Suicide and Self-Harm in Individuals with Eating Disorders

Not everyone with an eating disorder will engage in self-harm or think about suicide. However as a health professional it is important to be aware of identifying people who are at risk of self-harm and suicide, and preventing suicide. 

People with an eating disorder are likely to have a comorbid diagnosis. This can include depression, anxiety or  drug and alcohol issues which may increase their risk of suicide and self-harm. It is important then to consider these issues when conducting an assessment with a person with an eating disorder. 

Self-harm (or non-suicidal self-injury) is a deliberate act of self-inflicted injury intended to cause physical pain as a means of managing difficult emotions. Eating disorders themselves are harmful acts. 

Self-harm and suicide are not the same thing, and an act of self-harm is not necessarily an indication of suicidal thoughts or intentions. Acts of self-harm should be taken seriously and not misinterpreted as attention seeking behavior. It is also important to note that people who in engage in self-harm are at an increased risk of suicide. 

Self-harm is often used as a means to seek relief from psychological distress or emotional pain, to ‘feeling something’ when otherwise feeling numb, or as a way of communicating distress to others. Some eating disorder behaviours can also serve as a means of self-injury (e.g. purging). That is why it is important to determine the function of the symptoms of an eating disorder for each individual. 

The risk of suicide and self-harm may increase as the symptoms of the eating disorder decrease. So it is important to monitor this risk as the person recovers from their eating disorder. 

Currently, there is no single tool to assess the risk of suicide, and as such a thorough assessment by a confident health professional is best practice. Screening tools can support this process but should be used alongside a clinical interview.  

Managing an individual at risk of suicide and engaging in self harm requires a skilled health professional to comprehensively assess the risk, estimate the level of risk and determine appropriate interventions to minimise the risk. Appropriate interventions may include taking steps to mitigate the risk, accessing additional supports, as well as a safety plan. Risk should be monitored throughout treatment as an individual’s risk profile can change.  

For more information on suicide risk assessment and management protocol, see; Clinical care of people who may be suicidal. Developed by NSW Ministry of Health 2022.