The Psychology of Eating: From Healthy to Disordered Behavior

Eating Disorders 221

Physical complications

Death
At the far end of the spectrum is death. The crude mortality rates for anorexia
range from 3.3 percent in an 8-year follow-up study (Patton, 1988) and
5.1 percent in a cohort study of 246 eating disordered women (Herzog
et al., 2000) to 18 percent in a 33-year outcome study (Nielsen et al., 1998).
Fichter et al. (2006) explored outcomes after 12 years in 103 patients with
AN and reported that 7.7 percent had died by follow-up and that of those
still alive a third showed good outcomes, a third showed intermediate
outcomes, and a third showed poor outcomes. The results also showed that
mortality was associated with sexual problems, impulsivity, symptom
severity, and long duration of both the eating disorder and inpatient treat-
ment. Mortality rates have also been developed in comparison with other
populations. When compared to normal healthy populations matched for
age, gender, and follow-up times, standardized mortality rates vary from
6.2 (Papadopoulos et al., 2009) to 12.82 (Eckert et al., 1995). Compared
to other psychiatric problems, the mortality rate from anorexia is similar
to that for schizophrenia, affective disorder, and personality disorder 5 years
after a period of inpatient treatment (Zilber, Schufman, and Lerner, 1989)
but lower than psychiatric problems complicated by alcohol and substance
abuse. When compared to other women, anorexics are twice as likely to
die from their problem than other female psychiatric inpatients (Sullivan,
1995). The most common causes of death are suicide, infection, gastroin-
testinal complications, and severe emaciation (Herzog et al., 1992). One
study showed that an anorexic is 58.1 times more likely to commit suicide
than an equivalent white healthy woman (Herzog et al., 2000). Recently,
Bulik et al. (2008) explored suicide attempts in people diagnosed with AN
and reported that 16.9 percent attempted suicide and that this was higher
in those with purging AN (26.1 percent) and bingeing AN (29.3 percent)
compared to restricting AN (7.4 percent). In addition, once depression had
been controlled for, suicide attempts were associated with a number of comor-
bidities, including substance abuse, impulsive behaviors, and posttraumatic
stress disorders. Similarly, Fedorowicz et al. (2007) explored the predictors
of suicide in a French sample of patients with eating disorders and reported
a role for drug, alcohol, and tobacco use. Therefore, anorexia is a high
risk for mortality, particularly from suicide. Research also indicates that a
diagnosis of AN has implications for an individual’s life expectancy. Harbottle,
Birmingham, and Sayani (2008) carried out a survival analysis to produce
survival curves and illustrated a significant impact of AN on life expectancy.