Eating Disorders and Suicide: The Perfect Storm-

Why do people with eating disorders experience suicidal behavior?

Why do people with eating disorders (ED) experience such high rates of suicidal behavior?This was the question of a research study published in the journal BMC Medicine, titled 'The perfect storm': why are people with eating disorders at risk of suicide?

The main objective of the study was to identify the variables that influence suicidal behavior in people with eating disorders in order to develop theoretical models and more adapted interventions for these patients.

Photo: Fripik.Author: Fripik.Deskorgan: 14/Ga/25.

There is an increased risk of suicide in people with eating disorders.

The authors point out that eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive eating disorder, represent a global health problem with increasing rates of incidence internationally, especially since the COVID-19 pandemic.

Although mortality rates have decreased over time, EDs remain at high risk of all-cause mortality.In fact, suicide is the second leading cause of death among people with eating disorders.In particular, previous studies have found that people with anorexia nervosa are 18 times more likely to die by suicide, and those with bulimia nervosa are seven times more likely to die by suicide compared to age- and sex-matched reference groups.Statistics show that up to one-third of people with ED, across the spectrum of diagnoses, have attempted suicide.

Despite this link, the authors note that previous research has shown that eating disorders alone do not explain suicide rates because eating disorder symptoms are weak for suicide attempts.This suggests a need to investigate underlying causes, as existing theoretical models fail to fully explain the complex nature of suicidality risk in eating disorders.

Therefore, the aim of the study was to investigate the relationship between eating disorders and suicide risk, using an exploratory qualitative approach.Individual semi-structured interviews were conducted with a total of 49 participants: 30 individuals with lived experience of eating disorders and suicidal behavior and 19 health professionals with experience of ED treatment.

Maze of suicide. caught between illness and recovery.

After analyzing the cases, the researchers identified four main aspects.The first, called "no way out", describes in detail how the risk of suicide is deeply shaped by the experience of feeling overwhelmed both by the illness and during the attempt to recover from it.

According to the participants, the eating disorder felt like a "constant, never-ending, never-ending battle" that left them emotionally and physically exhausted.In this way, suicide was seen as an escape from this unacceptable situation.

However, the recovery process is not considered liberation.ED participants reported that alternative recovery is like “leaping into the unknown.”In this way, the eating disorder, even if it is a source of harm, can also be a “survival tool,” eliminated by threat.The researchers point out that the absence of disorder, as a coping structure, can trigger “feelings of exposure, loss, and abandonment,” such that recovery feels like an “emotional free fall.”

Additionally, recovery is often described as a period of "feeling worse, not better," characterized by loneliness and hopelessness.This often contributes to suicidal thoughts.The authors noted that when individuals access external indicators of progress, such as weight gain,Support is often withdrawn.It reinforces the feeling that their suffering is no longer seen and rationalized.This situation can increase emotional needs and make someone's life unsustainable.

A climactic experience: Invisible emotion and condemnation in silence.

The second theme, which the authors called "the experience of feeling alienated," explores how disconnection and exclusion increase destructive ideation.Thus, as stated in the text, the intersection of eating disorders with personal identity (gender, neurodivergence) implies disease involvement.sizes are not properly related to disease.One of these prejudices is to consider anorexia as a female diagnosis.

In neurodivergent people, suicidal thoughts have been triggered by feeling “out of sync” with the world and support systems.

Additionally, this study highlights the weight of silence and stigma surrounding suicide, which makes it a "negative" topic even in clinical settings.In this regard, many participants said that talking about suicide to other people around them was "big", causing fear or dread.The authors note that, for some participants, eating disorders were considered a path to "slow suicide" and, therefore, less stigmatizing and less harmful to their loved ones than direct action.Silence about suicide and the belief that no one can help in this matter increases feelings of disconnection and loneliness among people with eating disorders.

Despite pain, participants talked about protective factors against suicide risk.These factors not only include access to formal treatment, but also consider the importance of relationships with others and the organization of events in life.

According to the results, when people were in the most difficult ED times, it was important to "put the hope of safety to their loved ones or professionals".

Another key factor was "finding purpose" and rebuilding a life outside of the eating disorder.For many, ATT "took away their identity, purpose and future."Rebuilding an identity that transcended illness allowed people to find reasons to live.

Lack of care reinforces the risk.

What They See Is Weight explores how unhealthy eating habits can exacerbate isolation and increase the risk of suicide.

Participants described how suicidal ideation was transferred to eating disorder treatment. From the clinic, physical health indicators such as weight were considered a priority.and there was no mental health assessment.The authors point out that this type of practice increases feelings of emotional abandonment.Which leads to more hopelessness.

Sharing care is also important.ED services typically focus on eating symptoms.and suicidal thoughts are the responsibility of the general mental health team.

ED participants perceived treatment as sometimes traumatic; in particular, trauma was reported to be caused by those being refused or excluded from treatment if they did not meet certain physical criteria.Therefore, the health status must be at a very critical level to be included in care programs, neglecting patients with eating disorders.

On the other hand, the attitude of healthcare workers who offer validation, humane and warm care protects against suicidal behavior.

These results have important clinical implications.The authors note, on the one hand, the dangers of prioritizing rapid relief of symptoms by focusing on patient severity.In this regard, they note that the complexity of the experience requires flexible, individualized, and person-centered care that does not focus solely on symptom reduction.

Similarly, they warn that suicide risk is active and constantly changing, which means that risk varies throughout the course of the disease and during recovery.For this reason, suicide risk assessment should be considered throughout the process.

Furthermore, the study reinforces the need for healthcare professionals to be confident in treating suicide directly, rather than talking about suicide and referring patients to other services because of suicidal risk.

Foye, U., Kakar, S., McNamara, et al.(2025).'It's a perfect storm': Why are people with eating disorders at risk of suicide?A qualitative study.BMC Medicine, 23 (481).https://doi.org/10.1186/s12916-025-04326-1.