Eating disorders and suicide: The hidden risk to patients

When many people think of the risks of eating disorders going unaddressed, they likely think of physical risks such as heart failure, muscle atrophy, damage to organs such as the liver, pancreas, and kidneys, hormone imbalances, and more. One risk that you may not consider is the second leading cause of death among individuals with anorexia nervosa – suicide.

Looking at the NICE guidelines for treatment of eating disorders, suicide is only mentioned twice and never as a risk factor relating specifically to those with eating disorders. But what do we know about this correlation and how can this inform care for those with eating disorders?

Summary

Eating disorders are mental health conditions like anorexia, bulimia, and binge eating disorder, often driven by emotional distress or body image concerns. They can affect anyone but are most common in people aged 12–25. Suicide risk is significantly higher among those with eating disorders, especially anorexia. While treatments exist, more focus is needed on assessing and addressing suicide risk in this group.

Table of contents

• What are the types of eating disorder?
• Who is most at risk of developing eating disorders?
• What have studies shown about links between eating disorders and suicide?
• What are the statistics around suicide and specific eating disorders?
• What more is to be done in supporting those with eating disorders?

What are the types of eating disorder?

An eating disorder is categorised as a mental health condition where excessive control, binge eating, or purging are used to manage emotions or as an attempt to remedy excessive worry over weight or body shape. There are a variety of categories for eating disorders, including:

• Anorexia nervosa - trying to control your weight by not eating enough food, exercising too much, or doing both.
• Bulimia – a lack of control over what you eat or binge eating, followed by purging with methods such as vomiting or misuse of laxatives or water pills.
• Binge eating disorder - eating large portions of food until you feel uncomfortably full or sick.
• Avoidant/restrictive food intake disorder - avoiding certain foods, limiting how much you eat, or both. This includes Orthorexia, which is an excessive preoccupation with eating healthy food.
• Pica - eating things that are not considered food and that do not provide nutritional value.
• Other specified feeding or eating disorder – disordered eating that does not exactly fit the expected symptoms for any specific eating disorders.

Who is most at risk of developing eating disorders?

Anyone can get an eating disorder, with estimates suggesting that over 725,000 people in the UK have been diagnosed with an eating disorder. Eating disorders can develop at any age, but the risk of onset is highest for adolescents and young adults between the ages of 12 and 25.

While women and girls have an increased risk of developing eating disorders, there has been an increase in the prevalence in men and boys, with the lifetime average risk of developing an eating disorder worldwide being 19.4% for women and 13.8% for men.

Some risk factors for developing an eating disorder include:

• Genetics – those with parents or siblings who have an eating disorder are more likely to have one, too.
• Mental health issues - trauma, anxiety, depression, obsessive-compulsive disorder and other mental health issues can create higher risk.
• Frequent dieting - dieting is a risk factor for an eating disorder, especially in those whose weight fluctuates often.
• Bullying – those who have experienced bullying related to their weight are more likely to develop problems with eating and eating disorders.
• Stress and life changes – a loss of control in other areas of life may cause a desire for more control over diet.

What have studies shown about links between eating disorders and suicide?

Studies have found that suicide attempts and repeated attempts are common among patients with eating disorders. Approximately one-quarter to one-third of people with an eating disorder have thought about suicide, and one-quarter to one-third of people have attempted suicide. Overall, around 26% of people with an eating disorder attempt suicide.

What are the statistics around suicide and specific eating disorders?

The most research has been done into suicide rates in relation to anorexia nervosa and bulimia. The following statistics apply to each diagnosis.

Anorexia nervosa

• Compared to those without eating disorders of the same age and gender, people with anorexia are 18 times more likely to die by suicide.
• The likelihood of those with anorexia committing a serious suicide attempt are higher than in any other eating disorder.
• Of those with eating disorders who attempt suicide, those with anorexia have the highest risk of dying.
• Having children has been associated with 65% lower general mortality risk in those with anorexia.
• Men with anorexia are less likely to have a history of a suicide attempts compared to women with anorexia.

Bulimia

• Compared to those without eating disorders of the same age and gender, people with bulimia are seven times more likely to die by suicide.
• Suicide attempts are made more frequently in those with bulimia than those with anorexia, with one-third of women with a diagnosis of bulimia having at least one suicide attempt.
• Compared to adults, diagnosis of bulimia in adolescents appears to raise the risk of suicidality and self-harm.

What more is to be done in supporting those with eating disorders?

NICE guidelines suggest treatment of eating disorders through eating-disorder-focused cognitive behavioural therapy (ED-CBT), Maudsley anorexia nervosa treatment for adults (MANTRA), specialist supportive clinical management (SSCM), or eating-disorder-focused focal psychodynamic therapy (FPT).

Research has found that 46% of people make a full recovery from eating disorders but, when considering the figures we’ve seen on the percentage who attempt suicide, there is still a lot to be done to ensure the care they receive captures this clear need for intervention.

Alongside the treatments outlined for eating disorders then, it is critical that clinicians and caretakers more proactively evaluate those with eating disorders to determine their suicide risk. Raising awareness of this increased risk will help those supporting people with eating disorders to offer complete support that could be valuable in saving lives.

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If you are struggling with suicidal thoughts, please contact Samaritans for urgent support or speak to your healthcare provider. You can call Samaritans for free on 116 123.