Suicide prevention is a critical aspect of mental health care, especially for individuals living with eating disorders. These complex and life-threatening conditions affect not only physical health but also psychological and social well-being.
Research shows that people with eating disorders are at a significantly higher risk of experiencing co-occurring psychiatric disorders such as anxiety, depression and obsessive-compulsive disorder. These comorbidities can intensify eating disorder symptoms and make treatment more challenging. Importantly, they also increase the likelihood of suicidal ideation, suicidal behaviors, and non-suicidal self-injury.
For clinicians, family members, and friends, understanding the factors that contribute to this vulnerability is essential for providing compassionate, effective support and care.
Eating disorders are multifaceted and manifest in one’s thoughts and beliefs about themselves and their bodies as well as how they interact with food and what behaviors they use to manage their internal distress.
- For some, their eating disorder focuses on their struggle with low self-esteem, body image distress, feelings of guilt related to their body size/shape/weight, and perfectionism.
- For some, their relationship with food is the avenue by which they use to cope with their history of trauma, interpersonal relationships, or their disappointment in their school or work performance.
While eating disorders are a spectrum and for some these “eating disorder type” thoughts and behaviors are infrequent, for others these thoughts, beliefs and behaviors can become all-consuming and debilitating.
One example is someone who experiences body image distress and has an intense fear of gaining weight. For them, the idea of weight rehabilitation and their body changing in recovery makes them turn to self-harm as a method of coping.
Another example is someone who feels as though they can’t stop themselves from engaging in eating disorder behaviors such as binge-eating or compulsive exercise. They may be in a cycle of unwanted behavior without improvement or relief that they feel there is no path forward to recovery, making them vulnerable to mental distress and suicidal ideation.
Additionally, we cannot underestimate the impact that malnutrition has on one’s ability to process and manage difficult emotions and life circumstances. From dissatisfaction with their bodies to relapsing after years of being in treatment, this distress can make someone vulnerable to feelings of hopelessness and suicidal ideation.
Common warning signs for suicidal ideation:
Knowing common warning signs for suicidal ideation can help those caring for someone with an eating disorder provide compassionate and responsible care. Some common warning signs for suicidal ideation and suicidal behavior include:
- Feeling trapped, hopeless or helpless
- Extreme mood swings
- When someone expresses that they feel like a burden to those around them
- Making statements like, “I can’t do this anymore” or “Things will never get better.”
- Making suicidal statements like, “I just want to kill myself” or “I wish I was dead.”
- Increased isolation and being less social
- Writing good-bye notes and/or researching methods of suicide
- Engaging in risk taking behaviors such as driving recklessly or increased substance use
How to provide support
Family members, peers or other social supports can take action to provide safe and effective care for someone with an eating disorder who also is experiencing suicidal ideation.
Create a safe space for your loved one to talk.
Avoid making the topic of suicidal thoughts “taboo”. Be willing to discuss your loved one’s feelings of hopelessness, and provide a non-judgmental space where they can express their thoughts and feelings. Doing this can help your loved one feel that they can honestly share what they are feeling and thinking.
Validate their experience.
Don’t dismiss the feelings that your loved one has around their body and relationship with food.
Remind them that they matter.
Be consistent in giving verbal encouragement and reminding your loved one of their value and worth apart from their appearance and their progress in recovery.
Develop a safety plan.
Work with clinicians to create a thorough safety plan if the individual is engaged in outpatient or PHP/partial hospitalization service and will be home in the evenings. This may include removing access to medications and putting them in a lock box, removing access to sharp objects, and locking up firearms or removing them from the home for a period of time.
Get an assessment.
If your loved one is not established with mental health treatment but has demonstrated any of the warning signs above, it is appropriate to bring them to an emergency department or psychiatric hospital to determine the best level of care.
The road to recovery from an eating disorder can be long and healing is not linear. However, understanding the unique vulnerabilities of those who experience an eating disorder can help us as clinicians, family members and friends bring comfort, provide timely interventions and support one’s recovery journey.
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