The perfect storm: Why are people with eating disorders at risk of suicide?

This blog was written by the studies Principal Investigator Dr Moritz Herle and Dr Una Foye. Please note it includes mentions of suicide.

Eating disorders have a high mortality rate, with suicide being a leading cause of death in people with anorexia.

Understanding this risk is key to developing better prevention strategies, yet no qualitative studies have explored it so far.

What the study looked at:

This study wanted to understand why people with EDs are at such high risk of suicide. To do this we talked to 30 people with lived experience of both an ED and suicidal thoughts/behaviours, plus 19 healthcare professionals who work with EDs, and asked about their experiences and views about this topic.

What did we find?:

1. “No Way Out”: The Unique Role of Eating Disorders in Suicidality Across Illness and Recovery: For people with eating disorders, suicidal thoughts often came from feeling trapped; not just by the illness itself, but also by the challenges of trying to recover. It wasn’t always about a sudden crisis, but about a long-term sense that there was “no way out”. Living with an ED could feel unbearable, yet recovery could also be frightening and uncertain. This constant feeling of being stuck fed into suicidal thoughts and feelings. It wasn’t only about symptoms or treatment—it was about how the illness affected someone’s sense of self, control over their life, and hopes for the future.

2. The Outsider Experience: Feeling Unseen, Misunderstood, and Burdensome: For many people with EDs, they felt invisible or misunderstood, especially if they didn’t match stereotypes (e.g., male, non-white, neurodivergent, in a larger body).  Feeling cut off from others, ashamed, or pushed to the edges can make suicidal thoughts worse and stop people from asking for help. In addition, stigma and silence around suicide meant people often hid their suicidal thoughts (even from professionals) out of fear of rejection or being misunderstood, reinforcing these feelings of being an outsider who is isolated and alone, believing there was no safe place to be honest about their struggles.

3. Sparks of Hope: Protective Factors Against Suicidality: While much of the data reflected distress and hopelessness, people also spoke about moments that helped them stay alive. These protective experiences were not limited to formal treatment but emerged through connection, purpose, and feeling believed. These protective moments didn’t erase the pain but instead offered something to hold onto. Having even small reasons to stay alive, like connection with someone, a future goal, or feeling believed helped interrupt suicidal thinking. Such hope could be “held” by others (therapists, friends, peers) during times when the person couldn’t hold it themselves.

4. “They Only See Weight”: How Gaps in ED Care Reinforce Isolation and Risk: This theme looks at how suicidal thoughts were influenced not just by the emotional impact of the eating disorder itself, but also by participants’ experiences with support systems during crises. They described how aspects of care, like hard-to-access services, a focus only on physical danger, or disjointed support, sometimes left their suicidal feelings unnoticed. Instead of reducing risk, the lack of proper support often made feelings of hopelessness and isolation worse, fuelling their suicidality.

This study shows helps us build a better understanding of suicidality for people with EDs as it shows that the link between EDs and suicidal thoughts is complicated, while showing new ways that these thoughts and feelings occur – things that current theories don’t fully explain.

By listening to people with eating disorders and the clinicians who support them, we learned more about why suicidal feelings can happen and how they can show up at different stages of the illness and during recovery.

The findings show that treatment should focus on the person, not just the symptoms. Care needs to be flexible, personal, and based on proven approaches. This helps people get the support they need and address the thoughts and feelings behind suicidality.

You can read the full paper here.

If you are affected by any of the issued discussed in this article you can get help here. You can also find out more information about Eating Disorders, and access support, from the charity BEAT. If you are impacted by suicidal thoughts them remember, the Samaritans are always available to speak to by calling 116 123 from anywhere in the UK.