide is that evolution has seen to it that we are born with very well-honed instincts for self-preservation. We are born wanting to live, not wanting to die. So, to make a lethal attempt, an individual needs to have the ability to do so. How do they get that? My research has found that genetics plays a substantial role,¹² but exposure and habituation to painful or provocative experiences might also play a substantial role. 

Individuals with eating disorders are repeatedly exposed to pain through behaviors such as fasting, self-induced vomiting, and excessive exercise. Over time, these behaviors may increase pain tolerance and reduce fear of death, thereby increasing the capability for suicide and suicide risk.^13,14

Shared Risk Factors: Impulsivity, Trauma, Genetics, and Interoceptive Dysfunction

Other shared risk factors for both eating disorders and suicidality may help explain their link.^15,16 Some of these shared risk factors appear to include:

• Impulsivity: Heightened impulsivity, particularly in binge/purge disorders, may increase suicide risk.
• Trauma: A history of trauma is common in individuals with eating disorders and is a well-known risk factor for suicidality.
• Genetics: Genetic vulnerabilities may predispose individuals to both eating disorders and suicidal behavior.¹⁷
• Interoceptive Dysfunction: Disrupted awareness of internal bodily states, common in eating disorders, may not only impact recognition of hunger and fullness but also lead to disconnection from the body itself. Feeling disconnected from one’s body may allow an individual to see their body as an object or “other.” As you can imagine, it should be much easier to harm a body that you are disconnected from and see as an object than a body with which you are connected and appreciative of.¹⁸

Vulnerable subgroups

Unfortunately, we know that LGBTQ+ young people experience significantly greater rates of both eating disorders and attempting suicide compared to their heterosexual and cisgender peers.^19,20 In fact, more than half of LGBTQ+ young people between the ages of 13 and 24 have been diagnosed with an eating disorder at some point in their life (according to a new report by the National Eating Disorder Association (NEDA), and The Trevor Project). 

Additionally, LGBTQ+ youth with a history of an eating disorder were found to have nearly 5-6 times greater odds of attempting suicide compared to those who have never had an eating disorder.⁵

Breaking the Stigma and Increasing Awareness

One of the biggest barriers to addressing the link between eating disorders and suicide is the stigma surrounding both conditions. Many people still view eating disorders as a matter of personal choice rather than serious mental health conditions. 

Similarly, suicide is often met with silence or misunderstanding. Increasing public awareness, advocating for better screening in medical and mental health settings, and integrating suicide prevention into eating disorder treatment can help save lives.

Getting Help

Eating disorders are complex, life-threatening illnesses that extend far beyond food and weight. Recognizing the elevated suicide risk among individuals with eating disorders is crucial for improving treatment outcomes and ultimately saving lives. 

If you or someone you know is struggling with an eating disorder and experiencing suicidal thoughts, reaching out for help can be the first step toward healing. Recovery is possible, and no one has to face these challenges alone.

Suicide Helplines

• 988 Suicide & Crisis Lifeline: Call 988
• Crisis Text Line: Text TALK to 741-741
• The Trevor Project: 1-866-488-7386