Welcome to the 'Work and Bipolar or Depression' Blog from Natalie Cawthorne

Welcome to the 'Work and Bipolar or Depression' Blog from Natalie Cawthorne

PTSD Panic Attacks: How to (Try to) Calm Down

I Stopped Watching the News to Help My Anxiety

Tips to Handle Borderline PD When You're Physically Sick

How to Remember to Take Your Medications

How to Get Rid of Toxic Shame from Your Past

Relationship Between Bulimia and Suicide, Suicidal Thoughts

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Trigger warning: This post contains a frank discussion of suicide pertaining to the link between bulimia and suicide.

Eating disorders have been trivialized for decades. However, people struggling with these illnesses have an elevated risk of death by suicide compared to other psychiatric disorders, with bulimia having the highest attempted suicide rates. High comorbidity associated with bulimia – and the dearth of research – makes it difficult to tease apart what contributes to suicide risk. But people need to know that both bulimia, and the suicidality that accompanies it, can be treated and overcome.

Why Are Bulimia and Suicide So Closely Linked?

Historically, eating disorders have been viewed as affecting young, white and affluent women. They were once thought to be restricted to Western culture, stemming from an obsession with appearance and thinness. These stereotypes have dissolved over time. Still, the invisibility of bulimia – a pernicious medical and psychiatric illness – often means that it continues to be misunderstood.

People with bulimia are nearly eight times more likely to die by suicide than the general population.1 According to a 2013 study, 27.9% of students with a history of an eating disorder reported experiencing suicidal ideation, making specific plans, or attempting suicide. The highest rates of risk were among people with bulimia (45.2%), closely followed by anorexia (34.6%).2

Bulimia survivors tend to struggle with mood disorders and other psychiatric conditions, such as anxiety disorders, depression, and substance abuse. Each of these disorders harbors an increased risk of suicide, making it difficult for healthcare providers to pinpoint precisely what underlies patients’ suicidal thoughts, in turn, posing a barrier to effective treatment.

Certain characteristics, such as internalizing personality traits and impulsivity, have been shown to make bulimics more vulnerable to suicidal ideation. Researchers have suggested that it’s specifically the lethal combination of these traits with bulimia that leads to suicidal behaviors.3 But there are sparse studies devoted to this topic.

The Toxicity of Silence Concerning Bulimia and Suicide

Bulimia is like a tornado that wreaks havoc on all areas of life: health, relationships, mental wellbeing. Yet, survivors can go undiagnosed and untreated for years, stuck in a vicious loop of restricting, bingeing and purging. As the illness escalates, tipping into despair, people can feel like they have nowhere to turn. But full recovery is possible.

The first step towards recovery may be stepping into a 12-step support group meeting, such as Overeaters Anonymous (OA) and Food Addicts Anonymous (FAA), where people can share their experiences with other survivors. The 12-step program might not be for everyone. Though, there are many other effective treatments and resources to help people manage and overcome bulimia and suicidal ideation, including evidence-based practices like cognitive behavioral therapy (CBT), psychotherapy, and family-based therapy (FBT).

It can take people years to understand, much less open up about the fact that they’re struggling with this complex disorder. People with bulimia struggling with suicide ideation should remember that they’re not alone. The more we talk about it, the less these discussions engender secrecy and shame. Given the strong link between bulimia and suicidality, it’s important to continue investigating the factors contributing to suicidal ideation, which can help guide mental health professionals in preventing and reducing suicide risk during treatment. 

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.


  1. Eating Recovery Center. Managing Suicidality in Eating Disorder Patients - Anne Marie O'Melia, MS, MD. Accessed September 27, 2016.
  2. Bodell, P., et al. "Comorbidity-Independent Risk for Suicidality Increases with Bulimia Nervosa But Not with Anorexia Nervosa". Journal of Psychiatric Research. February 4, 2013.
  3. Forcano, L., et al. "Suicide Attempts in Bulimia Nervosa: Personality and Psychopathological Correlates." European Psychiatry. March 2009.

Anxiety Is Temporary -- Suicide is Forever

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Trigger warning: This post contains a frank discussion of suicide and temporary anxiety.

As September is Suicide Awareness Month, it is only appropriate that the subject of suicide and temporary anxiety should be touched upon in this blog. Like with any mental illness, the specter of suicide is never far from the man or woman with anxiety. When you think about it, this makes sense – to someone weathered and beaten by an unending torrent of stress, suicide can seem to be a logical way to end that stress and keep your mind at peace. This, of course, is a failure of logic, for as the title of this blog makes clear, anxiety is temporary, while suicide is forever.

Why Anxiety Is Temporary

It may strike some of you as misguided to claim anxiety is temporary. After all, if you are diagnosed with an anxiety disorder, that doesn’t go away. The best you can do is try to control it with therapy, medication, or another form of anxiety treatment. So I understand if some of you disagree with me calling anxiety a “temporary” malady.

But consider this. Though anxiety disorder may last a lifetime, does that necessarily mean anxiety has to define you? Of course not. I get anxiety much more than others, of course, and there are certainly days when that anxiety feels crippling. But I understand myself well enough to know that those are the bad days. They don’t last forever, and they always pass. Other bad days will come in the future, but again, those too will pass. In that sense, anxiety still is temporary.

Why Suicide is Permanent

Suicide, of course, is categorically different. Once a person makes the choice to take their own life, and they succeed, there is no taking that back. The ramifications of that decision must be taken seriously.

To die by suicide because of anxiety is to affirm that anxiety, a temporary affliction, is the strongest force in life. That nothing else can overcome that strength.

But of course, it can. Life is about so much more than those moments that make us anxious. Friendship, love, art, exploring new opportunities – all of these things (and much more) are as much a part of life as anxiety is. Added together, their beauty must be a compelling counterargument to suicide. Is losing all of these things worth it? Surely it can’t be.

If that isn’t enough, consider this. Suicide is not a personal choice. A person who commits suicide leaves behind a trail of family and friends that will have to spend a lifetime trying to navigate the consequences of that decision. I cannot understand how anyone could willingly choose to consign their loved ones to live in such a world.

For these reasons and more, suicide should never be considered a solution, even when your anxiety is at its worst. The bad days will always be just that: bad days. They do not equal a bad life. Please feel free to use the resources below if you or someone you know may be at risk of suicide.

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.

How First Responders Treat Mental Health Concerns in Toledo

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Trigger warning: This post contains a frank discussion of suicide and suicide attempts pertaining to first responders and mental health crises calls.

As a mental health worker, I am always concerned about how first responders treat mental health concerns and crises (such as safety checks and suicide attempts). Safety checks are when law enforcement checks on someone who has been reported in danger or will possibly harm himself or others. Here in Toledo, suicide attempts are taken very seriously by emergency services. However, safety checks are of low priority.

I've worked for a few different mental health organizations and for the handful of times I've had to interact with first responders while working, they were professional, supportive, and respectful. I was very grateful for their help. However, many clients, coworkers, and community members have had experiences that differ from mine.

First Responders for Mental Health Concerns Training

Toledo, like many cities, could benefit from an increase in staff and training to its local emergency services. A lot is going on in Toledo and first responders are kept very busy.

We need more Crisis Intervention Team (CIT) trained police officers. CIT training is model many first responders use to help people with mental health and addiction issues access they medical treatment they need instead of getting them involved in the criminal justice system. It is a model widely used in the US.

Most of our CIT trained officers have been on the force a while and have more seniority, so they get to choose what shift they work before the others. Most prefer to work during the day, so we have a disproportionate amount of CIT officers on first shift compared to other shifts. A recent call for a client at work who was suicidal was placed on second shift, and one major concern reported by the staff and clients involved was that the officers lacked compassion.

One aspect that's really positive about Toledo's emergency services is that the 911 operators are also offered CIT training. This is crucial since they are usually the first point of contact for a person in crisis.

I think every emergency services department can benefit from more CIT training. It is so important to fight stigma and promote understanding -- especially among first responders.

First Responders for Mental Health Crises Like Suicide

Calls for a person who is suicidal in Toledo are of a low priority unless the means are readily available, such as having a gun. Suicide attempts are of high priority. When a person who is suicidal is of low priority in Toledo, they could be waiting for over an hour. EMS responds faster than the police so some people take advantage of that and say they need an ambulance.

There are advantages and disadvantages that many weigh when the police and EMS need to take a person who is suicidal to a psych unit. In the Toledo area, there is one particular hospital that many prefer to go to for psychiatric care, and if the police transport, they will take you to the hospital of your choice. However, they will take much longer to respond and they will cuff you. If an ambulance transports, they will respond much faster but can only take you to the nearest hospital.

Always Ask for Help When You Need It

Experiences vary from city to city, but it's unfortunate that sometimes you have to learn to work the system to get the services you need. Don't ever let other's experiences deter you from getting help. If you are in crisis, please don't hesitate to ask for the help you need. This article highlights the experiences where I live. Every city has its own protocol.

For those of us involved in the mental health community, it's important to stay informed and advocate for our needs to be met by our city's services.

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.