Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality


Purpose of Review

This narrative review evaluates recent literature on the associations between eating disorders and suicidality and discusses potential shared mechanisms that may account for these relationships. Additionally, the review highlights shortcomings with the literature to date and suggests avenues for future research.

Recent Findings

Individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder experience elevated rates of suicidality compared to the general population. Suicide risk is higher when eating disorders occur with other psychological conditions. Additionally, genetic factors, emotion dysregulation, trauma, stressful life events, and lack of body regard may have roles in the development of both eating disorders and suicidality.


Much of the risk for suicidality in eating disorders appears to be driven by comorbid psychopathology and genetic factors. However, the lack of longitudinal research makes it difficult to draw conclusions about the directionality or temporality of these relations; thus, novel methods are needed.

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Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Correspondence to April R. Smith.

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April R. Smith, Shelby N. Ortiz, Lauren N. Forrest, and Dorian R. Dodd declare no conflict of interest.

Elizabeth A. Velkoff reports support from the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE 1645475 during the conduct of the study. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Smith, A.R., Ortiz, S.N., Forrest, L.N. et al. Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality. Curr Psychiatry Rep 20, 77 (2018). https://doi.org/10.1007/s11920-018-0931-x

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  • Eating disorders; anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorders
  • Suicidality
  • Suicidal ideation; suicide attempt; suicide