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Don't read this post about suicide and eating disorders

Posted Oct 01 2008 8:13pm

You don't want to read this. This topic freaks you out, brings up your worst fears, and you just can't face it.

You know eating disorders can kill. You've heard that anorexia is the deadliest of psychiatric illnesses. And don't forget: bulimia is under-counted because coroners prefer to write: "cardiac arrest" or "electrolyte abnormality" instead.

But suicide is a leading cause of death for people with eating disorders, and ignoring that fact doesn't help.

And this is gonna hurt - I'll warn you in advance - these suicides do not happen just at the "dangerously low" weights we all titter and point at. In fact, suicide in eating disorders often happens when recovery is under way.

Suicide kills more people in the US than homicide does: 30,000 a year. But I think we tend to have a compassion deficit on the topic because it appears to be self-imposed. Eating disorders and suicidality are not choices; they are symptoms of disease.

Our firm and loving support needs to extend beyond the initial weight gain and the brave initial efforts the patient makes to recover. The hell for them isn't just when they are starving or purging - those activities numb the pain - their hell is reaching and then maintaining a healthy body and active brain. That takes many months of brain-rending work, and may have to be done more than once.

Yet the supports that get a person to "look better" are often withdrawn when they do.

I don't mean worrying, suspecting, snooping, and despairing: I mean maintaining generous and appropriate levels of support. College can wait. Independence can wait. Cutting back on therapy bills can wait. Our normal lives can wait.

If you read this far, you deserve some good news now: research is uncovering clues to who among us is the most vulnerable to suicidality. This may lead to better monitoring in future, and a better understanding of what mechanisms underlying the thoughts and behaviors.

Although anti-depressants have been largely ineffective for underweight ED patients, they may have a role in individual cases. Yes, antidepressants are believed to cause more suicidal thoughts at the beginning of treatment, but did you know that the same effect is found with psychotherapy? Recovery is hard.

Not recovering is harder, though. We can't let our fears of suicide cloud that truth: staying ill isn't an option. Negotiating and giving in to the illness won't prevent suicide: they make it more likely. Early and firm intervention, full recovery, and long term supports are what we CAN do. And must.

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