Dying To Be Thin: Attachment to Death in Anorexia Nervosa (original) (raw)
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Journal of Affective Disorders, 2008
Background: Suicide is a leading cause of death among individuals with anorexia nervosa (AN). In this paper, we examined competing explanations of the high rate of death by suicide among individuals with anorexia nervosa (AN). Methods: Nine case reports of individuals with AN who died by suicide were evaluated to determine whether death by suicide occurred a) because physical health was so compromised that what would be a non-lethal suicide attempt in a healthy adult became a fatal suicide attempt, or b) because highly lethal suicide attempts that would have killed any adult, healthy or medically compromised, were made. Results: The findings converged with the latter hypothesis, as predicted by Joiner's [Joiner, T., 2006. Why People Die By Suicide. Harvard University Press, Cambridge, MA] theory of suicide, which suggests individuals with AN may habituate to the experience of pain during the course of their illness and accordingly die by suicide using methods that are highly lethal. Limitations: This study utilized case reports instead of an experimental design, which impedes its ability to comment on whether there is a causal relationship between Joiner's theory and death by suicide among individuals with AN. Conclusions: Clinicians are encouraged to carefully assess suicidality in AN patients, paying particular attention to issues related to lethality.
Causes of Death in Patients with a History of Severe Anorexia Nervosa
Objective: This study reports causes of death for a cohort of 35 patients with severe anorexia nervosa (AN), who were treated between 2012 and 2020, and descriptive information on their medical and psychological comorbidities is provided. Methods: Three hundred and seventy patient names were submitted to the National Death Index (NDI). The NDI reviewed whether a death certificate matching each patient’s identifying information existed, and if it existed, specific causes of death were noted. The original group of 370 patients consisted of 229 individuals who had been treated voluntarily and 141 who had been treated involuntarily. Results: Thirty-five patients from the 370 (0.09%) submitted to the NDI were confirmed deceased. Most (83%) were female with an average age of 38.5 years (SD:12.7) and average body mass index (BMI) of 12.8 kg/m² (SD:2.4). The total number of patients with AN listed as a cause of death was 24 (69%). Two patients died as a result of suicide. Twenty-eight (80%)...
European Journal of Clinical Nutrition, 2007
Objective: To evaluate long-term mortality rate of anorexia nervosa (AN) patients in a southern Italy population compared to the most recent literature. Design: Retrospective and review setting. Patients and interventions: One hundred and forty-seven female AN patients, consecutively admitted from 1994 to 1997 to the Outpatient Unit, were re-examined between June and November 2003. Our data are compared with 10 other studies published since 1988. Results: One hundred and twenty-three deaths in 2240 patients, amounting to a total mortality rate of 5.25% were reported in the literature. Deaths due to suicide, AN-related and AN-unrelated diseases were 1.20, 3.07 and 0.98%, respectively. After correcting for unrelated deaths, mortality rate was 4.27%. In our 8-year follow-up, we found a mortality rate of 2.72% (1.82% after correcting for unrelated deaths). Standardized mortality ratio was 9.7. Conclusion: We interpret our favourable findings as a consequence of an integrated, clinical-nutritional and psychiatric approach. Finally, considering AN demographic characteristics, that is young female subjects in Westernized societies, mortality rate is confirmed to be dramatically high. Sponsorship: 'Federico II' University of Naples.
Responding to “Terminal anorexia nervosa: three cases and proposed clinical characteristics”
Journal of Eating Disorders
The treatment of eating disorders raises many ethical debates given the pervasiveness with which this illness impacts individuals, especially as the length of time with the illness increases. A recent case study supported the appropriateness of pursuing medical aid in dying for individuals with eating disorders who wish to end their fight with their disorder. This correspondence raises concerns related to this controversial proposal as the current authors dispute that the use of medical aid in dying for individuals with eating disorders is ethically judicious or appropriate. Additionally, this correspondence highlights additional treatment implications that should be considered when trying to provide individuals with eating disorders with the best evidence-based care possible, with the goal of promoting steps toward recovery.
Mortality in eating disorders: A descriptive study
International Journal of Eating Disorders, 2000
Objective: We report rates and causes of death for a cohort of 246 eatingdisordered women and provide descriptive information on their eating disorder and comorbid diagnoses. Method: Data on mortality were collected as part of a longitudinal study of anorexia nervosa and bulimia nervosa, now in its 11th year. Other data sources included death certificates, autopsy reports, relative interviews, and a National Death Index search. Results: Seven deaths have occurred during the study, all among anorexic subjects with a history of binging and purging and with comorbid Axis I disorders. The crude mortality rate was 5.1%. The standardized mortality ratios for death (9.6) and suicide (58.1) were significantly elevated (p < .001). Conclusions: Anorexia nervosa is associated with a substantial risk of death and suicide. Features correlated with fatal outcome are longer duration of illness, binging and purging, comorbid substance abuse, and comorbid affective disorders.
Suicidal Behavior in Eating Disorders
Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry, 2023
Many studies have shown that people with eating disorders have higher rates of suicidal ideation, suicide attempts, and completed suicide than the general population. One of the diseases with the highest suicide rate among psychiatric disorders is anorexia nervosa. Some hypotheses have been proposed to explain possible causes of increased suicidal behavior in eating disorders. Some conditions common to eating disorders and suicidal behavior, such as dissatisfaction with the body and interoceptive deficits, have been cited. It has been conclusively shown that psychiatric comorbidity, especially the co-diagnosis of depression, increases the risk of suicide in patients with eating disorders. However, increased suicidal behavior in eating disorders cannot be explained by comorbidity alone. The interpersonal psychological theory of suicide (IPTS), developed by Joiner, aims to understand why people commit suicide and to explain the differences in individual suicidal behavior. Some researchers have thought that the increased suicidal behavior of people with eating disorders, especially anorexia nervosa patients, is expected from the perspective of IPTS. The compensatory behaviors of patients with eating disorders, such as vomiting or chronic restrictive food intake, are painful and challenging actions for the body. It can be considered that repeated encounters with painful and challenging experiences form a habit in the individual and reduce pain avoidance. When viewed from the IPTS perspective, decreased pain avoidance may explain the increased suicide attempts and completed suicides of individuals. Clinicians working with eating disorder patients must conduct regular and comprehensive assessments of suicide. Comorbidities such as major depression, anxiety disorder, and substance-use disorder should not be overlooked in patients with eating disorders and should be taken seriously.
Suicidality in eating disorders: Occurrence, correlates, and clinical implications
Clinical Psychology Review, 2006
This review summarizes the published studies on suicide and suicide attempts in individuals with eating disorders, highlighting rates of occurrence, clinical correlates, and implications for practitioners. Multiple studies find high rates of suicide in patients with anorexia nervosa (AN) [Standardized Mortality Ratio (SMR) for suicide range from 1.0 to 5.3], whereas suicide rates do not appear to be elevated in bulimia nervosa (BN). In contrast, suicide attempts occur in approximately 3-20% of patients with anorexia nervosa and in 25-35% of patients with bulimia nervosa. Clinical correlates of suicidality in eating disorders include purging behaviors, depression, substance abuse, and a history of childhood physical and/or sexual abuse. Patients with eating disorders, particularly those with comorbid disorders, should be assessed routinely for suicidal ideation, regardless of the severity of eating disorder or depressive symptoms.
Journal of Eating Disorders, 2021
Background Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. Methods Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Fun...
Anorexia nervosa: A literature review
Progress in Health Sciences, 2020
Introduction: Anorexia nervosa is a food intake disorder characterized by acute weight loss that it could cause severe psychosomatic problems. Purpose: To present the data and information as well as the treatment related to Anorexia nervosa. Materials and methods: The study material consisted of reviewed articles on the topic found in Greek and globally accepted electronic databases, Pubmed, Scopus, Medline, Google Scholar, regarding the effects of Anorexia nervosa on health and its treatment. Results: Initial symptoms of Anorexia nervosa and Bulimia Nervosa may be characterised by bodyrelated negative interpretation bias, distorted body image and pronounced body dissatisfaction. Anorexic patients refuse to eat with their family or in public places. They lose weight by drastically reducing their total food intake, with a disproportionate reduction in the amount of meals containing carbohydrates and fats. The term Anorexia is unfortunate, because a decrease in appetite does not occur...
Outcome and prognosis of anorexia nervosa. A retrospective study of 41 subjects
The British Journal of Psychiatry, 1990
of 41 subjects. Outcome and prognosis of anorexia nervosa. A retrospective study References http://bjp.rcpsych.org/content/156/1/92#BIBL This article cites 0 articles, 0 of which you can access for free at: permissions Reprints/ permissions@rcpsych.ac.uk to To obtain reprints or permission to reproduce material from this paper, please write to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/156/1/92