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Suicidal Anorexics: Determined to Die?
Thursday, Feb. 28, 2008 By KATHLEEN KINGSBURY
Deciding not to eat sounds to most people the very definition of
suicide. It is perhaps
no surprise then that a new study concludes that when anorexics
choose to take theirown lives, they tend to employ some of the most
lethal methods available. Yet, inmany ways, the new research
conducted at the University of Vermont represents alandmark shift
in how doctors understand suicidal tendencies in patients
sufferingfrom anorexia nervosa.
Anorexia has the highest mortality rate of any psychiatric
disorder. But psychologistspreviously believed that those high
rates of death were due to patients' already deterioratedphysical
state. The hypothesis was that these are people already on the
verge of death theywere so malnourished and underweight that even
the slightest suicide attempt could easilylead to death.
The new study's authors have shown this assumption is wrong in
most cases. Extrapolatingfrom nine case studies of anorexics in
Germany and Boston, they concluded that such suicidesare not simply
a call for help gone wrong, but that anorexics are genuinely
determined to diewhen they attempt to kill themselves. Some of the
disturbing means the nine patients profiledused included jumping in
front of moving trains, ingesting dangerous household cleaners
andsetting oneself on fire. These patients also tended to isolate
themselves before their suicideattempt, most likely in order to
reduce the possibility they would receive life-saving help."We
established that these patients' death had little to do with their
low body weight," sayslead author Jill Holm-Denoma, a professor of
clinical psychology at Vermont and an experton treating eating
disorders. "The methods that they chose could have killed
anyone."Holm-Denoma's work reaffirms, among many others, a 2003
Harvard University study thatconcluded anorexic women are, by
nature of their illness, self-destructive, leading them tohave a
likelier propensity toward suicide as well as alcohol abuse. That
study of about 250women suffering eating disorders showed the risk
of death by suicide among by anorexicwomen to be as much as 57
times the expected rate of a healthy woman. Research on suicidein
2006 by psychologist Thomas Joiner at Florida State University took
those conclusions onestep further and suggested anorexics habituate
to pain, making them fearless of death, andthus more likely choose
a more lethal means to end their lives. Holm-Denoma's
research,however, is one of the first studies of the specific
methods that suicidal anoxerics use. Thegruesome methods they chose
as well as how they isolated themselves from rescue, Holm-Denoma
says, leaves little doubt that they wished to die.
The new findings, to be published this spring in theJournal of
Affective Disorders, comeduring this year's National Eating
Disorder Awareness Week. As many as 10 million womenand one million
men in the United States suffer from an eating disorder such as
anorexia or
bulimia, according to the National Eating Disorder Association
(NEDA). Females betweenthe ages of 15 and 24 are 12 times more
likely to die from anorexia than all other causes ofdeath, the NEDA
reports. And suicide is the primary cause of death for anorexics,
greatereven than starvation. Holm-Denoma stresses her research
highlights how seriously treatment
providers must take suicide risks amongst those suffering from
eating disorders. "Thelikelihood of whether a patient wants to
lethally hurt herself must be assessed right away,"Holm-Denoma
says, adding, "Addressing psychiatric needs must be paramount."For
the families of anorexics, Holm-Denoma's research only affirms
their worst fears. One of
the biggest frustrations these families face when their loved
one is diagnosed with anorexia ishow they can obtain affordable
psychiatric help. Insurers rarely pick up the bill. Most health
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plans argue that eating disorders require mental health
treatment not covered by most policiesand therefore refuse to pay
for long-term care. In the direst cases, health plans will often
covera brief hospitalization to stabilize a patient's weight. But
once she begins to gain weight again,she will be sent home. "The
biological crisis may have passed," says Barbara Anthony,
aBoston-based lawyer and executive director of Health Law
Advocates, an organization that
aids families. "But hospitals and health plans have done little
to provide these patients withthe mental health care they
desperately need."Meanwhile, costs related to in-patient treatment
for an eating disorder can range from $25,000to $30,000 a month.
Many families are forced to take out second mortgages or
depletesavings. Such situations are tragic, Holm-Denoma says.
"Anorexia is one of the most serious
psychiatric diseases our society faces," she says. "Our work
shows even further that moreneeds to be done to prevent it."
