Why don’t we talk about suicide
when we talk about eating disorders?
That’s what I wanted to know when I learned of supermodel Ruslana
Korshunova’s leap from her 9 th floor balcony in Manhattan last
week. Authorities quickly deemed the
20-year-old’s death a suicide. According to New York Magazine, “Korshunova
felt confused about the direction of her life, lost several pounds, and seemed
to suffer from an undefined stomach problem.” But she was also 5-foot-eight and wore a Size 4. What no one would say outright is that she was
likely one of the 40% of high fashion models who, according to a 2007
investigation by the British Fashion Council, suffer from eating disorders.
Instead, coverage of Korshunov’s death pointed to
prescription drugs, a demanding work schedule, an ex-boyfriend, and even
conspiracy theories about the Russian mafia. "There's no way she would
have killed herself," a friend from her home town in Kazakhstan told the
New York Daily News. "She loved life so much."
Yet the London Telegraph quoted from Korshunova’s blog three months ago: "I'm so lost. Will I ever
find myself?" This is not the voice
of a cover girl at the top of her game; it is the voice of virtually every
person who suffers from a serious eating disorder.
According to David Herzog, professor of psychiatry at
Harvard Medical School and director of the Harris Center for Advocacy in Eating
Disorders at Massachusetts General Hospital, anorexia nervosa not only has the
highest mortality rate in general but also the highest successful suicide rate of any mental illness.
The overlap of eating disorders with depression, panic
disorder, post-traumatic stress disorder, substance abuse or dependence,
dramatic or erratic behavior, and self-harming behaviors, makes it difficult to
tease out the exact role an eating disorder plays in suicidal behavior. What’s less debatable is the fact that a
starved brain does not function like a normal brain.
When I was struggling with anorexia as a fashion model at
the same age as Korshunova, a loud voice in my head played a continuous loop:
“You’re never good enough. You don’t
deserve to eat. You fat pig, push
yourself harder. Harder! Why don’t you
That voice belonged to “ED,” as people in the eating
disorders community today call their illness. It’s the same voice that prompted one young woman now in recovery to
write me recently, “ If I
still have an eating disorder next year, I will be dead---because if it doesn't
kill me I will kill myself--I'm NOT willing to go on living in this hell any
What people who trivialize eating disorders as “choices” or
“diets” do not understand is that these diseases warp the mind. There is nothing rational about the thoughts
of someone with anorexia or bulimia. These are existential illnesses that
gradually conflate life with death, control with surrender.
Dr. Cynthia Bulik and colleagues at the eating disorders
program at the University of North Carolina at Chapel Hill recently looked at
patterns of attempted suicide among 413 mostly female subjects in the Genetics
of Anorexia Nervosa Collaborative Study. Almost 17 percent of these women had
made at least one suicide attempt between age 7 and 40. More than half of these
attempts required medical attention.
Particularly revealing is the difference in rates depending
on the type of eating disorder
behavior. Women with “restricting
anorexia nervosa” severely reduce their food intake but do not binge or purge. Just
over 7 percent of this group had attempted suicide. Among those who restricted and also binged,
purged, or involved laxative or diuretic abuse, the attempt rate leapt to
between 20 and 30%.
As I discovered when writing my book Gaining, behavior in eating disorders relates directly to core
temperamental traits, such as impulse control. People
who binge and purge tend to have lower impulse control than people with
restricting anorexia, who tend to be more compulsive and anxious. Suicide attempts among these groups are also
likely to reflect these traits. One may
methodically horde enough pills for the day when she can no longer “go on
living in this hell.” Another may
impulsively jump nine stories from her apartment balcony.
way, it’s death -- not beauty or glamour, and certainly not choice -- that lies
at the unmentionable end of “successful” eating disorders.