Brief reportDeaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia–suicide link
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.
References (26)
- et al.
Personality and eating disorders: A decade in review
Clinical Psychology Review
(2005) - et al.
The Structured Interview for Anorexic and Bulimic Syndromes for DSM-IV and ICD-10: reliability and validity
European Psychiatry
(2001) - et al.
Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa
Journal of the American Academy of Child and Adolescent Psychiatry
(1993) - et al.
Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank
The American Journal of Surgery
(2005) - et al.
Elevated pain threshold in anorexia nervosa subjects
Biological Psychiatry
(1999) - et al.
Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation
American Journal of Psychiatry
(1985) - et al.
Temperament, character, and suicide attempts in anorexia nervosa, bulimia nervosa, & major depression
Acta Psychiatrica Scandinavica
(1999) - et al.
Long-term mortality in anorexia nervosa
British Journal of Psychiatry
(1992) - et al.
Twelve year course and outcome predictors of anorexia nervosa
International Journal of Eating Disorders
(2006) - et al.
What predicts suicide attempts in women with eating disorders?
Psychological Medicine
(2004)
Why People Die By Suicide
Predictors of mortality in eating disorders
Archives of General Psychiatry
The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies
Archives of General Psychiatry
Cited by (41)
Socio-demographic and psychological risk factors for suicidal behavior among individuals with anorexia and bulimia nervosa: A systematic review
2019, Journal of Affective DisordersCitation Excerpt :These interesting findings regarding symptomatology and the elevated risk in both restricting and purging subtypes may be explained in terms of the interpersonal theory of suicide (IPTS), especially given its unique approach to EDs. ED patients may habituate to the experience of pain during the course of their illness—through repeated over exercising, vomiting, and laxative abuse— which may result in suicide by using highly lethal methods (Holm-Denoma et al., 2008; Selby et al., 2010; Smith et al., 2013, Stein et al., 2013). Collectively, these studies suggest that ED behaviors constitute painful experiences, and by habituating to them, ED patients have an increased acquired capability for suicide.
Fasting and acquired capability for suicide: A test of the interpersonal-psychological theory of suicide in an undergraduate sample
2015, Psychiatry ResearchCitation Excerpt :Three recent studies provide additional, albeit, indirect support for the relationship between fasting and ACS. Holm-Denoma et al. (2008) demonstrated that individuals with AN use highly lethal suicide methods that would likely result in death even in individuals of normal weight status. Selby et al. (2010) found an association between the restrictive subtype of AN and the frequency and lethality of suicidal behavior, even after controlling for endorsement of other types of painful and/or provocative behavior (e.g., self-induced vomiting, non-suicidal self-injury).
Aberrant pain perception in direct and indirect non-suicidal self-injury: An empirical test of Joiner's interpersonal theory
2013, Comprehensive PsychiatryCitation Excerpt :One hypothesis about why patients with anorexia nervosa (AN) are at increased risk for suicide is that individuals with AN are physically fragile and are thus more likely to die from methods that would be significantly less lethal to healthy individuals. In a study examining the selection of suicide in nine patients with AN, Holm-Denoma et al. [19] reported that all patients (9/9) in their study used methods of suicide that would have been lethal for a healthy individual. The data from this small study suggest that the “fragility hypothesis” [20] does not explain the increased risk for suicide in AN patients.
Factors associated with suicide attempts and nonsuicidal self-injurious behaviors in patients with eating disorders
2013, Revista Colombiana de PsiquiatriaThe Interpersonal-Psychological Theory of Suicide to Explain Suicidal Risk in Eating Disorders: A Mini-Review
2021, Frontiers in Psychiatry