Rethinking comorbidity: A case study of syndemic risk, eating disorders, and suicidal behaviors in adolescent girls of color

Decades of research have established a significant association between people struggling with an eating disorder and suicidal thoughts and behaviors. Despite a robust literature indicating a link between these two mental health conditions, few studies have explored how differential risk factors interact over time to produce this comorbidity. Using the lens of syndemic risk, this study applied a critical case study design to identify the social and contextual conditions that give rise to the circumstances in which eating disorders and suicidal behaviors cluster together. Specifically, we draw on life history and clinical ethnographic interviews with an adolescent and her mother to illustrate the intersections between psychosocial and structural processes. Through our analysis, we develop a model for syndemic risk that foregrounds poverty, racism, heterosexism, and gender oppression as critical to the production of mental health comorbidities. As we delineate in our findings, multiple forms of oppression led to a higher risk of exposure to stressful and traumatic experiences, including physical maltreatment, emotional abuse and neglect, sexual coercion, and peer victimization. These events contributed to the emergence of psychological and social vulnerabilities associated with heightened eating disorder and suicide risk. Ultimately, our qualitative study contributes to understanding how syndemic risk factors interact and mutually reinforce one another over time to shape comorbid psychopathology. In doing so, our findings shift understandings of mental illness as emerging from individual vulnerabilities to a conception of mental health that is framed within a multidimensional perspective.