Are eating disorders a form of suicide?

17th July 2008

Are eating disorders a form of suicide?

posted in Eating Disorders |

The blog Between Living and Existing wrote about a new eating disorders awareness PSA campaign across Canada. The Looking Glass Foundation, a non-profit organization seeking to develop Canada’s first residential center for the treatment of adolescents with eating disorders, is the sponsor of the campaign. Their PSAs sound very hard-hitting — images shown include girls compulsively weighing and measuring themselves and a bulimic using a broken toothbrush — and seek to expose the realities of eating disorders.

I applaud any effort to raise awareness of and education about eating disorders. I especially applaud the organization for not being afraid to show the often harsh and definitively unglamorous side to an eating disorder. I further applaud the organization for seeking to establish a residential treatment facility, and for its summer camp and scholarship programs. We need more organizations like The Looking Glass Foundation.

My only issue with the campaign, and it’s a minor quibble, is its theme: “Not every suicide note looks like a suicide note.”

It’s a common stereotype that people with an eating disorder are subconsciously or even consciously trying to kill themselves. And I can see where many might get this idea. After all, eating disorders erode not only the mind, but also the physical self. Many sufferers, like me, are left with lasting physical reminders of our eating disorders years after we have reached a stable point in our recovery — that is, if one succeeds in recovery. For all too many, recovery is the carrot forever dangling out of reach. And don’t doubt it: Eating disorders are as real and deadly as cancer. There is no cure. The final symptom is suicide.

I’m sure there are people with a death wish who hope an eating disorder will help them achieve this goal, but for me and most people with eating disorders I know and have talked to, eating disorders aren’t a way to die. They’re a way to live. There is a reason why people who promote anorexia as a lifestyle choice say that a dead anorexic is a failed anorexic. For many, an eating disorder is a way to cope with larger emotional issues in their life. We are unable to comprehend and manage the real issues in a healthy and constructive way, and so we fall back on our bodies, allowing its behaviors and compulsions and urges to say what we really feel and need. In flesh, we describe a pain we can not communicate in words. For me, my eating disorder came at a unique crossroads in my life, a time when I felt deeply depressed, confused and unsure of myself and also a time of great upheaval in my family, personal and professional life. Starving gave me a goal, a way to stand out and exert control.

Many eating disorders naysayers like to bandy about the statistic that only some two hundred people die each year from anorexia, but the truth is, we have no way to realistically estimate just how many people die each year from an eating disorder. One would be hard-pressed to find anorexia or bulimia cited as the cause of death on any death certificate, just as obesity itself is never listed as a cause of death. Most often, it is the complications that arise from an eating disorder — heart irregularities, malnutrition, kidney failure, electrolyte imbalances, depression and suicide, etc… — that cause the death of a person with an eating disorder. And since we don’t even have a reliable estimate of the numbers of people with an eating disorder — many cases go unreported for fear of shame or due to a lack of resources — we will never be able to pinpoint a reliable estimate of just how many lives are taken each year by eating disorders.

It is true that an eating disorder is often a silent cry for help. It is also true that starvation and chemical imbalances brought on by an eating disorder often cause such great depression in sufferers that many feel suicide is the only way out of their pain. It is also true that eating disorders have the highest mortality rate of all mental illnesses. In fact, the annual death rate associated with anorexia alone is more than 12 times higher than that of all other causes combined for females between 15 and 24 years of age. But most people with an eating disorder do not want to die and their disorders are not a suicide note in the making. Most people with an eating disorder want to live – and an eating disorder allows them the only way forward they know how to take in order to keep living.

Eating disorders carry with them great ironies: Most develop as a form of control, but soon begin to control us; the object of our obsession does not bring us happiness, but rather more sorrow and pain; and no matter how much weight we lose, it’s never thin enough. But perhaps greatest irony of all is that that which allows us to live has also the power to kill us.

What about you? Would you say your eating disorder represented a form of suicide or is it instead a way to cope with life?

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This entry was posted on Thursday, July 17th, 2008 at 7:00 am and is filed under Eating Disorders. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On July 17th, 2008, Emily

said:

I love what you say about eating disorders being a way to live. I recently found an anxiety test I had taken a couple of years before I became anorexic. I had scored “severe anxiety.” Retaking the test now, after undergoing treatment for anorexia for two and a half years but still restricting and exercising compulsively, I scored much lower — only “mild anxiety.” What this suggests to me is that, on a day-to-day basis, my food and exercise compulsions actually helped me cope with the anxiety I was experiencing before. Of course, as you say, we start these behaviors to be in control, but they soon control us: when I can’t get access to the “right” foods or when I can’t exercise, my anxiety levels rise precipitously!

posted on July 17th, 2008 at 9:57 am

2 On July 17th, 2008, tokaiangel

Exactly like Emily, my eating disorder and exercise compulsion began as a way to manage my anxiety problems - and it worked, to an extent. However, the psychological byproduct of becoming massively underweight was, for me at least, intense depression and loneliness that led me to want to continue losing weight in order to die. I can see that it’s not the same for everyone, but all these mental illnesses (anorexia, anxiety, depression) feed into and off each other so much that in some cases it’s hard to tell where one ends and the another begins.

TA x

posted on July 17th, 2008 at 4:08 pm

3 On July 17th, 2008, Fat Girl

Eating disorders are CERTAINLY a way to cope with life and anyone who thinks different hasn’t experienced the disorder.. Seriously, perhaps death may be caused by eating disorders, and perhaps at times those of us who have the disorder may feel like we want to end it, but the disorder is definitely our way of coping- and it can only do so much.

posted on July 17th, 2008 at 6:42 pm

4 On July 17th, 2008, Amy

That’s what I always said about cutting when people would misinterpret the act as a suicide attempt. Yes, sometimes I really just wanted to die, but cutting was for living. It was about pulling my shit together (if only momentarily) and being to press on with the day.

posted on July 17th, 2008 at 7:24 pm

5 On July 18th, 2008, Jackie

What you said about the irony that having an eating disorder and feeling that’s what you need to live, but it can also kill you. It reminded me of a tattoo Angelina Jolie has, the Latin proverb “quod me nutrit me destruit” (what nourishes me destroys me). I think the concept that people are associating EDs with suicide, is not much different than people assuming if someone is self-harming they want to kill themselves.

Both are means of crying out for help. Maybe they should stop trying to suggest EDs or self-harm are suicidal behaviours in themselves, and realize the help that is not granted to people suffering from either is what may contribute to suicidal thoughts.

I also am tired of the, “Well if we keep hassling them about their problem, they’ll stop” Same sort of situation with fat, “Well if we bully them enough, they’ll have to change.” I used to cut myself alot in high school. I wasn’t diagnosed as having chronic depression until I graduated. Why? Well I wasn’t failing, yeah that’s what they told me. I couldn’t see the school psychatrist cause I was doing too well in school. I kept yelling “Well fine, then I’ll fail if that what it takes for me to get help!” nobody bothered. I was in Special Ed, they probably just thought, oh another retard being an upstart.

I have Asperger’s Syndrome, which is a higher functioning form of Autism. Although discussion has been taking place, considering that Asperger’s Syndrome might be it’s own thing, aside from the Autism spectrum. What I’m saying is, I was put in Special Ed not cause I was all that learning disabled, more because schools like to throw any student who may need extra help into Special Ed. Which isn’t what it was for, it certianly wasn’t created as a haven for drug abusers to complain about their problems, while people who were BORN with disabilities have time taken from them.

What I’m trying to get across, is presuming that what is a behaviour as a coping response to great stress is a sign someone might want to commit suicide. Maybe people need to try to help. Not just say, oh well they’re a lost cause, they’re just going to kill themselves anyways. It’s like when they asked Marilyn Manson what he would’ve wanted to say to the kids who caused Columbine, his response was “I’d listen to them, because that’s what nobody did.”

posted on July 18th, 2008 at 8:41 am

6 On July 19th, 2008, Moonlight0806

I would respond to the question by inquiring if the people who wrote the ad “Not every suicide note looks like a suicide note” had ever spoken with a person with anorexia.

I would bet my life savings that any given anorexic would have more informed nutritional understanding than the average person or even some medically trained personnel. Anorexia makes most people obsess about nutritional information. It becomes a balance of eating just enough of what you absolutely need to keep yourself alive. I would also argue that any given anorexic knows their bodies physical limits better than most athletes. They survive off of pushing their limits to the extreme on a daily basis. They are generally motivated to keep themselves as health as possible under the circumstances. I remember going to a girl scout event in elementary school where they showed up a reality type video where a girl apparently chose to not be anorexic anymore because someone told her it was suicide and suicide was a sin, so she didn’t wan to go to hell because she was anorexic. I called BS on the movie and i was only 9 at the time.

posted on July 19th, 2008 at 1:20 am

7 On July 19th, 2008, anonymous

Not sure if objecting to the tagline of the ads constitutes a minor quibble since that’s all there is to them, other than footage of emaciated girls measuring themselves and lying on the telephone.

This might be of interest:

The meaning of self-starvation: Qualitative study of patients’ perception of anorexia nervosa
Ragnfrid H. S. Nordbø, Cand Psychol 1 *, Ester M. S. Espeset, Cand Psychol 1, Kjersti S. Gulliksen, Cand Psychol 1, Finn Skårderud, MD 2, Arne Holte, PhD 1 3
1Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
2Lillehammer University College, Lillehammer, Norway
3University of Oslo, Oslo, Norway
email: Ragnfrid H. S. Nordbø (ragnfrid.nordbo@fhi.no)

*Correspondence to Ragnfrid H. S. Nordbø, Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway

Funded by:
Health and Rehabilitation Foundation via the Norwegian Council for Mental Health
Norwegian Research Council

Keywords
eating disorder • psycho therapy • treatment • function • illness perception

Abstract

Objective:
Anorexia nervosa (AN) patients tend to place a positive value on their symptoms. Many clinicians believe that this plays a central role in maintaining the disorder. However, empirical research on how patients attribute meaning to their symptoms is lacking. This study aims at systematically exploring the meaning that the patients with AN attribute to their anorectic behavior.

Method:
A qualitative, descriptive, phenomenological design was used. Eighteen women aged 20-34 with AN (DSM-IV) were interviewed with an informant-centered interview. The interviews were tape-recorded, verbatim transcribed, coded, and analyzed phenomenologically, using a QSR-N*Vivo software program.

Results:
The psychological meanings that the informants attributed to their anorectic behavior could be summarized in eight constructs: Security (feeling of stability and security), Avoidance (avoiding negative emotions), Mental strength (inner sense of mastery), Self-confidence (feeling acknowledged and worthy of compliments); Identity (achieving new identity), Care (eliciting care from others), Communication (communicating difficulties), and Death (wishing to starve oneself to death).

Conclusion:
The eight constructs may have central functions in the maintenance of AN and should be regarded when patients’ motivation and goals for treatment are assessed. Further study of the possible functions of the constructs in maintaining AN is warranted. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006.

posted on July 19th, 2008 at 4:15 pm

8 On July 24th, 2008, Jeanne

For me, my eating disorder is a coping mechanism. A way for me to survive. To function. To keep living, even a half-life.

That isn’t to say that I haven’t thought about ending the pain. Ending the suffering. Ending it all. It’s at these times, when the emotions drown me, when the pain is so intense that i grow numb, that not even my eating disorder helps, I find other ways to cope. Because for me, ending it all is not an option.

But that’s just me.

posted on July 24th, 2008 at 9:40 am

9 On July 31st, 2008, miwome

Heh, “quod me nutrit me destruit” is a veeeery popular pro-ana slogan. I’m fairly certain Jolie has some form of disorder, but that’s neither here nor there and certainly none of my business.

I agree that eating disorders are a way to live. I think for a lot of profoundly lonely and confused young women they provide a narrative structure and a sense of orientation–you always know exactly how close to or far from your goal(s) you are.

That’s why I’ve never been able to describe ED-NOS, cutting, smoking cigarettes, and voluntarily depriving myself of sleep (not all at once, usually) as “self-destructive,” regardless of what loved ones may say. I do it for a reason, even if I don’t always fully understand.

posted on July 31st, 2008 at 2:29 am