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Restrictive Eating Linked to Increased Likelihood of Suicidal Ideation

Key findings

  • In this study of 82 adolescent and young adult females with low-weight eating disorders, 26% reported suicidal ideation
  • Fasting was associated with increased likelihood of suicidal ideation and was significant beyond the effects of binge eating episodes and purging
  • Clinicians should screen for suicidal ideation in all patients with eating disorders, especially in those low-weight patients who engage in fasting

Individuals with anorexia nervosa (AN) are 18 times more likely to die by suicide than young women in the general population, as reported in Comprehensive Psychiatry. In one study reported in General Hospital Psychiatry, 20% to 43% of individuals with AN reported current suicidal ideation, a known risk factor for suicide attempts.

Kamryn T. Eddy, PhD, and Jennifer J. Thomas, PhD, co-directors of the Eating Disorders Clinical and Research Program in the Department of Psychiatry at Massachusetts General Hospital, and colleagues examined the relationship between suicidality and specific eating behaviors, rather than diagnoses. According to their report in the International Journal of Eating Disorders, restrictive eating significantly predicts suicidal ideation, beyond the effects of binge eating or purging.

Study Details

The researchers studied 82 adolescent and young adult females who had been diagnosed with a low-weight eating disorder. They used the Beck Depression Inventory (for participants ≥18) or the Child Depression Inventory (for adolescents) to assess suicidal ideation. Active suicidality was an exclusion criterion for the study.

Eating behaviors were assessed using the Eating Disorder Examination (EDE). To inquire about restrictive eating, the researchers asked, "Have you gone for periods of eight or more waking hours without eating anything?"

That item measures fasting, just one type of restrictive eating. Still, the researchers chose to use it instead of the entire restraint subscale of the EDE because other items on that subscale assess cognitive restraint rather than restriction.


The researchers found that:

  • 24 of the 82 participants reported fasting, 15 reported binge eating and 20 reported purging
  • 21 participants (26%) reported suicidal ideation
  • In a logistic regression model, restrictive eating predicted suicidal ideation (β = 0.78, P = 0.02) but binge eating and purging did not

Restrictive Eating as a Form of Self-Harm

Restrictive eating occurs across all types of eating disorders, not just in patients with the AN-restricting subtype. Clinicians should regularly assess for suicidal ideation in patients who engage in restrictive eating, especially fasting.

Clinicians should also realize that thoughts of self-harm may underlie eating disorders to begin with. Participants in a previous study published on the International Journal of Eating Disorders reported engaging in disordered eating with intent to hurt themselves physically, in the moment and long-term, with some hope and knowledge of dying sooner due to these behaviors.

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