By Dr Louisa Beckford, Consultant Psychiatrist at Orri
World Suicide Prevention Day takes place on 10th September each year. The aim is to raise awareness and acknowledge the international commitment and action to reduce deaths by suicide. In the UK, many mental health organisations and suicide prevention charities act together as part of the National Suicide Prevention Alliance.
Orri is marking World Suicide Awareness Day by hosting an educational webinar focused on eating disorders and suicide on 18 September 2024. Preparation for this has allowed us as a team to think more about this difficult topic – one that sadly affects most clinicians working in the field of eating disorders at some point in their working lives.
The raised mortality associated with eating disorders is widely recognised and frequently referred to in publications. However, the focus is often on deaths due to physical health complications. The fact that between 20-25% of deaths in eating disorders are due to suicide is not always given much consideration.
A recent Lancet Psychiatry paper specifically looked at deaths by suicide in people diagnosed with eating disorders. The researchers studied a large cohort of deaths spanning approximately 20 years. Almost 400 were deaths by suicide. These were individuals who had been in contact with mental health services and who had an eating disorder diagnosis.
The group shared many common risk factors for suicide with the non-eating disorder cohort. Significant factors in the eating disorder group were longer illness duration, more deaths by overdose and increased co-morbidity.
The fact that between 20-25% of deaths in eating disorders are due to suicide is not always given much consideration.
Co-morbid psychiatric conditions are frequently found in individuals with eating disorders in an acute day treatment setting. We routinely assess clients for ASD, ADHD, depression, anxiety, OCD, PTSD, and alcohol and drug disorders. Self-harm is a common presentation, and this increases the risk of suicide. Self-harm is increased in patients with bulimia.
Co-morbid physical conditions such as IDDM, (insulin-dependent diabetes) chronic pain, and long-lasting effects of eating disorder behaviours such as laxative use, osteoporosis and associated disabilities, may also increase suicide risk in eating disorders. Management of these conditions alongside eating disorders could modulate suicide risk.
Clinicians have long been aware that enduring eating disorders appear to be associated with an increased risk of suicide and the Lancet paper confirms this.
Other factors that may increase risk of suicide in more generic eating disorders include the loss of work, identity, lack of relationships, sexual abuse and domestic abuse. Interestingly, adverse life events just prior to the suicide were less common in the eating disorder cohort in the Lancet publication.
Interpersonal theories of suicide examine whether individual factors like feelings of ‘burdensomeness’ can contribute to suicide in individuals. Individuals with eating disorders may feel they are a burden to their family, friends, and may have received messages from healthcare providers that they are a drain on a stretched healthcare system.
Feelings of shame and worthlessness may accompany an eating disorder. Many people living with an eating disorder never seek help for the eating disorder.
Particular behaviours associated with increased shame include binge eating, purging and laxative use. High levels of repetitive exercise such as running indoors, climbing up and down stairs or exercising in the early hours of the morning can contribute to feelings of isolation and hopelessness.
We welcome the discussion on suicide and eating disorders and support efforts to reduce suicide in this population. If you want to learn more about the complexities of managing suicidal risk in patients with eating disorders, join us for our upcoming webinar for healthcare professionals on Wednesday 18th September at 6:30 pm, hosted by Kerrie Jones, CEO and Founder of Orri, Dr Louisa Beckford, Consultant Psychiatrist at Orri, and Dr Joanna Silver, Lead Psychological Therapist at Orri.
Click here to register.
Lancet Psychiatry 2024; 11: 592–600
Suicide in individuals with eating disorders who had sought mental health treatment in England: a national retrospective cohort study
Catherine Hercus, Alison Baird, Saied Ibrahim, Pauline Turnbull, Louis Appleby, Urvashnee Singh, Nav Kapur.
