Just How Strong is the Link between Anorexia and Suicide?
The shocking mortality rate for anorexia — higher than for any other psychiatric disorder — is not due just to starvation or physical deterioration, says new research, but to sufferers committing suicide in the most violent and determined of ways.
Anorexia is well known to have the highest mortality rate of any psychiatric disorder. In fact, females between the ages of 15 and 24 are 12 times more likely to die from anorexia than all other causes of death, according to the National Eating Disorders Association in America. But according to new research conducted at the University of Vermont, to be published in the Journal of Affective Disorders, this shocking mortality rate is not due just to starvation or the physical deterioration which makes the person more likely to die during a suicide attempt.
Nine case studies included in the research recount actual suicide attempts by people with anorexia in which there is no doubt that the person was determined to die. The people concerned isolated themselves thoroughly before their suicide attempt and used drastic and fairly foolproof methods such as jumping in front of trains, ingesting household cleaners and setting themselves on fire. This study extends the findings of a more comprehensive 2003 study of about 250 women with eating disorders, which showed the risk of death by suicide among by anorexic women to be as much as 57 times the expected rate of a healthy woman.
This research puts a new slant on death by anorexia; it becomes harder to imagine it as the slow fading away of a woman who wants to revert to girlhood, or a cry for help by a passive victim. Neither is it possible to envisage this as a form of self-harm: it’s hard to see swallowing a lethal dose of bleach as a coping strategy. It brings a whole new level of violence and desperation to the picture. These people, usually women, cannot stand their existences anymore and want to put an end to them quickly and forcefully. There seems to be active self hatred at work.
There is a certain prevalent image of the character type of a young woman suffering from anorexia which stresses her perfectionism, desire to fulfill expectations, to be a good girl, to the extent where she forgets her own basic needs entirely and starts to be trapped within her own rules. It is a picture of passive “femininity” taken to a lethal extreme. I would say that there is important insight here but the image overlooks a kind of violence, the sheer force involved in anorexia. We are dealing with a very different phenomenon from that of a depressed person who just cannot face another day and takes an overdose hoping never to wake up again.
The force of the concentration and drive which so many people with anorexia have at their disposal, which they need in order to starve themselves, must be taken into account by those family, friends or professionals, who are trying to support anorexia recovery. It is not purely a question of strengthening someone who is visibly weakening. The self hatred, focused on the body, which is an integral part of anorexia may not be verbally expressed to others — but the potential for its violent eruption is always there, and should not be underestimated.
Secrecy and a degree of isolation are also integral parts of anorexia, especially, maybe, when there is a lot of help available and sufferers are pushed towards a greater degree of ingenuity in order to hide their eating/non-eating patterns. This is fertile ground for suicidal intent to be hidden, and it may not be what relatives or therapists are looking for, as everything seems to revolve around eating.
During recovery, when it seems that the person with anorexia has wholeheartedly undertaken the struggle against anorexia and is winning, there may be another flashpoint which could be easy to miss. If we see anorexia as a way of avoiding the pain of various feelings, thoughts or experiences, as a wonderfully time and energy consuming strategy for switching off your life, then obviously when we drop the strategy the reason which necessitated its use starts to come to the fore again. These thoughts, feelings and experiences may be unbearable. Really sensitive, careful support is needed, even when it seems that the person is “getting better” in terms of the symptoms of anorexia.
Maybe this is the whole point, maybe actually anorexia is essentially not all about eating, not about the strategies of perfectionism, body images in our culture, or the need for control. Maybe, as narrative therapy — and many survivors — would understand it, anorexia is more like an aggressive, malevolent, full on attack on the self which needs to be fought head on, before it kills. (For a summary of the approach on this site, see my book review of Biting The Hand That Starves You: Inspiring Resistance to Anorexia/Bulimia by Maisel, Epstein and Borden.)
Maybe anorexia is a spirit-crushing opponent (a member of the same family as depression) who can cleverly get into our own heads, and who can be fought in the long term not by weight gain and healthy eating plans but by being helped along the hard path of starting to accept — and to nourish — the real, messy, imperfect, painful lives we have and find something joyful and meaningful to do with all that strength of purpose.
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This article was last reviewed by on Monday, 10th March 2008. You can leave a reply below.
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11th March 2008
Or, to put it another way: what is missed is the violent shadow of perfectionism.
As pointed out many years ago (but still not widely understood in my, not so humble, opinion): every neurosis is a creative adjustment. It is not about the neurosis. Take away a person’s coping mechanism and then you are surprised they aren’t happy? This isn’t exactly surprising. People who pursue this strategy just aren’t terribly bright.
Once people understand what the anorexia is for, then they can start exploring other ways of meeting this need/desire, and where it came from (it may have come from someone who they don’t like, who did terrible things to them – and may decide they don’t want to be controlled by them anymore for instance).
I’m not saying that dealing with anorexia is easy. From all reports it is remarkably difficult. But then so is dealing with this degree of determination and violence involved.
29th July 2008
The most fatal mental disorder is anorexia, but more specifically binge-purge type anorexia. This means the individual binges and purges and meets less than 85% of their expected body weight.
In addition, suicide idealization may not be caused by the anorexia. Many with eating disorders have an existing, undiagnosed mood disorder which the anorexia is an attempt to medicate.
20th August 2008
The younger age bracket is always used when Anorexia is discussed, what are the statistics for middle aged women to experience anorexia?
Someone very close to me is going through this at the moment and it has been described as a ’slow suicide’ and that anorexia is a side effect (because of the rapid weight loss) of what is really going on mentally.
I can’t believe she is the only 40something year old to go through this at this point in her life.
Any comments or insights will be gratefully received.
11th March 2009
I am constantly amazed at how self-destructive eating disorders can be. It seems as though the perfectionism facet may play into the suicide finality of attempts. That is, verbalized, perhaps, “I won’t mess up my own death.” So, the means to suicide become so violent, that no way exists to escape.
9th June 2009
I have had years of experience with dealing with a sibling with anorexia. It is directly linked to deprivation, a controlled element in ones life, although very uncontrolled. My sister recently has passed away due to complications. Her existance was a continual fight on a rollercoaster ride. I do not think she really could see the detrimental effects such self control could have one oneself, she was so focused on the pain that the self inflicted suffering was better than pain received from outside elements in her life.
It is a form of suicide as it was discussed over and over how her body would begin to suffer and not be able to recover for the devistation of lack of care. At times it was a choice to die…….at other times it was i dont want to die……then there came the day there was no choice. Her body decided for her.
At first yes it was directly linked to self image…..to look good, be tiny, be thin, wear all the pretty clothes the models could wear. It later became more of a control over pain. I realize not all victims follow the same path but I can say I turly wish that others have more effect on someone they love ……i was there everyday and it felt like i was watching a life slip away…..as it did!!
14th June 2009
I completely relate to this article. I had anorexia through out my teenage years. I forced myself to ascend from that black hole near the age of 19, but I still sometimes feel like I’m living at its edges. The self hatred can be immense, the desire to be smaller is an expression of the hatred of that which can not be controlled in ones self and in one’s life. It is violent. I have always felt more of an object than a human being in other people’s eyes. I feel like they will never see me for who I am but for what I appear to be. Even then, I feel that if one was to know me just by what I am inside, they would still feel I am worth nothing. I have fantasies of violent deaths for myself, especially when I am under profound stress or blame myself for all that has gone amiss with my life, even things I know rationally I have not control over. These thoughts help me feel vindicated for existing in my eternally ‘imperfect’ and sick state…because then I know that I am willing to ‘admit’ to myself that I possibly do not have the true right to live because I’m so awful, and possibly unlovable by anyone. These thoughts help me cope with fear. I know I could do it, I have not yet obviously, and part of myself hopes I never become so hopelessly full of self-hate and conflict that I take that final step. In some ways, I would rather be dead than return to anorexia itself–but that is the dilemma–I can not find a ground to stand on where I don’t want to destroy myself one way or another. Suicidal ideation is just another manifestation that has grown stronger from time to time since I forced myself out of the anorexic way of ‘living’(well, actually dying). This truly is a deadly mental illness. I can see there are people in this world who do not feel this way and they live much happier lives, not living with such a deep hatred and dissatisfaction with themselves that seems impossible to shake, no matter what. The only way out I can see is to accept everything ‘bad’ that comes into my life mainly as chance that can’t be mitigated in any way, and to be deeply thankful for what is given to me. There is no escape from pain for any living being, nor true total control in any form for any of us. It is a fact of life. Anorexics can’t seem to get their minds around this concept. Even in death, they have not escaped the chaos of the universe, but in their struggle have made pain and unhappiness more imminent at least in the lives of those around them, by running from it through starvation and suicide.