EDs and Suicide Behavior
The relationship between EDs and suicidality has been well documented in clinical samples, with risk transcending categorical diagnosis (Duffy et al., 2021; Forrest et al., 2016; Udo et al., 2019). For instance, Udo and colleagues (2019) found that 24.9% of those with a history of anorexia, 31.4% of those with a history of bulimia, and 22.9% of those with a history of binge eating disorder had attempted suicide in their lifetime. However, EDs are undertreated and underdiagnosed (Udo & Grilo, 2018), meaning clinical samples only capture a small percentage of those struggling with maladaptive eating behaviors. Additionally, diagnostic crossover is a common feature of eating disorders, as a change on one single symptom may result in a different diagnosis (Castellini, 2011), and research suggest that those who transition between different ED diagnoses may be at higher risk for suicide attempts (Udo et al., 2019). As such, research is needed to examine suicide risk across maladaptive eating symptom presentation and severity level.
Although suicidality is associated across all EDs, purging behaviors are of particular concern, with studies revealing that this maladaptive eating behavior is significantly associated with suicide attempts (Lipson & Sonneville, 2020; Pisetsky et al., 2013; Udo et al., 2019), while restricting behaviors seem to be more strongly associated with suicidal ideation (Forrest et al., 2016). For instance, Udo and colleagues (2019) found that the prevalence of suicide attempts was substantially higher for individuals diagnosed with anorexia nervosa who purged (44.1%) than those diagnosed with anorexia who did not purge (15.7%). Other research has demonstrated that the number of maladaptive eating of symptoms a person is experiencing is significantly, positively associated with suicidal ideation and suicide attempt, where risk increases with each symptom endorsement (Lipson & Sonneville, 2020).