Yes, Eating Disorders Can Be Deadly

Death and Eating Disorders

Now that I am surrounded by a social media community that includes eating disorder professionals, affected family members, and sufferers alike, it is hard to escape the reality that eating disorders do kill. On a fairly regular basis, the community is rocked by the news of yet another life lost to a vicious, unrelenting eating disorder. The toll these deaths take on the community is palpable. The wall of memory (of lives lost to eating disorders) on Middle Ground Musing’s website grows.

One image from the October 2015 March Against ED rally in Washington DC – green shirts worn by those who had lost a loved one to an eating disorder – still haunts me. According to a study by Warren and colleagues in 2012, about one-fourth of surveyed eating disorder specialists has experienced the death of a patient from suicide or cardiological-related problems.

We often hear about the dangers of obesity, but we hear less commonly about the risks of eating disorders. Eating disorders may seem benign, but this is a myth.

Early intervention markedly improves treatment outcome, which is one reason to ensure individuals with eating disorders receive a prompt diagnosis and access to treatment, preferably evidenced-based wherever possible.

Mortality rates

Studies report varying death rates from eating disorders, but there are common findings.  Collectively, eating disorders have the highest death rates among all mental illnesses.

In most studies, anorexia nervosa has the highest mortality rate of the different eating disorders. In a recent study by Fichter and colleagues, individuals with anorexia nervosa experienced a standardized mortality rate of 5.0 – that is, they were five times more likely to have died over the study period than age-matched peers in the general population.

Individuals with bulimia nervosa and binge eating disorder had a standardized mortality rate of 1.5 (were 1.5 times more likely to die than peers without eating disorders).

A meta-analysis by Arcelus and colleagues found similar standardized mortality rates to Fichter’s study:  5.86 for anorexia nervosa, 1.93 for bulimia nervosa, and 1.92 for eating disorder not otherwise specified (EDNOS). Research has demonstrated higher death rates for bulimia nervosa and EDNOS than these figures. According to one study, the mortality rate for anorexia nervosa patients aged 25 to 44 followed after hospital discharge was 14 times that of age-matched non-eating disordered peers. (That’s 14 times!)

Causes of death

Suicide and cardiovascular complications top the list. Fichter and colleagues found that three-quarters of the deaths for patients with an anorexia nervosa diagnosis were due to cardiovascular complications related to low body weight. A study by Huas and colleagues found that there are two main predictors of death for individuals with bulimia nervosa: a history of prior suicide attempts and a lower minimum BMI.

Across a number of studies, suicide is a common cause of death, and an elevated suicide rate is found amongst all eating disorder diagnoses. Studies have shown that approximately 20% of the individuals with anorexia who had died had committed suicide, and 23% of the bulimia nervosa deaths were from suicide. 

Patterns and predictors of death

Patients with anorexia nervosa seem to tend to die at an earlier age than those with bulimia nervosa or binge eating disorder, primarily in early adulthood.  Predictors of shorter time to death include a higher number of lifetime eating disorder hospitalizations, premature discharge from the hospital, alcohol abuse, older age of eating disorder onset, poorer social adjustment, and lower body mass index at the time of hospitalization.

Eating disorders need to be taken seriously:

It is common for patients with eating disorders to not believe their problem is serious.  Often, people with eating disorders won’t know they have a problem or an eating disorder. If you are a loved one of a person with an eating disorder, please encourage your loved one to get help. If you are suffering from an eating disorder and are not in treatment, please reach out to a treatment professional. With treatment, most people with eating disorders do recover!  


Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry 2011; 68.  

Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE. Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry 2009;166: 1342-1346.

Fichter, M., & Quadflieg, N. (2016). Mortality in eating disorders – Results of a large prospective clinical longitudinal study. International Journal of Eating Disorders.

Hoang U, Goldacre M, James A. Mortality following hospital discharge with a diagnosis of eating disorder: National Record Linkage Study, England, 2001-2009 (2014). International Journal of Eating Disorders, 47(5):507-515.

Huas C, Caille A, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A et al. (2011). Predictors of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatrica Scandinavica, 123:62-70.

Huas C, Godart N, Caille A, Pham-Scottez A, Foulon C, Divac SM et al. (2013). Mortality and its predictors in severe bulimia nervosa patients. European Eating Disorders Review, 21:15-19.

Keel PK, Dorer DJ, Eddy KT, Franko D, Charatan DL, Herzog DB. (2003). Predictors of mortality in eating disorders. Arch Gen Psychiatry.

Warren, C. S., Schafer, K. J., Crowley, M. E., & Olivardia, R. (2012). Qualitative analysis of job burnout in eating disorder treatment providers. Eating Disorders, 20, 175-195. 

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