Why Intervention Is Necessary to Prevent Eating Disorder Deaths

It's a myth that the effects of eating disorders aren't as dangerous as the effects of other mental health conditions. Unfortunately, health complications related to eating disorders can be fatal.

However, early intervention markedly improves treatment outcomes, which is one reason to ensure people with eating disorders receive a prompt diagnosis and access to treatment.

Mortality Rates in People With Eating Disorders

Studies report varying death rates from eating disorders, but there are common findings. It's estimated that every 52 minutes, someone dies from a complication of an eating disorder—that's 10,200 deaths per year in the United States.

Anorexia nervosa may have the highest mortality rate of other eating disorders that have been studied. One study reports that people with anorexia nervosa experienced a standardized mortality rate of 5.35—that is, they were about five times more likely to have died over the study period than age-matched peers in the general population.

People with bulimia nervosa and binge eating disorder had a standardized mortality rate of 1.5 compared to their peers who didn't have eating disorders. A meta-analysis found that the standardized mortality rate was 1.92 for the diagnosis of other specified feeding and eating disorder, formerly known as eating disorder not otherwise specified (EDNOS). 

Mental Health and Eating Disorders

The link between eating disorders and other mental illnesses is strong. In some cases, the symptoms of a pre-existing condition worsen because of an eating disorder. But even without a pre-existing condition, a person's mental health is negatively affected by the progression of an eating disorder.

The following conditions commonly coexist with eating disorders:

• Anxiety disorders (especially social anxiety disorder)
• Borderline personality disorder (BPD)
• Depression
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD), particularly for those with bulimia
• Self-harm
• Substance use disorder
  

Someone with an eating disorder may find it difficult to maintain social relationships (especially if they are hiding their eating disorder from loved ones), keep their jobs, go to school, and function in their everyday life. They may feel stressed and alone as a result of their eating disorder. They may also feel guilt and shame.

There is an increased risk of suicidal behavior linked with anorexia nervosa, bulimia nervosa, and binge eating disorder. Someone with an eating disorder and another psychiatric illness may be at an increased risk of suicidal behavior.

Causes of Eating Disorder-Related Deaths

There are a number of medical complications that can arise from eating disorders, many of which are fatal. In addition, the increased risk of suicide that people with eating disorders face is another cause of eating disorder-related deaths.

Cardiovascular Complications

Cardiac-related issues cause one-third of all deaths in patients with anorexia. Common cardiac complications that occur among people with anorexia include bradycardia (slow heart rate) and hypotension (low blood pressure).

Both anorexia and bulimia are linked with a greater risk of heart arrhythmia (a heartbeat that is too fast or too slow) and congestive heart failure.

Anxiety and stress, which many people with eating disorders experience, are also linked with an increased risk of cardiovascular disease.

Binge eating disorder may cause excess weight and obesity, at which point a person also has a higher risk of developing cardiovascular disease and high blood pressure.

Dehydration

Dehydration is a significant risk that people with anorexia and bulimia face. Dehydration can cause electrolyte imbalances in the body, altering levels of elements like calcium, potassium, sodium, and magnesium.

Electrolyte imbalance is the most common cause of sudden death in people who die from bulimia nervosa, as purging drastically affects electrolyte levels in the body.

Diabetes

Though not recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), "diabulimia" is a term used to refer to people with type 1 diabetes who purposely don't use enough insulin in an effort to lose weight. However, this is a dangerous and fatal practice.

Malnutrition

Malnutrition is when the body doesn't receive adequate vitamins, nutrients, and minerals to keep functioning properly. Malnourishment causes a loss of muscle mass (including cardiac muscle mass) and decreased respiratory and gastrointestinal functioning. People with anorexia can experience malnutrition and starvation, which can be fatal.

People with binge eating disorder and bulimia can experience malnutrition as well. Malnutrition is linked with long-term health problems like diabetes and heart disease, which can be fatal. There are also negative mental health effects linked with malnutrition such as depression and anxiety.

Refeeding Syndrome

Refeeding syndrome can occur in people with anorexia who receive artificial feeding to treat malnutrition. In some cases, the drastic shift in electrolytes from refeeding causes metabolic changes that result in seizures, respiratory failure, and death.

Suicide

Suicide is a major concern for those with all types of eating disorders. One study found that suicide is the second leading cause of death for people with anorexia and that the risk of suicidal behavior is increased for those with bulimia and binge eating disorder compared to the general population.

On average, people with anorexia are 18 times more likely to die by suicide and people with bulimia are seven times more likely.

Treatment Types

Fortunately, there are many options when it comes to treating eating disorders. The appropriate treatment options for someone depend on a variety of factors including the type of eating disorder they have, how severe their condition is, what a doctor recommends, and what insurance will cover (or what they are able to afford out of pocket).

Hospitalization

Someone who is in immediate danger as a result of an eating disorder (for instance, if they're experiencing dehydration, malnutrition, arrhythmia, or heart failure) should get to an emergency room as soon as possible. Some people with anorexia require a nasogastric tube, which is a tube inserted through the nose that will administer necessary nutrients to prevent starvation.

Doctors and nurses in a hospital are able to provide 24-hour supervision for those with eating disorders who require it.

Treatment Centers

There are different types of treatment centers for eating disorders. Some provide outpatient care, which means you live and sleep at home but you go to the treatment center for counseling. Depending on what type of program you're in and the level of care you need, you might go once a week for a few hours or you might go every day for multiple hours until symptoms improve.

Treatment centers usually provide a team of specialists to work on each person's case. For instance, your team may include a medical doctor, psychologist or psychiatrist, registered dietician, and social worker.

Goals of treatment include providing education on nutrition, preventing medical complications, reducing eating disorder behaviors (such as binging, purging, or restricting), and restoring weight if necessary.

Therapy

The following types of therapy are often used to treat eating disorders:

• Cognitive behavioral therapy (CBT): A therapist will help a patient understand the underlying thoughts and attitudes behind their eating disorder behaviors. They will teach healthy coping mechanisms to help a person overcome dangerous eating behaviors.
• Family-based treatment (FBT): FBT is often used for adolescents with eating disorders. Parents and caregivers are taught how to support their children at mealtime by deciding what they will eat and encouraging them to eat.
• Group therapy: Being in a group setting can help someone with an eating disorder talk about their experiences and learn from their peers. Group therapy can provide a person with strong interpersonal relationships that can help during recovery.
• Interpersonal psychotherapy (IPT): Along with CBT, IPT is considered one of the "most established" treatments for eating disorders. IPT can help a person gain control over their eating behaviors and rituals.

One study found that adolescents with anorexia who had been ill for more than three years had a poor response to family and individual therapy. Research has found that over time, anorexia can cause damage to a still-developing brain, which can make it harder to treat the eating disorder.

Medication

There aren't medications approved to treat anorexia, but a healthcare professional might prescribe an antidepressant such as Prozac (fluoxetine), Celexa (citalopram), or Zoloft (sertraline) to treat depression or anxiety in people with anorexia.

These antidepressants are selective serotonin reuptake inhibitors (SSRIs) that increase serotonin levels in the body, increasing feelings of well-being and regulating mood and anxiety.

Vyvanse (lisdexamfetamine) is a stimulant that is commonly prescribed for attention-deficit/ hyperactivity disorder (ADHD), but it is also FDA-approved for binge eating disorder. It works by increasing norepinephrine and dopamine in the body, which may help regulate overeating.

Finding Support

It is common for people with eating disorders to believe that their behaviors surrounding food are not serious.

If you are a loved one of a person with an eating disorder, please encourage your loved one to get help. If you are coping with an eating disorder and are not in treatment, please reach out to a healthcare professional.

If you are living with an eating disorder, talk to your primary care physician or a mental health professional such as a therapist.

A therapist can review your options with you and together, you can decide the best course of treatment. A therapist may also recommend you meet with a psychiatrist if you could benefit from taking medication for your eating disorder or an underlying mental health condition.

Eating Disorder Prevention

The first step to eating disorder prevention is education. Learning about different types of eating disorders can help diminish the stigma that people with eating disorders face. Avoid making comments about other people's bodies, what people eat, and how much of it they eat.

Try not to call foods "good" or "bad," which implies there should be guilt or shame surrounding "bad foods." While it's important to acknowledge which foods are more nutritious, try not to be hard on yourself or others for indulging in less nutritious foods once in a while.

Parents and caregivers can try keeping an open dialogue on food, weight, and body image with their families. Remember, kids notice if you judge or name-call yourself based on your weight or your eating habits. Celebrate yourself and others for talents, unique qualities, and individuality (not solely for appearance).

Eating disorder prevention programs such as the National Eating Disorder Association's The Body Project have been found to be effective in preventing eating disorders among young women in high school and college. The program helps participants achieve body satisfaction and challenge society's thin ideal.

Healthcare professionals should also be held accountable for recognizing the warning signs and risk factors for eating disorders in all of their patients—especially people of color, people who are overweight, and men, all of whom are often overlooked when it comes to being diagnosed with an eating disorder.

You can speak to your healthcare professional about potential triggers, such as getting weighed in at the doctor's office. Having an open dialogue is important.

A Word From Verywell

If you have an eating disorder (or you're concerned you are developing one), try to reach out to a doctor or a mental health professional as soon as possible. If you have a loved one with an eating disorder, gently encourage them to seek help. Left untreated, the symptoms of eating disorders often worsen. But eating disorders are treatable, and you can recover.