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.

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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.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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