How to Identify Signs of Suicide in Patients With Eating Disorders

Eating disorders impact about 30 million people in the United States. They are associated with high levels of premature mortality, including an increased risk for suicide. Without treatment, up to 20 percent of people with a serious eating disorder will die. Much like eating disorders, suicidal thoughts can affect anyone regardless of age, gender, or any other demographic categorization. 

As providers, there are certain warning signs of suicidal thinking that you should be looking out for, as well as an appropriate way to approach someone when you spot these warning signs.

The Link Between Eating Disorders and Suicide

A study from JAMA Psychiatry on suicide and eating disorders found that the risk for a suicide attempt is markedly higher among individuals with an eating disorder. The study researchers concluded that loved ones and treatment providers should remain vigilant for signs of suicidal thinking or behavior, regardless of whether the patient has a co-morbid disorder. However,  it is important to note that the presence of co-morbid disorders does elevate the risk of suicide for one with an eating disorder.

Research has shown those with eating disorders often present with a second disorder such as substance use disorder, anxiety, trauma, or depression. That is why it is so important that every disorder a person is experiencing is treated during eating disorder treatment. 

The Important Role of Providers in Suicide Prevention

In the United States, one-half of the people who die by suicide saw a physician in the preceding month, and one third was being treated for a mental illness at the time of their suicide, according to an article in American Family Physician by Jeffrey Stovall, MD and Frank J. Domino, MD. This shows how likely it is that providers will come into contact with someone contemplating suicide and emphasizes the importance of looking for the signs of suicidal ideation. 

7 Warning Signs of Suicidal Thinking 

Certain words or actions can alert you that someone needs help. People with eating disorders who are experiencing suicidal thoughts may:

1. Express thoughts about death or dying or not being around in the future. 
2. Talk about feeling hopeless or having no purpose.
3. Start to create a plan by searching online and elsewhere for ways to end their lives.
4. Display increased anxiety or anger, experience mood swings, or suddenly display a sense of relief or improvement in symptoms.
5. Increase their use of alcohol or drugs, or engage in other reckless behaviors.
6. Begin to withdraw from social activities, isolate themselves from others, or start to give away their possessions. 
7. Say that they feel like they have no reason to live or are a burden to those around them because of their disorder.

Sometimes patients may not verbally express their suicidal thoughts, but it shows in their actions, such as physical signs of substance use or withdrawal, restlessness, or agitation. If your patient is showing signs that indicate a higher risk for suicide, addressing it is of the utmost importance. Comments such as, “I notice you seem sad today,” or “Something else seems to be troubling you today,” may be a good way to start the conversation with someone you are concerned about. Good eye contact, empathetic responses, and a direct invitation such as, “Tell me more,” can be important indicators to the patient that you care about them and want to understand what they are going through. Asking about the patient’s family life, school, work, and relationships may allow the patient the opportunity to reveal suicidal thoughts.

How to Help Someone Experiencing Suicidal Thoughts

Providers may encounter patients with suicidal ideation frequently and knowing how to best approach them can make a huge difference in that patient’s life. If you are concerned about one of your patients, begin with the following steps:

• Have an honest conversation with the patient in private.
• Listen to the patient’s story.
• Avoid minimizing the patient’s problems.
• Assure the patient that you care.
• Ask directly about any suicidal thoughts.
• Encourage the patient to seek treatment and offer referral suggestions.

If the patient does acknowledge their suicidal thoughts, it is important to take them seriously and help them remove any lethal means in their possession. If there is an imminent risk of suicide, for safety reasons you should escort the patient to mental health services or an emergency room.