A few weeks ago, my friend Alex asked if I'd consider writing about eating disorders and suicide risk. This time of year, she said, is particularly hard for people with eating disorders.

If you think of one of the central activities during the winter holiday season, you'll figure out why. This time of year is all about food.

Whether it's a family dinner where everyone is watching what you eat or don't eat, or an office conversation about new year's resolutions to lose weight, for a person with an eating disorder, food, eating, and weight - which are always a focus - are unavoidably front and center at this time of year.

Alex reminded me that anorexia has the highest mortality rate of all mental illnesses. While many people who die from an eating disorder die because of the effects of the eating disorder on the heart, there are also many people who take their own lives.

I wanted to know, from her perspective as someone who's struggled for years with anorexia, about the link between eating disorders and suicide risk.

Many people, said Alex, think that a person with an eating disorder who dies by suicide "can't take living with the eating disorder anymore." But, it's more nuanced than that. Trying to recover from an eating disorder, particularly anorexia, may increase a person's risk of suicide.

The process of recovery, which involves gaining or "restoring" weight, "feels unbearable." Alex described feeling vulnerable and depressed, with increased anxiety. The sense that these feelings will never end can be overwhelming.

During the process of weight restoration, "everything you've been avoiding is there. Your brain is working again because you're eating. You're forced to deal with feelings that can be too much."

That sense of hopelessness she described is a key risk factor for suicide. So is the isolation a person with an eating disorder may experience if she's feeling disconnected from friends or family.

I asked Alex if there is anything friends and family can do to show support for loved ones with eating disorders, particularly at this time of year. She said:

  • "Try to make meals as comfortable as possible. If you are hosting a party, ask "Is there is something in particular I can make for you?"
  • "Don't make appearance- or weight-related comments.”
  • Check in, specifically asking about the eating disorder.

Even though I know that Alex struggles with anorexia, I never ask her about it. Sure, I ask how she's doing, generally. But, I don't ask directly, specifically, about her eating disorder.

It surprised me how much stigma about eating disorders I've accepted as normal, even though I work in the mental health field. When Alex asked, "If I had cancer, would people not ask me how I'm doing?" I found myself thinking, to my surprise, "But, that's different."

It's not. Although different people will have different feelings about being asked about an eating disorder, pretending like it doesn't exist at all isn't a way to show support. In fact, Alex said, "by people not saying anything, they're helping me buy into the idea that I'm fine."

For a person with an eating disorder, talking about it involves balance. While it may be uncomfortable to field comments about how your body looks, it may be comforting to have a caring friend ask about how you’re feeling.

For friends and family, the effects of an eating disorder on the physical body complicate having conversations about someone’s health. As is the case for many other mental health conditions, a person may look fine and feel terrible. But, perhaps because of the physical effects of the illness, which can be what friends and family notice first, it may be even harder to talk about the emotional side of things.

If you’re struggling with these issues this holiday season, the Multiservice Eating Disorder Association offers coping tips and some advice for dealing with the increased focus on food - and the increased stress of the holiday season.

Alex helped me realize that support can be a gift for a friend with an ongoing struggle. Alex, I've benefited from your expertise, which you’ve earned through your personal experience. Thank you.

Copyright 2013 Elana Premack Sandler. All Rights Reserved. 

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