Why We Need to Talk About Anorexia When We Discuss Suicide Prevention

Anorexia nervosa can be fatal — 10% of people living with anorexia die from the mental illness. Anorexia has the highest mortality rate of any mental health condition — which can be terrifying knowledge for people with eating disorders — but there’s very little discussion about why so many people with anorexia pass away.

At first glance, the high mortality rate for people with anorexia nervosa may seem simple to explain — people who aren’t fully nourishing their bodies for long periods of time may be at risk of injury, illness, or death. But even though many people with anorexia do pass away because of the physical effects of their symptoms, a surprisingly large amount die by suicide too.

Suicide is the twelfth leading cause of death in the United States, and in 2017, 1.4% of global deaths were by suicide. For people with anorexia, however, the numbers are even graver. Among people with a history of anorexia, the prevalence of suicide is 24.9%, with suicide attempt rates at 44.1% for people with the binge/purge subtype of anorexia and at 15.7% for people with the restrictive anorexia subtype.

There are myriad reasons why suicide and suicide attempt rates may be so much higher for people with anorexia. Malnutrition can affect brain function, which can lead to mood changes and difficulties with critical thinking. The psychological component of anorexia — pervasive thoughts about food, weight, and body type — can be detrimental as well, overwhelming people with anorexia nervosa until they feel a need to “escape” from their eating disorder thoughts, behaviors, and compulsions. Moreover, many people with anorexia nervosa enter treatment settings in which they are no longer able to eat or perform other daily life activities on their own terms, and the carceral practices many eating disorder treatment centers use to “contain” clients’ eating disorder symptoms can leave clients wondering if suicide is the only way to no longer feel trapped.

The reasons behind the significant amount of suicides of people with anorexia are not discussed often — but they should be. Eating disorder treatment providers are often so focused on treating the physical and psychological symptoms of anorexia itself that they may overlook clients who are suicidal. Doctors may view refeeding as an immediate need for people with anorexia but may not ask their patients about co-occurring depression symptoms, suicidal thoughts, or past suicide attempts. 

However, openly recognizing that malnutrition and organ failure are not the only causes of mortality in anorexia nervosa can save people with this potentially fatal mental illness from dying by suicide. Providing trauma-informed care in eating disorder treatment settings, screening for suicide risk and developing effective safety plans, and focusing on treating other mental illnesses, like depression, anxiety, bipolar disorder, and borderline personality disorder (BPD) directly alongside anorexia may lower suicide risk in people with anorexia nervosa. Discussing the risk of suicide in people with anorexia and reducing the stigma surrounding suicide among people with eating disorders may help people with anorexia who have contemplated suicide feel less alone as well — which could also prevent suicide.

As Suicide Prevention Awareness Month continues, it’s important to remember that addressing daily struggles for people with anorexia nervosa is suicide prevention. Allowing people with anorexia to discuss their comorbid mental illnesses in treatment, providing them with safe, healthy coping skills for when their eating disorder thoughts feel too overwhelming to handle, effectively treating eating disorder clients’ past trauma, and dismantling the current eating disorder treatment structure to make it more gentle and less carceral may prevent suicides — and eventually may ultimately reduce the suicide rate for people with anorexia. Anorexia nervosa isn’t just a collection of potentially fatal physical symptoms; it’s also heavily linked to suicide deaths — so treating anorexia in an effective, empathetic, and trauma-informed way may be a necessary form of suicide prevention.