Fear of Death in Patients With Severe Eating Disorders Experiencing Life-Threatening Medical Crises.
BACKGROUND: Fearlessness about death, an essential component of suicide capability, remains understudied in the context of actual death-related experiences, whether suicidal in nature or not. One population in which both suicidal intent and desire and life-threatening states are relevant is eating disorder patients in potentially lethal medical crises. METHODS: We examined changes in fear of death across hospitalization in a sample of 84 severely malnourished patients, diagnosed with anorexia nervosa (93%) or avoidant/restrictive food intake disorder (7%), undergoing intensive treatment for severe weight loss in an inpatient medical stabilization unit. RESULTS: In contrast to the typical distribution of fear of death scores found in other samples, scores in our intensive care unit eating disorder sample displayed significant bimodality, with some patients indicating elevated fear of death at admission and some indicating no fear of death at all. Still, despite elevated desire and intent to die on average at admission, the modal reaction to intensive medical care was initially high levels of fear of death that subsequently decreased across treatment. CONCLUSIONS: Findings indicate significant increases in fear of death, a protective factor against suicide, for individuals facing death as a distinct and real possibility, that decreases as stabilization occurs. However, results also suggest a potential bifurcation of patients such that a subgroup of patients experience alarmingly low levels of fear of death, even at the height of their medical crisis. Implications for recurrence of disorder leading to rehospitalization or increased suicidal capability leading to future suicide attempts are discussed.
