Suicidality in eating disorders: Ocurrence, correlates, and clinical implications

Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, MA 02115-5000, USA.
Clinical Psychology Review (Impact Factor: 7.18). 11/2006; 26(6):769-82. DOI: 10.1016/j.cpr.2006.04.001
Source: PubMed


This review summarizes the published studies on suicide and suicide attempts in individuals with eating disorders, highlighting rates of occurrence, clinical correlates, and implications for practitioners. Multiple studies find high rates of suicide in patients with anorexia nervosa (AN) [Standardized Mortality Ratio (SMR) for suicide range from 1.0 to 5.3], whereas suicide rates do not appear to be elevated in bulimia nervosa (BN). In contrast, suicide attempts occur in approximately 3-20% of patients with anorexia nervosa and in 25-35% of patients with bulimia nervosa. Clinical correlates of suicidality in eating disorders include purging behaviors, depression, substance abuse, and a history of childhood physical and/or sexual abuse. Patients with eating disorders, particularly those with comorbid disorders, should be assessed routinely for suicidal ideation, regardless of the severity of eating disorder or depressive symptoms.

29 Reads
  • Source
    • "Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in interpersonal relationships, selfimage , and affect (APA, 2013) and is marked by impulsivity and recurrent suicidal and self-mutilating behavior. Suicidal behavior and self-harm also occur among patients with Bulimia nervosa (BN; Corcos et al., 2002; Crow et al., 2009; Franko & Keel, 2006; Preti, Rocchi, Sisti, Camboni, & Miotto, 2011) and a robust and differential pattern of comorbidity has been found between BPD and BN in clinical samples of mixed personality disorder (PD; Reas, Rø, Karterud, Hummelen, & Pedersen, 2013). Significant associations have also been found between purging behavior, personality traits, and self-injury or suicidality in women with eating disorders (ED) (Paul, Schroeter, Dahme, & Nutzinger, 2002) and adolescent psychiatric inpatients (Zaitsoff & Grilo, 2010), consistent with clinical observations linking BN with impulsivity and dysregulation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Few studies have investigated whether a diagnosis of Bulimia nervosa (BN) confers additional risk of life-threatening behaviors such as self-harm and suicidal behavior in borderline personality disorder (BPD). Method: Participants were 483 treatment-seeking women diagnosed with BPD according to the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997; Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; APA, 1994) and admitted to the Norwegian Network of Psychotherapeutic Day Hospitals between 1996 and 2009. Of these, 57 (11.8%) women met DSM-IV diagnostic criteria for BN according to the Mini-International Neuropsychiatric Interview (M.I.N.I.; Sheehan et al., 1998) and they were compared with women with BPD and other Axis I disorders. Results: We found that comorbid BN is uniquely and significantly associated with increased risk of suicidal behavior among women being treated for BPD. Findings underscore the importance of routinely screening for BN among women seeking treatment for BPD, as co-occurring bulimia appears to be a significant marker for immediate life-threatening behaviors in this already high-risk population, which is a significant public health issue. A significantly greater proportion of women with BPD-BN reported suicidal ideation at intake (past 7 days), engaged in self-harm behavior during treatment, and attempted suicide during treatment. All bivariate associations remained significant in the logistic regression models after controlling for mood, anxiety, and substance-related disorders. Conclusion: The presence of a concurrent diagnosis of BN among women with BPD is significantly and uniquely associated with recent suicidal ideation, and self-harm behavior and suicide attempts during treatment after controlling for major classes of mental disorders. Co-occurring BN appears to represent a significant marker for immediate life-threatening behaviors in women seeking treatment for BPD. Extra vigilance and careful monitoring of suicidal behavior during treatment is important for these individuals, and routine screening for BN is warranted.
    Journal of Consulting and Clinical Psychology 12/2014; 83(3). DOI:10.1037/ccp0000014 · 4.85 Impact Factor
  • Source
    • "Whether the risk of suicide attempts across ED subtypes differs remains a matter of some disagreement, with some studies reporting no difference in the prevalence of attempts (Bulik et al., 1999; Herzog et al., 1999; Milos et al., 2004), some reporting higher prevalence of suicide attempts in individuals with BN than in those with AN (Favaro & Santonastaso, 1996, 1997), and others reporting higher prevalence of suicide attempts in individuals with AN than in those with BN (Franko et al., 2004). The differences are likely attributable to differences in subtyping diagnostics, although one fairly consistent finding is higher risk among the binge-purge subtype of AN than individuals with the restricting subtype (Bulik et al., 2008; Favaro, Tenconi, & Santonastaso, 2006; Franko & Keel, 2006). However, most of the research has focused on differences in prevalence of suicide attempts across AN subtypes and BN. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated whether the prevalence of lifetime suicide attempts/completions was higher in women with a lifetime history of an eating disorder than in women with no eating disorder and assessed whether eating disorder features, comorbid psychopathology, and personality characteristics were associated with suicide attempts in women with anorexia nervosa, restricting subtype (ANR), anorexia nervosa, binge-purge subtype (ANBP), lifetime history of both anorexia nervosa and bulimia nervosa (ANBN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Participants were part of the Swedish Twin study of Adults: Genes and Environment (N = 13,035) cohort. Lifetime suicide attempts were identified using diagnoses from the Swedish National Patient and Cause of Death Registers. General linear models were applied to evaluate whether eating disorder category (ANR, ANBP, ANBN, BN, BED, PD, or no eating disorder [no ED]) was associated with suicide attempts and to identify factors associated with suicide attempts. Relative to women with no ED, lifetime suicide attempts were significantly more common in women with all types of eating disorder. None of the eating disorder features or personality variables was significantly associated with suicide attempts. In the ANBP and ANBN groups, the prevalence of comorbid psychiatric conditions was higher in individuals with than without a lifetime suicide attempt. The odds of suicide were highest in presentations that included purging behavior (ANBN, ANBN, BN, and PD), but were elevated in all eating disorders. To improve outcomes and decrease mortality, it is critical to be vigilant for suicide and identify indices for those who are at greatest risk. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Abnormal Psychology 11/2013; 122(4):1042-56. DOI:10.1037/a0034902 · 4.86 Impact Factor
  • Source
    • "Patients with EDs constitute a highly distressed, high-risk population, with prevalent suicidal attempts and ideation and deliberate self-harm. Among adults, 3% to 20% with AN and 25% to 35% with BN report a history of attempted suicide; completed suicide is more common in AN than BN [15,16]. Exact rates among children and adolescents are unknown. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background To describe the rates, indications, and adverse effects of psychotropic drug prescription in a specialist tertiary hospital child and adolescent eating disorder service. Methods Retrospective case note study of all active eating disorder patients (N = 115) over the period of treatment from referral to time of study (M = 2 years), covering patient demographics, clinical characteristics, drug prescriptions, indications, and adverse effects. Results Psychotropic drugs were prescribed in 45% of cases, most commonly antidepressants (41%), followed by anxiolytics (29%) and antipsychotics (22%), with 8% initiated before referral to the specialist eating disorder program. Common indications were depressed mood, agitation, anxiety, and insomnia. Patient clinical severity and complexity was associated with prescribing. Adverse effects, mostly minor, were recorded in 23% of antidepressant prescriptions, 39% of antipsychotic prescriptions, and 13% of anxiolytic prescriptions. Second generation antipsychotic prescription was associated with subsequent new onset binge eating, in this preliminary observational study. Self-harm by overdose of psychotropics occurred in 11% of patients prescribed medication. Conclusions Psychotropic medications were frequently prescribed to adolescent eating disorder patients to treat distressing symptoms. Prospective randomised controlled trials to clarify efficacy and safety are needed. Given the difficulties of conducting clinical trials in this population, services are encouraged to monitor and audit medication safety and efficacy in everyday practice, and to report their findings.
    International Journal of Eating Disorders 08/2013; 1(1):27. DOI:10.1186/2050-2974-1-27 · 3.13 Impact Factor
Show more


29 Reads
Available from