From the Guidelines
Anorexia nervosa significantly increases suicide risk, and immediate professional help is necessary for individuals who may be suicidal. If you're concerned about someone with anorexia who may be suicidal, seek immediate professional help through emergency services or go to the nearest emergency room. Treatment typically involves a comprehensive approach including medical stabilization, nutritional rehabilitation, and psychological interventions, as recommended by the American Psychiatric Association 1. Specific medications like antidepressants (SSRIs such as fluoxetine 20-60mg daily) may help with co-occurring depression and anxiety. Hospitalization is often necessary for severe cases with medical complications or acute suicide risk. Family-based treatment (FBT) for younger patients and cognitive behavioral therapy (CBT) for adults have shown effectiveness, as stated in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1. Some key points to consider in the treatment of anorexia nervosa include:
- Individualized goals set for weekly weight gain and target weight, as recommended by the American Psychiatric Association 1
- Eating disorder-focused psychotherapy for adults, which should include normalizing eating and weight control behaviors, restoring weight, and addressing psychological aspects of the disorder 1
- Eating disorder-focused family-based treatment for adolescents and emerging adults with an involved caregiver, which should include caregiver education aimed at normalizing eating and weight control behaviors and restoring weight 1 Regular monitoring of both physical health and mental status is essential throughout recovery, as suicide risk may persist even during weight restoration phases. The connection between anorexia and suicide stems from the psychological distress, body image issues, and neurobiological changes caused by malnutrition that affect mood regulation. It is crucial to prioritize the individual's health and safety above all other considerations, as emphasized in the 2014 Female Athlete Triad Coalition Consensus Statement 1.
From the Research
Anorexia and Suicide: Prevalence and Associated Factors
- Anorexia nervosa (AN) is a severe psychiatric disorder associated with high mortality rates, and suicidality is a significant concern in this population 2.
- Studies have reported that approximately one-quarter to one-third of people with AN have thought about suicide, and one-quarter to one-third of people with AN have attempted suicide 2.
- Individuals with AN are 18 times more likely to die by suicide compared to gender and age-matched comparison groups 2.
Clinical Correlates of Suicidality in Anorexia Nervosa
- Clinical correlates of suicidality in AN include purging behaviors, depression, substance abuse, and a history of childhood physical and/or sexual abuse 3.
- Binge-purging AN is associated with higher rates of suicide attempts and non-suicidal self-injuries compared to restricter-type AN 4.
- Unemployment, personality disorders, and lifetime sexual abuse are also associated with suicide attempts in AN patients 4.
Assessment and Treatment of Suicidality in Anorexia Nervosa
- Clinicians should carefully assess suicidality in AN patients, paying particular attention to issues related to lethality 5.
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be used as adjunctive treatment to psychotherapy for relapse prevention and improvement of depressive and anxiety symptoms in weight-restored anorexic patients 6.
- However, antidepressants should not be used as sole therapy for AN, and their use should be carefully monitored due to potential complications and lack of efficacy during acute treatment 6.