Abstract
ObjectiveCompared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED).MethodCase-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.ResultsAN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1–13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2–9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt.ConclusionThere are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
Highlights
Eating disorders (ED) are biologically based serious mental disorders with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life [1]
There were no significant differences between the group in proportion of patient with a chronic medical comorbidity
As expected in the ED sample, the lowest body mass index (BMI) since onset was lower in the anorexia nervosa (AN) sample than in the bulimia nervosa (BN) sample (p,0.0001)
Summary
Eating disorders (ED) are biologically based serious mental disorders with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life [1]. In anorexia nervosa (AN), this excess mortality is explained in part by the physical complications and in part by an increased rate of suicide. Approximately 20 to 40% of deaths in AN are thought to result from suicide [2,3] with SMRs for suicide of 31 in a recent meta analysis [4] and ranging from 13.6 to 56.9 [2,3,5]. In bulimia nervosa (BN), the same meta-analysis found a lower SMR of 7.5 [4] with some studies showing no excess mortality [6] and more recent data suggesting that suicide rates may be increased in this group [7]. Studies comparing rates of suicidal behavior in AN and BN have had mixed results with some finding no difference between AN and BN [10,11] and others finding lower rates of suicide attempts (SA) in AN than BN [12] [for review see [13]]
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