Suicide Risk and Eating Disorder Recovery

Eating disorders are complex illnesses, and so is the pain that often surrounds them. Suicide remains a leading cause of death among people with eating disorders, yet conversations about risk can still feel taboo. In 2022, an estimated 12.8 million U.S. adults seriously considered suicide, 3.7 million made a plan, and 1.5 million attempted to take their own lives. 

A 2025 study, Exploring suicide risk among female inpatients with eating disorders: a clinical perspective, found that individuals with anorexia were found to be 31 times more likely to die by suicide, while diagnoses of bulimia nervosa (BN) and binge eating disorder (BED) were also associated with elevated rates of suicidal ideation and attempts. 

Research on adolescents with eating disorders further highlights the frequency of attempts, ideation, and self-harm in this population. The intersection of suicidality and eating disorders is not uncommon, but it is often under-acknowledged in both clinical and public conversations.

Let’s explore how risk can be identified and addressed, not only through formal assessments but also by building a shared understanding of warning signs, patterns, and points of intervention. For those who love or support someone in recovery, this may help name what you’ve sensed but not known how to say. 

For clinicians, it may offer a place to revisit your own approach to suicide risk assessment in the context of eating disorders. And for those who are struggling, this may be a reminder that the thoughts you have are not uncommon, you do not need to feel ashamed of them, and that support is available.

How Can You Tell if Someone with an Eating Disorder Is at Risk for Suicide?

It can be difficult to discern when someone is struggling with suicidal thoughts, particularly in the context of an eating disorder. Behaviors that raise concern are sometimes dismissed as symptoms of the eating disorder itself, or misinterpreted as mood fluctuations or resistance. But silence and subtlety are common, and warning signs are not always verbalized directly. Families, providers, and peers all play a role in noticing changes, especially when someone’s presentation or treatment engagement begins to shift.

When to Be Concerned: Recognizing Suicide Warning Signs

• Withdrawal from friends, family, or previously meaningful activities
• Noticeable changes in sleep patterns (too little or too much)
• Escalating mood variability, especially expressions of rage or hopelessness
• Preoccupation with death or dying
• Talking about feeling like a burden or having no reason to live
• Giving away meaningful items or saying goodbye to others
• Escalating self-harm behaviors
• Rapid weight loss or intensifying restriction
• Sudden disengagement from treatment or therapeutic supports
  

Risk Assessment in Eating Disorder Treatment

Assessing suicide risk within eating disorder treatment settings isn’t a one-time triage. It’s a dynamic process that is woven into the fabric of care across disciplines. Risk can fluctuate dramatically over the course of treatment, which means it must be monitored alongside nutritional, medical, psychiatric, and therapeutic progress.

Eating disorders themselves elevate risk, but that’s rarely the full picture. Comorbidities like depression, PTSD, OCD, and substance use are common. Stressors around identity, stigma, or family systems can also compound distress, especially when a client lacks access to a supportive community or affirming care. And for many clients in structured programs, the stability of routine can mask underlying risk that becomes more visible when structure begins to loosen.

Effective assessment involves more than identifying red flags; it means contextualizing what risk looks like for each individual. Nutritional status, trauma history, recovery ambivalence, social withdrawal, or the return of compensatory behaviors may all signal concern. But none of these exist in isolation.

 Ongoing communication across team members allows providers to notice when patterns shift or when subtle changes suggest a client is emotionally or psychologically less stable than they appear on paper.

Six Actions that Can Make a Difference

There’s no single script that works for every situation, but there are tangible steps that can increase safety and support. These actions don’t require perfection, just consistency and care. For professionals, family members, or anyone in a position to help, these six practices offer a foundation for suicide prevention:

• Ask directly. When suicide is suspected, it’s okay—and important—to ask about it clearly. Direct language does not increase risk; in fact, it can lower shame and open the door to honest conversation. If you’re unsure what to say, start with curiosity and compassion.
  
• Be present in a meaningful way. Presence is more than checking in. It’s being available to listen, holding space without rushing to solve, and staying connected through difficult moments. Consistency matters. So does authenticity.
  
• Create a safety plan. A good safety plan is collaborative and realistic. It names specific warning signs, coping strategies, and supportive people to call. It also includes steps to reduce access to means of harm, something that can be especially important when suicidal thoughts escalate quickly.
  
• Strengthen connection. Protective factors often grow in connection: trusted relationships, affirming communities, and therapeutic alliances. Connection may look like family involvement or peer support, or it may involve structured group spaces like higher-level-of-care treatment or support groups. The shared goal is to reduce isolation and foster a sense of belonging.
  
• Follow through during transitions. Risk often increases during periods of change, especially after leaving an environment like a treatment setting. Proactive contact, scheduled check-ins, and clear aftercare plans can help bridge the gap. Whenever possible, warm handoffs and early follow-up matter.
  
• Create a resource list. Not every person will want the same kind of support, but offering concrete, relevant options helps. Crisis lines, local services, ED-specific programs, and peer-led communities can all be part of the safety net. Have these resources ready, and help individuals access them without barriers.
  

Naming Risk, Reducing Shame, and Building Safer Systems

Suicidal ideation is more common in eating disorder recovery than many people realize. It can arise quietly, shaped by layers of shame, isolation, or hopelessness that often go unnamed in treatment spaces. When we talk about suicide openly, without judgment, we create the possibility for safety.

As providers, colleagues, or loved ones, part of our role is to remain attuned to subtle changes, recognize signs of distress, and offer a consistent message: this is not something to hide. Risk does not make someone untreatable. It means they deserve care that holds complexity and centers on safety.

To create a recovery-oriented environment, we can create spaces where these conversations are not only allowed, but expected. With shared language, clear protocols, and a compassionate stance, we can support each other in building systems for families, treatment centers, and communities that don’t just respond to risk, but anticipate it and hold it with care.