Reprinted from Eating Disorders Review
March/April 2005 Volume 16, Number 2
©2005 Gürze Books
Q: I’ve been treating a patient with bulimia nervosa who has made several suicidal gestures in the past few years. What are the chances that she’ll actually commit suicide and what should I be watching for? (M.M., Ann Arbor, MI).
A: Trying to guess how serious the suicidal risks are for a patient presents one of the most challenging problems in clinical practice, one that clinicians treating patients with anorexia nervosa (AN) and bulimia nervosa (BN) commonly face. In one prospective longitudinal study lasting almost nine years, 22.1% of patients with AN and 10.9% of patients with BN made a suicide attempt. Statistically, those with more severe depressive symptoms, self-harm, drug and alcohol abuse, laxative abuse, and personality disorders are more prone to suicidal behaviors (Franko, DL et al, Psychological Medicine 24: 843, 2004). In general, we know that past suicidal behaviors are linked with higher likelihood of future suicidal behavior and of completed suicides, so your patient is at higher risk than those who’ve never acted on suicidal impulses. Close monitoring and assessment for drug and alcohol abuse, severe depression, adverse life events and impulsivity must all be central issues in your treatment planning. Consultation with clinicians who work with suicidal patients may help provide practical suggestions and emotional support for you as you work with this patient.
— J.Y.
