A Familial Link between Eating Disorders and Suicidality?

The link between eating disorders and suicidality is known to be strong, but the reasons are not fully understood. Yao et al. (JAMA Psychiatry, 2015, published online January 13, 2016) recently examined the possibility of a familial contribution to the risk for suicidality. In this study, nearly 2.3 million participants in a three-year Swedish birth cohort were examined. Eating disorder diagnosis and suicide attempts, as well as mortality from suicide, were recorded from national registers.

Not surprisingly, increased risk in the eating disorders group for suicide attempt and death by suicide was identified (the risk was 5.3-fold and 5.4-fold, respectively). This remained true after accounting for depression, anxiety disorders, and chemical dependency (1.8-fold and 2.0-fold increased risks, respectively). Some of this increased risk ran in families: people with a sibling with an eating disorder had a 1.4-fold increase in the risk of suicide attempt.

This important paper makes several points. First, it adds further support for the idea that bulimia nervosa carries significant suicidality risk, just as does anorexia nervosa. Second, it shows this risk persists even when one takes comorbid depression, anxiety disorder, and chemical dependency into account. This is obviously important, because each of these diagnoses carries its own risk, and one could have imagined that that fact might have explained all of the risk in eating disorders. However, there clearly is risk specific to the eating disorder. Third, some of the risk for suicidality in eating disorders appears to be familial, impacting both risk for disordered eating and risk for suicidality.