Suicidality in young women and men with nervous bulimia: a systematic review

Currently, official statistics illustrate a disappointing trend regarding the increasing incidence of eating disorders (EDs). Despite the great interest in anorexia nervosa, traditionally considered the most "malignant" type of eating disorder, a significant increase in patients with bulimia nervosa cannot be denied. A significant number of studies have been conducted on the premature mortality of patients with bulimia, but the available data (especially regarding suicide) are quite contradictory. The aim of this study is to clarify prevailing views on the concepts of autoaggressive behavior in patients with bulimia nervosa (including suicidal patterns). Materials and methods: A systematic review of scientific publications in eLabrary, PubMed, and Google Scholar and Semantic Scholar. Following a staged selection of publications, 25 scientific papers were included in the study (out of 19,703 studies initially selected based on keywords). Results and discussion: Of the 25 papers devoted to the suicidological characteristics of bulimia nervosa, the majority of scientific papers attribute patients' suicidal risk to the influence of personality and behavioral characteristics (usually without specifying premorbid or acquired as a result of bulimia nervosa). Eight papers link suicidal and non-suicidal self-aggression with existing comorbid conditions, mostly personality and mood disorders, and substance use. Only four papers demonstrate a direct influence of bulimia nervosa on respondents' suicidal behavior without the influence of comorbid and personality components; one paper refutes the association between bulimia nervosa and suicidal risk. Conclusions: This systematic review demonstrates a high risk of suicide in patients with NB (without contextualization). Observed suicidal tendencies are driven by chronic body dissatisfaction and systematic compensatory behaviors (self-induced vomiting, use of laxatives and psychotropic drugs, and increased physical activity). Despite a significant number of studies citing the influence of premorbid personality traits and the presence of comorbidity, a number of studies emphasize a direct link between existing bulimia nervosa and a high risk of suicidal behavior.