title: Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link.
abstract: BACKGROUND
  Suicide is a leading cause of death among individuals with anorexia nervosa (AN). In this paper, we examined competing explanations of the high rate of death by suicide among individuals with anorexia nervosa (AN).
  
  
  METHODS
  Nine case reports of individuals with AN who died by suicide were evaluated to determine whether death by suicide occurred a) because physical health was so compromised that what would be a non-lethal suicide attempt in a healthy adult became a fatal suicide attempt, or b) because highly lethal suicide attempts that would have killed any adult, healthy or medically compromised, were made.
  
  
  RESULTS
  The findings converged with the latter hypothesis, as predicted by Joiner's [Joiner, T., 2006. Why People Die By Suicide. Harvard University Press, Cambridge, MA] theory of suicide, which suggests individuals with AN may habituate to the experience of pain during the course of their illness and accordingly die by suicide using methods that are highly lethal.
  
  
  CONCLUSIONS
  This study utilized case reports instead of an experimental design, which impedes its ability to comment on whether there is a causal relationship between Joiner's theory and death by suicide among individuals with AN.
  
  
  CONCLUSIONS
  Clinicians are encouraged to carefully assess suicidality in AN patients, paying particular attention to issues related to lethality.
authors.affiliation: University of Vermont, Burlington, Vermont, USA. Jill.Holm-Denoma@uvm.edu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Holm-Denoma
authors.forename: Tracy K
authors.initials: TK
authors.lastname: Witte
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Gordon
authors.forename: David B
authors.initials: DB
authors.lastname: Herzog
authors.forename: Debra L
authors.initials: DL
authors.lastname: Franko
authors.forename: Manfred
authors.initials: M
authors.lastname: Fichter
authors.forename: Norbert
authors.initials: N
authors.lastname: Quadflieg
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Joiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006185:Habituation, Psychophysiologic; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008960:Models, Psychological; D009026:Mortality; D009042:Motivation; D010146:Pain / Q000503:physiopathology; D012307:Risk Factors; D012934:Social Isolation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data