BY: Melissa Munn-Chernoff, PhD
DATE: September 29, 2016
This September is National Suicide Prevention Awareness Month. Suicide is the third leading cause of death in young adults1 and is common among women with anorexia nervosa and bulimia nervosa (BN).2,3 Less information is known about the association between suicide and binge-eating disorder (BED), including whether suicide precedes BED, BED precedes suicide, or whether both occur at the same time. A study released this month4 used two large, national samples of adolescents and adults to investigate the association between suicidality (which included suicidal ideations, plans, and/or attempts) and BED, as well as to determine their order of onset.
Over 10,000 adolescents aged 13-18 years from the National Comorbidity Survey Adolescent Supplement and approximately 3,000 adults aged 18-95 years from the National Comorbidity Survey Replication participated in the study. Given the wide age range for adults, participants were divided into 4 groups: 18-29 years, 30-44 years, 45-59 years, and 60+ years. The eating disorders examined were lifetime histories of BED, BN, and any eating disorder (i.e., anorexia nervosa, BN, or BED). All three eating disorder groups were included to determine whether the risk for suicidality was higher among individuals with BED compared with the other eating disorders, especially BN. In addition, other psychiatric disorders (mood, anxiety, substance use, or behavioral disorders) were examined to determine whether any associations between lifetime histories of eating disorders and suicidality remained significant after accounting for these co-occurring disorders.
Findings indicated that suicidality was significantly associated with any eating disorder and with BN in adolescents and most adult groups – individuals with eating disorders were more likely to report suicidality than individuals without eating disorders. Similarly, adolescents and most adults who had BED were significantly more likely to report suicidality than individuals without BED. Although both BN and BED were associated with suicidal thoughts, plans, and attempts, the association was greater for BN. Finally, for any eating disorders and BN, the results remained significant after accounting for other comorbid psychopathology among adolescents, but not in adults. The associations between BED and suicidality did not remain significant after accounting for these other psychiatric disorders in adolescents or adults.
Among adolescents with BED, 73 individuals reported suicidality. For adults, the number of individuals with BED who reported suicidality was as follows: 28 (18-29 years), 26 (30-44 years), 19 (45-59 years), and 5 (60+ years). Results suggested that the majority of adolescents tended to experience suicidality after BED onset, whereas for most adult age groups, they generally experienced suicidality before BED onset.
Despite the small number of individuals who reported suicidality, this study highlights the fact that suicidality is a major concern among individuals with BED and that it occurs both before and after BED onset. Suicidal thoughts, plans, and attempts are serious. This work nicely complements work conducted in our combined UNC/Karolinska team that revealed elevated risk for suicide across all eating disorders using data from Swedish Registers.5
If you or someone you know is experiencing any suicidal thoughts, plans, or attempts, there is help. A few national resources to speak with someone who can help are available below.
1 National Alliance on Mental Illness (2016). Retrieved September 15, 2016, from http://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month.
2 Chesney E, Goodwin GM, Fazel S (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153-160.
3 Crow SJ, Swanson SA, le Grange D, Feig EH, Merikangas KR (2014). Suicidal behavior in adolescents and adults with bulimia nervosa. Comprehensive Psychiatry, 55, 1534-1539.
4 Forrest LN, Zuromski, KL, Dodd DR, Smith AR (in press). Suicidality in adolescents and adults with binge-eating disorder: Results from the National Comorbidity Survey Replication and Adolescent Supplement. International Journal of Eating Disorders.
5 Pisetsky EM, Thornton LM, Lichtenstein P, Pedersen NL, Bulik CM (2013). Suicide attempts in women with eating disorders. Journal of Abnormal Psychology, 122, 1042-1056.
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