Brief report
Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia–suicide link

https://doi.org/10.1016/j.jad.2007.07.029Get rights and content

Abstract

Background

Suicide is a leading cause of death among individuals with anorexia nervosa (AN). In this paper, we examined competing explanations of the high rate of death by suicide among individuals with anorexia nervosa (AN).

Methods

Nine case reports of individuals with AN who died by suicide were evaluated to determine whether death by suicide occurred a) because physical health was so compromised that what would be a non-lethal suicide attempt in a healthy adult became a fatal suicide attempt, or b) because highly lethal suicide attempts that would have killed any adult, healthy or medically compromised, were made.

Results

The findings converged with the latter hypothesis, as predicted by Joiner's [Joiner, T., 2006. Why People Die By Suicide. Harvard University Press, Cambridge, MA] theory of suicide, which suggests individuals with AN may habituate to the experience of pain during the course of their illness and accordingly die by suicide using methods that are highly lethal.

Limitations

This study utilized case reports instead of an experimental design, which impedes its ability to comment on whether there is a causal relationship between Joiner's theory and death by suicide among individuals with AN.

Conclusions

Clinicians are encouraged to carefully assess suicidality in AN patients, paying particular attention to issues related to lethality.

Section snippets

Participants

The first sample (N = 136) was drawn from 554 consecutive women seeking treatment at Massachusetts General Hospital and 21 women seeking treatment from local clinics. Mean age of participants was 24.8 years (range: 13–45 years) at the study's onset. Mean duration of illness was 6.7 years (range: 3 months–24 years). See Herzog et al. (1993) for more information.

Procedure

After an initial phone screening (including informed consent), trained researchers interviewed participants at intake and follow-up points

Results

Table 1 provides our conceptualization of each case's risk for death and likelihood of rescue. It also provides information such as age, BMI at death, subtype of AN, and method of suicide.

Case #1 ingested an unknown quantity of chloral hydrate and 354.9 mL of Lysol Toilet Bowl Cleaner [which contains hydrochloric acid (HCl)], and then called 911. She died 4 h after being transported to the emergency room due to gastric hemorrhaging. Her blood alcohol at the time of death was 0.16%. Overdose of

Discussion

The current study considered the suicides of nine individuals with AN in an effort to evaluate two potential explanations of high rates of suicide in anorexic individuals: 1) attempt methods are less likely to be lethal, but death occurs because of compromised medical state and/or social isolation or 2) they use highly lethal suicide attempts, in the context of low rescue potential, that would likely kill any adult. The majority of available evidence supported the latter hypothesis. Seven of

Role of the funding source

Preparation of this article was supported, in part, by grants from the John Simon Guggenheim Memorial Foundation (JSGMF) and the National Institute of Mental Health (NIMH; 5 R01 MH3833305, R01 MH51201, K24 MH01759, 1 F31 MH077386-01, and R29 MH48097). The JSGMF and the NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

There are no conflicts of interest to report.

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