Eating Disorders and Suicide Risk: What Families Need to Know This September

September is Suicide Prevention Awareness Month, and on September 10, the world marks World Suicide Prevention Day. For families living alongside someone with an eating disorder, this month carries particular weight. Eating disorders and suicide risk are deeply and dangerously connected. Understanding that connection is not meant to frighten you. It is meant to equip you. The more you know, the better you can help.

The Statistical Reality: Eating Disorders and Suicide Risk

Eating disorders have the highest mortality rate of any psychiatric condition. Research published in the *American Journal of Psychiatry* has consistently shown that anorexia nervosa, in particular, carries a mortality rate roughly six times higher than the general population, and that suicide accounts for a significant portion of those deaths.

According to the National Institute of Mental Health (NIMH), individuals with anorexia nervosa are 18 times more likely to die by suicide than the general population. Studies show that approximately 20–25% of deaths in people with anorexia are by suicide, not from medical complications alone.

Bulimia nervosa also carries elevated risk. Individuals with bulimia have higher rates of suicidal ideation and attempts than the general population, even when controlling for other mental health conditions. Binge eating disorder, while studied less extensively in this context, is also associated with significantly increased rates of suicidal thinking.

These numbers are sobering. They are also a call to action, not a reason to despair.

Why the Overlap Exists

Eating disorders and suicidality do not simply co-occur by coincidence. There are well-documented psychological, neurobiological, and social reasons why they so frequently appear together.

Chronic hopelessness. One of the most powerful predictors of suicidal ideation is hopelessness, the belief that things cannot improve. Eating disorders are notoriously difficult to treat, and many individuals who have struggled for years internalize the message that they are “too sick” or “too far gone” to recover. This is not true. But it is a feeling that must be taken seriously.

Impulsivity. Particularly in bulimia nervosa and binge-purge subtype anorexia, impulsivity is a recognized feature. Impulsivity does not cause suicidality, but it can reduce the time between a crisis thought and a dangerous action. This is why safety planning and access to crisis support matters so much.

Shame and self-loathing. Eating disorders are rarely about food alone. Many individuals carry profound shame about their body, their behaviors, and their illness itself. Chronic shame is a significant driver of both depression and suicidal thinking. People who feel deeply worthless may struggle to believe they deserve care, or that asking for help is even an option.

Social isolation. Eating disorders tend to pull people away from relationships. Rituals around food become secretive. Shame creates walls. Withdrawal from social connection is both a symptom and a driver of risk. The National Eating Disorders Association (NEDA)]  identifies social isolation as one of the key factors that sustains and worsens eating disorder pathology.

Comorbid depression and anxiety. The majority of people with eating disorders also meet criteria for at least one other psychiatric condition, most commonly depression, anxiety, or PTSD. These conditions interact. Untreated depression amplifies hopelessness; untreated trauma fuels shame; untreated anxiety narrows the world until the eating disorder becomes one of the only things that feels controllable.

Warning Signs Families Should Know

You don’t need to be a clinician to notice a change. Families are often the first to observe warning signs, and the most important people to act on them.

Watch for:

• Increased talk of being a burden — phrases like “you’d be better off without me” or “I just can’t do this anymore”
• Giving away meaningful possessions — jewelry, sentimental items, or things connected to future plans
• Withdrawal from relationships — going quiet on people they were previously close to
• Expressions of hopelessness about recovery — “I’ll never get better,” “there’s no point in trying”
• Researching methods or means — this is a high-acuity warning sign and requires immediate response
• A sudden calm after a period of extreme distress — this can, in some cases, indicate a decision has been made
• Sudden worsening of eating disorder behaviors — severe restriction, increased purging, or extreme over-exercise during a time of high emotional stress

You do not need to be certain before you act. If something feels wrong, trust that feeling.

How to Talk About It: Safe Messaging Guidelines

One of the most important things families can do is create space for an honest conversation, without making the topic more dangerous.

Language matters. Use the phrase “died by suicide” rather than “committed suicide.” The word “committed” carries the weight of criminal language and adds stigma to an already painful subject. Saying someone “died by suicide” is both more accurate and more compassionate.

Ask directly. Contrary to an old myth, asking someone if they are thinking about suicide does not plant the idea. Research consistently shows the opposite: asking opens the door. You might say: *”I’ve been worried about you. Are you having thoughts of hurting yourself or ending your life?”*

Listen without problem-solving. When someone discloses suicidal thoughts, the most powerful response is not a solution, it’s presence. Say: *”Thank you for telling me. I’m here. We’ll figure out the next step together.”*

Do not promise secrecy. If someone asks you to keep their suicidal thoughts secret, be honest: *”I care about you too much to keep this between us. I want to get you the right support.”*

Stay with them. If you believe someone is in immediate danger, do not leave them alone. Remove access to means if possible, medications, sharp objects. Then call or text 988.

What to Do If You’re Worried

If you believe someone you love may be at risk, act now. You do not need to be sure. You do not need to have all the answers.

Immediate steps:

1. Stay with them. Physical presence matters.

2. Call or text 988 — the 988 Suicide & Crisis Lifeline is available 24/7, free, and confidential. Crisis counselors are trained to help both the person in crisis and the people calling on their behalf.

3. Text HOME to 741741 to reach the Crisis Text Line.

4. If there is immediate danger, call 911 or go to your nearest emergency room.

For longer-term support, eating disorder-informed mental health care is essential. General crisis support is a critical first step but ongoing treatment must address the eating disorder itself, alongside any co-occurring mood or anxiety disorders.

How Integrated Treatment Addresses Both

Treating suicidality without treating the eating disorder leaves the root cause untouched. Treating the eating disorder without addressing depression, trauma, or suicidal ideation leaves the person vulnerable.

Integrated treatment addresses both simultaneously. This means a clinical team that includes medical oversight, psychiatric care, therapists trained in both eating disorders and mood disorders, and evidence-based modalities like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), EMDR, and Trauma Resolution Therapy.

DBT, in particular, was originally developed to treat chronic suicidality and has strong evidence for both eating disorders and suicidal ideation. Distress tolerance, emotional regulation, and interpersonal effectiveness skills reduce the impulsivity and hopelessness that elevate risk.

Explore the full range of treatment options at Remedy Therapy Center  including residential, PHP, IOP, and outpatient programs designed to meet each person where they are.

Recovery from both is possible.

Research supports this. People who receive comprehensive, integrated care for eating disorders can and do recover, fully, meaningfully, sustainably. The path is not linear, and it is not short. But it exists.

You Are Not Alone in This

If you are a family member carrying fear for someone you love, please know: you are not overreacting. The concern you feel is appropriate and worth acting on.

If you are someone with an eating disorder who has had thoughts of suicide, please know: you are not broken, and you are not beyond help. These thoughts are a signal that you need more support, not evidence that recovery is impossible.

If you or someone you love is struggling with an eating disorder and thoughts of suicide, integrated care can help. Remedy Therapy Center offers residential, PHP, IOP, and outpatient programs for adult women. Call (844) 451-3303 we are available 24/7. If you are in crisis, call or text 988.