You must make a choice to take a chance or your
life will never change”.
|—||The greatest and most persistent blockages to your progress in life usually come from a single source—yourself.|
As a group, despite the variation in the content of the existing literature, the 66 publications described in this narrative review support the finding of a consistently high prevalence of suicidality associated with EDs. Specifically, AN is consistently associated with high rates of suicide, especially in the context of significantly elevated SMRs for adolescents and young adults. Contrary to previous findings, some recent studies have found that suicide risk appears elevated in BN as well, although there is more variability in the literature on BN study findings; this may be due to sample differences across studies, including the possibility that some individuals with BN may have a history of AN. Self-injurious behaviors are frequent in EDs, with higher rates among EDs that include binge and purge behaviors. Self-injurious behaviors, which may or may not include suicidal intent, are especially high among adolescents with EDs. Furthermore, recent investigations on individuals who engage in rigorous physical exercise are important because they suggest that over-exercise – often considered a self-injurious behavior among ED individuals – may pose additional risk beyond the physical consequence of the activity itself. Over-exercise may change pain sensation and in turn affect individuals’ acquired capability for suicide. Based on these findings, individuals with EDs, including those with BN symptoms, who engage in over-exercise, may be at higher risk for suicide. These data underscore the importance of assessing for suicide risk not just in individuals with AN, where suicide rates have long been recognized as elevated, but also in individuals presenting with BN and other ED symptoms. Ultimately, there are a number of risk factors associated with suicidality, which may occur across ED diagnoses. Clinicians must pay close attention to these factors, including chronicity of illness, comorbid diagnoses, history of abuse, and self-injurious behaviors, as occurrence of these factors may increase the potential risk of suicidality.