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).