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Suicide is a major cause of death among people who have eating disorders. Learn the warning signals of suicide and self-harm in anorexia, bulimia, and binge-eating disorders and what you can do to prevent it.

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder are serious psychiatric conditions. The physiological changes that disordered eating causes take a toll on the body. These physical changes sometimes result in death. But eating disorders can cause behavioral problems as well as metabolic problems. 

More than other psychiatric conditions, eating disorders may also result in self-harm and suicide, although different eating disorders carry different risks.

How often does anorexia nervosa result in death?

The overall mortality rate for anorexia nervosa is 20 percent. That is, one out of every five people who is diagnosed with anorexia will die in the course of that disease. However, even more people who have anorexia will attempt to end their own lives. One study found that up to 28 percent of people who are ever diagnosed with anorexia will make at least one suicide attempt.

Different kinds of anorexia result in different rates of attempted suicide. People who have anorexia whose only weight-restricting activity is avoiding food have an attempted suicide rate of 7.4 percent. People who have anorexia who also induce vomiting or use laxatives to purge themselves have an attempted suicide rate of up to 30 percent.

Suicide attempts in anorexia tend to be serious. About a quarter of people with this disease who attempt suicide die as a result of the attempt.

Men who have anorexia are less likely to attempt suicide than women who have anorexia. The rates are 4 percent for men with the disease and 29 percent for women with the disease. Women living with anorexia who have children are 65 percent less likely to attempt suicide than women living with anorexia who do not. 

How often does bulimia nervosa result in death?

Bulimia is much less likely to result in death than anorexia. Only about one-third as many people who have bulimia die from any cause compared to people with anorexia.

Even so, people who bear the burden of bulimia are at greater risk of attempting suicide than people who have anorexia. They are significantly more likely to think about suicide, and they are slightly more likely to attempt it. About one in three women who have bulimia eventually attempt suicide at least once.

How often does binge eating disorder result in death?

Binge eating seldom results in death, but when it does, the cause of death is much, much more likely than in other eating disorders to be the result of suicide. One study found that 59 percent of people who have a binge eating disorder make at least one attempt to end their lives by suicide. But suicide is not the only issue in binge eating disorder, anorexia, and bulimia.

People who have eating disorders are more likely to act out self-harm

Self-harm is an attempt to convert psychological pain into physical pain. One victim of self-harm who stabbed himself in the hand explained it this way: "I just had to feel something."  

Self-injurious behaviors may be impulsive (for example, burning, cutting, self-hitting, banging, scratching) or compulsive (for example, hair pulling, nail biting, skin picking). A study found that about 20 percent of people who have any eating disorder think about hurting themselves, and about 40 percent of those who symptoms are severe enough to require hospitalization perform some kind of self-hurting behavior.

Even when people don't intend to kill themselves, self-hurting behaviors can result in death. The overall weakness to the body caused by the eating disorder increases the risk of death.

What are the risk factors for self-harm and suicide?

Some people who have eating disorders are more likely to commit acts of self-harm and attempted suicide than others:

  • Teenagers are more likely to engage in self-harm or to attempt suicide if they have recently broken up with a romantic partner or if they have had to accept the loss of the dream of connecting with a desired romantic partner. Family conflict is another trigger for suicide in teens, particularly when the teenager feels like a burden to parents.
  • Adults with eating disorders are more likely to engage in self-harm or to attempt suicide if they are isolated from family and friends. Having multiple disease conditions in addition to the eating disorder increases the risk of self-injury. 

Researchers have uncovered alarming data about the supposedly milder category of eating disorders known as "eating disorders not otherwise specified," or EDNOS. These "milder" eating disorders are actually more likely to result in death than the "more serious" conditions such as anorexia, binge-eating disorder, and bulimia, possibly because they don't get the medical attention they need.

When should you be alarmed?

People who are planning suicide often give strong indications of their intentions. They may talk about death without fear or regret. They may give away their possessions. They may become more reckless. If they use recreational drugs, they may start using more dangerous drugs. If they engage in risky hobbies, they may start taking life-threatening risks in search of a high. They may display mood swings and "let it all hang out" in personal relationships. They may stop keeping up with friends and family.

What should you do if you believe someone is going to attempt suicide?

Talking about suicide is not the same as planning suicide. But when someone tells you exactly what they intend to do to end their life, intervention is required. Restrict access to pills, poisons, knives, and guns, and if you can't, seek emergency medical help for your loved one or friend.

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  • Kostro K, Lerman JB, Attia E. The current status of suicide and self-injury in eating disorders: a narrative review. J Eat Disord. 2014. 2:19. doi: 10.1186/s40337-014-0019-x.
  • Thornton LM, Welch E, Munn-Chernoff MA, Lichtenstein P, Bulik CM. Anorexia Nervosa, Major Depression, and Suicide Attempts: Shared Genetic Factors. Suicide Life Threat Behav. 2016 Oct. 46(5):525-534. doi: 10.1111/sltb.12235. Epub 2016 Feb 24. PMID: 26916469.
  • Photo courtesy of SteadyHealth

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