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WHAT’S DEATH GOT TO DO WITH IT?

Posted Oct 02 2008 3:13pm

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 just die!”

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 longer.”

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.

Either way, it’s death -- not beauty or glamour, and certainly not choice -- that lies at the unmentionable end of  “successful” eating disorders. 

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