Anorexia Nervosa Mortality in Australia: Royal Commission Findings (2003–2019)

The Royal Commission into Victoria's Mental Health System (2020) reported up to 184 deaths per year associated with anorexia nervosa in Australia (2003–2019).

Context

• Anorexia has the highest mortality of any psychiatric disorder (SMR 5–10×).
• Causes: Medical complications (electrolyte imbalance, cardiac arrhythmia, refeeding syndrome, organ failure) + suicide (↑ 18× general population).
• Australian prevalence: ~1% women, 0.3% men; peak onset 15–24y.

Systemic Gaps Identified

• Fragmented care (medical/psychiatric silos).
• Insufficient specialist beds (especially regional).
• Workforce shortages (psychiatrists, dietitians, therapists).
• Delayed early intervention.

Reforms Underway

• Integrated eating disorder hubs (medical + psychological).
• Stepped care models (GP → community → specialist inpatient).
• Medicare item numbers for evidence-based therapy (CBT-E, FBT, MANTRA).
• National Eating Disorders Strategy 2023–2033.

Early detection (SCOFF screen), family-based treatment (gold standard for adolescents), and medical stabilization save lives.