By reducing mental health stigmas, increasing awareness around the elevated risk of suicide among individuals with eating disorders, and promoting early intervention, prevention and healing are possible.

Content warning: This blog contains information and discussion around the topic of suicide.

If you or someone you know is experiencing a mental health, suicide or substance use crisis, or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.

Key Takeaways

• As a leading cause of death in the United States, suicide is a major public health issue.
• Suicide rates among people with eating disorders are significantly higher than the general population, particularly for those with Anorexia Nervosa.
• Eating disorders often co-occur with other mental health conditions, such as anxiety and depression, which can exacerbate symptoms and increase suicide risk.
• Eating disorder care is more effective when comorbid mental health conditions are treated simultaneously.
• Suicide prevention efforts should include raising awareness, reducing mental health stigmas, and promoting early intervention and treatment.

Table of Contents

1. Eating Disorders and Suicide Risk
2. Anorexia and Suicidality
3. Eating Disorders and Co-Occurring Conditions
4. Suicide Risk Factors
5. Warning Signs of Suicide
6. Suicide Prevention
7. Talking About Suicide
8. Suicide Prevention Resources

Eating Disorders and Suicide Risk

Eating disorders are complex, dangerous mental illnesses impacting 9% of the United States population and resulting in approximately 10,200 deaths each year. Eating disorders, which often co-occur with other mental health conditions such as anxiety and depression, come with many devastating health risks, including the elevated risk of death by suicide.

The stigma and fears surrounding these and other mental health topics make them difficult to acknowledge and discuss. However, conversations about eating disorders and suicide can save lives and are therefore urgently needed. People who are struggling with mental health challenges don’t always know how to ask for the help they need, often feeling trapped by shame or a perceived sense of burdensomeness. By learning to detect the early signs of struggle, friends, teachers, family, and community members can offer hope and help to those vulnerable to suicide.

Anorexia Nervosa and Suicidality

While all eating disorder diagnoses come with an elevated risk of suicide, the risk is greatest for those with anorexia.

Anorexia Nervosa has the second-highest mortality rate of any psychiatric disorder and the highest of any eating disorder. Suicide is a leading cause of death in the U.S., and the second leading cause of death for people with anorexia.

There are several factors that contribute to the heightened risk of suicide in individuals with anorexia, including extreme malnutrition, feelings of hopelessness, isolation, shame, and the physical and emotional strain of the disorder itself.

Related: Anorexia Nervosa – Signs, Symptoms, Causes, and Treatment

Eating Disorders and Co-Occurring Conditions

Anxiety disorders, mood disorders, trauma, and substance use disorders are not uncommon challenges among people with eating disorders, a majority of whom struggle with at least one other mental health condition. Approximately 56.2% of those with Anorexia Nervosa, 94.5% of those with Bulimia Nervosa, and 78.9% of those with Binge Eating Disorder (BED) meet the criteria for at least one other mental health diagnosis. One study shows an astounding 94% in this category.

Co-occurring mental health conditions can complicate the diagnosis and treatment of eating disorders and exacerbate symptoms. Therefore, a thorough assessment by mental health professionals is essential to identify and address all relevant mental health issues in individuals with eating disorders. Treatment intervention plans must address both the eating disorder and any other mental health issues simultaneously to achieve the best outcomes.

Suicide Risk Factors

Eating disorders and other mental health conditions, such as depression, elevate the risk of suicide. Other risk factors include:

• History of self-harming behavior
• Impulsiveness
• Access to lethal means
• Previous suicide attempts
• Lost a loved one to suicide
• History of abuse
• History of trauma
• Financial problems
• Bullying
• Social isolation
• Chronic pain

Learn More: Risk and Protective Factors | Suicide | CDC

Warning Signs of Suicide

Warning signs of suicide include:

• Talking about wanting to die or wanting to end their lives
• Talking about feeling trapped
• Feeling hopeless
• Feeling unbearable pain (emotional or physical)
• Talking about being a burden
• Withdrawing from family and friends
• Giving away important possessions
• Saying goodbye or “I love you” to friends and family
• Putting affairs in order
• Taking extreme risks, such as driving recklessly
• Talking about death often
• More talk about guilt or shame
• Disrupted sleep or eating patterns

Suicide Prevention

Suicide prevention efforts should include awareness of the heightened risk among individuals with eating disorders, and educational programs can play a role in destigmatizing these conditions and promoting early intervention. It’s simply not enough to invite people who are struggling to “just ask for help.”

Together, families, friends, and communities can try to prevent mental health crises by:

• Promoting greater suicide prevention awareness
• Educating themselves on the risk factors and signs of suicidal ideation
• Learning how to have empathetic, judgment-free conversations about mental health
• Learning how to have empathetic, judgment-free conversations about substance use
• Avoiding stigmatizing language
• Knowing what resources are available for people in crisis
• Checking on people (including those that “always seem happy”)
• Advocating for greater access to mental health resources

Talking About Suicide

It is of vital importance when talking about suicide to avoid reinforcing the very stigmas that prevent people from seeking mental health care. Remember that suicide attempts are not attention-seeking but help-seeking.

Be Direct and Open

Despite misconceptions to the contrary, talking to someone about suicide won’t cause or increase suicidal thoughts or push someone to act on them. Open communication can reduce loneliness, fear, and isolation. Studies show that talking openly about suicide is more likely to reduce suicidal thoughts and lead to improvements in overall mental health in treatment-seeking populations.

Choose Your Words Mindfully

The words people use when discussing suicide should be chosen carefully and mindfully. Avoid saying things that reinforce stereotypes, prejudice, stigmas, or discrimination against people with mental illness and suicidal ideation or anything that refers to or defines people by their diagnosis.

You may catch yourself using problematic language about suicide or mental illness at some point. If that happens, correct yourself out loud, turning the conversation into a learning experience.

Examples:

He is suicidal. → He is struggling with suicidal thoughts.

They committed suicide. → They died by suicide.

Failed suicide → Non-fatal suicide attempt.

She is bipolar. → She has bipolar disorder.

Learn More: Suicide Language Guide

Help For People Struggling With Eating Disorders and Suicidality

Many individuals with eating disorders experience high levels of shame and self-criticism, which can contribute to social withdrawal and isolation. Although feelings of “burdonsomeness” or a perceived lack of belonging may seem benign, they can be dangerous if an individual acquires the lethal means or capability for suicide. 

People with eating disorders and co-occurring mental health conditions are at elevated risk for suicide and must receive treatment for comorbidities simultaneously – and as early as possible – in order for care to be effective and for eating disorder recovery to be sustained post-treatment.

Suicide Prevention Resources

If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.

• How to Ask Someone About Suicide | NAMI: National Alliance on Mental Illness
• Risk and Protective Factors | Suicide | CDC
• Zero Suicide
• Resources – Speaking of Suicide
• Risk factors, protective factors, and warning signs | AFSP
• Suicide Prevention
• Words Matter: Suicide Language Guide
• NIMH » Suicide Prevention