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Anorexics at
high risk for suicide
(May
2008 Issue)
By Pamela Berard
A new study shows that anorexics who are suicidal use highly lethal
methods to kill themselves, challenging the theory that the high
rate of suicide among anorexics is because of their weakened physical
conditions.
Jill Holm-Denoma, Ph.D., lead author and assistant professor of
psychology at the University of Vermont, says psychologists seeing
someone with anorexia must consider that they have a very high risk
relative to other people of committing suicide.
"I think the biggest thing we take from the clinical perspective
is that we really want to highlight for providers that when they
are seeing someone with anorexia they need to do a very thorough
suicide assessment," she says.
The two leading causes of premature death for people with anorexia
are suicide and compromised nutritional status. "People with anorexia
have the highest rate by suicide when compared to all other psychiatric
groups," including bipolar disorder and schizophrenia, Holm-Denoma
says.
In the study, slated to be published in the Journal of Affective
Disorders this spring, researchers found that those who committed
suicide used methods that offered little hope of rescue - including
ingesting toilet bowl cleaner, jumping in front of a train and hanging.
People who kill themselves "are people who have developed some
capacity to tolerate self-inflicted wounds," Holm-Denoma says. Frequent
exposure to very painful situations results in "people building
up some capacity where eventually they have the capacity to kill
themselves. They just habituate to the idea."
Holm-Denoma says that anorexics have already had experience overriding
pain, including the incredibly strong biological urge to eat, which
may help explain how they override the urge to live. Anorexics also
may suffer from other painful medical conditions (such as cardiovascular
distress).
This thought is in line with the theory by Thomas Joiner, Ph.D.,
who published the book, "Why People Die by Suicide." Joiner's theory
of suicidal behavior predicts that "high lethality suicide attempts
are made only by people who have habituated to pain and fear through
repeated exposure to painful situations," according to the study.
Other research has found high pain thresholds among individuals
with anorexia, the study reports.
The study followed more than 130 anorexics for an average of more
than eight years, and evaluated nine (eight women, one man) who
committed suicide to determine whether they died because of compromised
physical health or because the attempts were highly lethal and would
have killed any adult. The findings supported the latter theory,
indicating the likelihood of death as "high" or "medium to high"
in the majority of cases, and the likelihood of rescue as "low"
or "low to moderate" in the majority of cases.
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