How to Get Help When You Have an Eating Disorder and Are Suicidal (2023)

Information presented in this article may be triggering to some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Eating disorders can be painful illnesses, at times robbing their victims of their health, happiness, social life, and occupational achievements. It is accordingly no surprise that suicide is a major cause of death for people with eating disorders.

Although medical complications related to malnutrition are the leading cause of death among individuals with anorexia nervosa, suicide is believed to follow closely behind. Suicidal behavior is elevated in patients with anorexia nervosa, bulimia nervosa, and binge eating disorder, the three eating disorders that have been most studied.

Eating disorders have the highest mortality rate of any mental disorder. While studies have shown varying results, patients with eating disorders appear to be between 1.5 and 14 times more likely than same-aged peers to die. Mortality rates are the highest for patients with anorexia nervosa but are high for any person with an eating disorder.

In a recent comprehensive study of mortality in eating disorders, researchers found that suicide was the most common non-natural cause of death. Two-thirds of the non-natural deaths among patients with anorexia nervosa and all of those among patients with bulimia nervosa and binge eating disorder were from suicide, leading the researchers to conclude that “suicide is a major concern not only in [anorexia nervosa] but in all eating disorders.”

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Watch Now: Common Signs of an Eating Disorder

Suicidality

Suicidality refers to a wide range of thoughts and behaviors. It can range from passive ideation (passive thoughts about not wanting to live anymore) to lethal attempts. There is also nonsuicidal self-injurious behavior which refers to acts of self-harm such as cutting, burning,scratching, or harming the skin. These behaviors, which less often reflect a true desire to die and more often a mechanism for managing emotional distress, will not be discussed in this article.

Rates of suicide and suicidal ideation differ for the types of eating disorders:

Anorexia Nervosa

Between 20 and 43 percent of those with anorexia nervosa report current suicidal ideation. One study showed that 23 percent of adults with a lifetime diagnosis of anorexia nervosa reported suicidal ideation—this is in comparison to adults in the general population, who report lifetime suicidal ideation in the range of 5 to 15 percent.

(Video) ARE EATING DISORDERS SUICIDAL BEHAVIOR? | Mental health w Kati Morton | Kati Morton

Patients with anorexia are also two to nine times more likely than peers to attempt suicide. One study showed that patients with anorexia were 18 more times likely to die by suicide than in a comparison group.

Bulimia Nervosa

There are comparatively fewer studies on suicide and bulimia nervosa. The results we have seem to show that the estimates of suicidal ideation and attempts among patients with bulimia nervosa are similar or greater than among patients with anorexia nervosa, but the risk of suicide death is somewhat lower.

Between 15 and 23 percent of those with bulimia nervosa report current suicidal ideation. Lifetime suicidal ideation is between 26 to 38 percent among patients with bulimia nervosa. Female patients with bulimia nervosa are seven times more likely to die by suicide than females in the general population.

Binge-Eating Disorder (BED) and Other Specified Feeding and Eating Disorder (OSFED)

There is even less research on suicidality in BED and OSFED. Current suicidal ideation among patients with BED or OSFED is estimated to be between 21 and 23 percent. One study has shown that patients with BED were five times more likely to have attempted suicide than peers without eating disorders. One study found that patients with OSFED were four times more likely to die by suicide than gender and age-matched peers.

Risk Factors

Although suicidal behavior can occur with any type of eating disorder, research suggests it may be more common among patients with certain presentations. Suicide attempts appear to be more common among patients with anorexia binge-purge subtype compared to the restrictive subtype. Some studies have shown that suicide attempts are correlated with purging behaviors including laxative abuse and self-induced vomiting.

The risk for suicide attempts is higher when the eating disorder occurs with other disorders such as depression or substance abuse. One study showed that 80 percent of people with anorexia nervosa who attempted suicide reported their attempt occurred while they were depressed. Suicidality might also be more common among eating disorder patients with a history of childhood abuse.

Genetic studies have shown that anorexia nervosa and suicidality occur together because of shared genetic factors.

Research shows that individuals who have attempted suicide two or more times are at greater risk for a future attempt and previous attempters are at the most risk approximately six months to two years after their attempt.

Warning Signs

Warning signs of suicide may include:

  • A change in behavior or the emergence of new behaviors, especially relevant if it occurs after a painful event or loss
  • Talk about wanting to kill themselves, feeling hopeless, being a burden, feeling trapped, or pain that can’t be dealt with
  • Behaviors such as increased alcohol or drug use, searching for means to end their lives, withdrawal, and social isolation, sleep changes, calling or visiting people to say goodbye, giving away important possessions, aggression, and fatigue
  • Moods such as depression, anxiety, apathy, shame, anger, irritability, or sudden relief

How to Look Out for Suicide Warning Signs and Risk Factors

Assessment

Because of the elevated risk of suicide, a routine suicide risk assessment should be a part of eating disorder treatment. Two empirically validated and accessible suicide measures include the Joiner’s Suicide Risk Assessment (JSRA) and the Linehan Risk Assessment and Management Protocol (LRAMP).

The JSRA, which is based on the interpersonal theory of suicide, is a semi-structured interview that results in an individual being classified into a risk category (low, moderate, severe, or extreme). The LAMP provides a structured checklist for assessing, managing, and documenting suicide risk and guides the clinician to provide appropriate clinical intervention. Clinicians should also screen eating disorder patients for a family history of suicide.

Treatment

Psychiatric hospitalization can be considered for the treatment of suicidality in eating disorders because it provides increased security for the patient. Other strategies for the short-term management of crises can include increased monitoring and social support, removal of lethal methods, and the treatment of acute psychiatric symptoms.

When a patient indicates that he or she is suicidal, the focus of treatment should be preventing suicide. Dialectical behavior therapy (DBT) is an empirically validated treatment that was developed specifically for patients with suicidality and self-harm. It has also been successfully applied to the treatment of eating disorders. In DBT, behaviors are targeted according to a hierarchy. Suicidal behaviors are considered the highest priority for treatment.

(Video) Treatment for Eating Disorders

The Best Online Therapy ProgramsWe've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

Getting Help

If you are having thoughts about suicide, it’s extremely important to reach out for help. Family and friends can often help you through a crisis. There are also many additional resources available for you or a loved one to talk to.

Who to Call

National Suicide Prevention Lifeline: 1-800-273-8255

  • The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Crisis Text Line: Text TALK to741-741

  • The text line provides a free, 24 hour a day, 7-day a week confidential text message service for people in crisis.

If you or a loved one are in immediate danger, call 911.

If you are worried that someone close to you may be having thoughts about suicide, don’t be afraid to ask them, “Are you having thoughts about suicide?” Research shows that directly asking someone does not put the idea in their head or increase their risk of making an attempt. By contrast, it is often experienced as an empathic concern.

Keep them safe, remove access to lethal items if you can, and engage with and listen to them. Share your concern for them and let them know you care. Help them connect with professional help or a suicide hotline.

What to Say to Someone Who Is Suicidal

A Word From Verywell

If you (or a loved one) are in crisis or experiencing any suicidal thoughts, plans, or attempts, it is important to reach out for help. When you feel bad it is common to believe that you will always feel bad. It can be hard to remember that feelings are temporary and that things can get better. You are not the only one who has felt this way. Let others help you through this tough time. Also, remember that eating disorders are treatable.

Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

(Video) Suicide Prevention and Eating Disorder Patients - Dr. Kamila Cass, Clinical Psychologist at ACUTE

How to Get Help When You Have an Eating Disorder and Are Suicidal (1)

By Lauren Muhlheim, PsyD, CEDS
Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy.

(Video) Eating Disorders and Suicide | HealthyPlace

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FAQs

Can malnutrition cause suicidal thoughts? ›

Malnutrition may be the underlying biological mechanism behind the unimaginable act of suicide.

What is the average time to overcome an eating disorder? ›

While the psychological piece to eating disorder recovery is often a life-long endeavor for many individuals, the average length of stay for our lower levels of care can vary from about four weeks (Partial Hospitalization Program) to eight weeks (Intensive Outpatient Program).

Who should I contact if I have an eating disorder? ›

A team approach is often best. Those who may be involved in treatment include medical doctors, mental health professionals, and nutritionists. The participation and support of family members also makes a big difference in the success of eating disorder treatment.

Can not eating be a coping mechanism? ›

More often than not, an eating disorder acts partly as a coping mechanism. Many who suffer from anorexia describe the need to “have control over something” in a world where they feel they otherwise do not. The restriction of food may provide a sense of security, structure, or order that feels reassuring.

What is an Orthorexic? ›

What Is Orthorexia? Orthorexia is an unhealthy focus on eating in a healthy way. Eating nutritious food is good, but if you have orthorexia, you obsess about it to a degree that can damage your overall well-being. Steven Bratman, MD, a California doctor, coined the term in 1996.

Can starvation cause depression? ›

Restricted eating, malnourishment, and excessive weight loss can lead to changes in our brain chemistry, resulting in increased symptoms of depression and anxiety (Centre for Clinical Interventions, 2018b).

What happens to your brain when you have anorexia? ›

Parts of the brain undergo structural changes and abnormal activity during anorexic states. Reduced heart rate, which could deprive the brain of oxygen. Nerve-related conditions including seizures, disordered thinking, and numbness or odd nerve sensations in the hands or feet.

What percent of anorexics fully recover? ›

Research suggests that around 46% of anorexia patients fully recover, a 33% improving and 20% remaining chronically ill. Similar research into bulimia suggests that 45% make a full recovery, 27% improve considerably and 23% suffer chronically.

Does anorexia shorten lifespan? ›

The disease has the highest mortality rate of all mental health disorders. As many as 20 percent of the people who suffer from anorexia will eventually die from it. And the longer a person suffers from anorexia, the greater their risk of dying becomes.

How long can you go without food before being hospitalized? ›

However, without staying hydrated (without water) as well, the human body can only live 3 to 5 days. Researchers believe that a person can live for up to three weeks without food as long as they have water to drink. Without both water and food, a person cannot survive for more than four days.

How do you get someone to eat? ›

Try giving encouragement and gentle reminders to eat, and of what they are eating. Try not to worry about mess - it's more important for the person to eat than to be tidy. Wipe clean mats and covers may help. It's important the person doesn't feel rushed and they are given enough time to eat.

Does starvation reduce anxiety? ›

For those individuals with a predisposition to anorexia, starvation will directly reduce the amount of tryptophan and serotonin in the brain, thus reducing anxiety, partially explaining the lack of anxious or 'hangry' responses to lower caloric intake.

Does PTSD affect eating? ›

Eating disorders are often developed as maladaptive coping skills. Additionally, risk factors for eating disorder development are often PTSD symptoms such as having difficulty regulating emotions, negative self-view, feelings of shame, and negative emotion-states.

What does anorexia do to your skin? ›

Frequent skin signs in anorexia nervosa include asteatotis, xerosis, follicular hyperkeratosis, carotenoderma, hyperpigmentation, acne, pruritus and facial dermatitis, Dr. Strumia says.

What is the fear of not eating called? ›

People with this phobia are sometimes mistakenly thought to suffer from anorexia, an eating disorder. While those with anorexia fear the effects of food on body image, those with cibophobia are afraid of the food itself. However, people can experience both disorders at the same time.

What are five health consequences of anorexia? ›

Health Consequences of Anorexia Nervosa

The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower. Reduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure.

What happens if you go too long without eating? ›

Skipping meals: Causes the body to lower its metabolism (how much energy it needs to function) Causes us to burn less energy (fewer calories) Can lead us to gain weight when we eat our usual amount of food Leaves us with little energy because the body has run out of the fuel we get from food Leaves us sluggish and ...

What is it called when you starve yourself? ›

Anorexia. If you get an anorexia diagnosis (known as anorexia nervosa), you're not eating enough food. This means you're not getting the energy you need to stay healthy. Some people think anorexia is about slimming and dieting, but it's much more complex.

What happens to your mood when you don't eat? ›

Mood is badly affected by under-eating. Under eaters generally feel depressed, low, and prone to be easily irritated or enraged. Panic attacks are a very common side-effect of undereating and are only likely to subside when you recover back to a healthier body weight.

How can malnutrition affect you mentally? ›

The functional consequences of such malnutrition include not only physical changes but also psychological changes such as depression, anxiety, irritability, apathy, poor sleep pattern and loss of concentration.

How does malnutrition cause mental illness? ›

Consequences of Malnutrition on Mental Health

Carbohydrates are the body's main source of energy. Without it the brain cannot function properly and blood sugar becomes unstable. This can disrupt serotonin, which can increase anxiety, feelings of frustration, depression, sleep disturbances, and intense cravings.

Can malnutrition cause bipolar disorder? ›

As with physical conditions, bipolar disorder is likely to be impacted by diet and nutrition.

Can malnutrition cause anxiety? ›

Being deficient in certain minerals and vitamins can affect your physical and mental energy, your body's health along with the biochemical balance in your brain, resulting in anxiety or increasing the levels you're currently experiencing.

Videos

1. EDNOS: Most Dangerous, Unheard of Eating Disorder | Nightline | ABC News
(ABC News)
2. Understanding Suicide Risk in Eating Disorders
(UMN Psychiatry)
3. How to Help Someone Who is Suicidal
(Psych2Go)
4. Suicide Crisis - Eating Disorders
(KSNF KODE)
5. A Day in the Life of Anorexia Nervosa
(Demystifying Medicine McMaster)
6. Signs of an Eating Disorder
(Psych Hub)
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