Anorexia is the most lethal psychiatric disorder, carrying a six fold increased risk of death — four times the death risk from major depression, WebMD reports.

The odds are even worse for people first diagnosed with anorexia in their 20s. They have 18 times the death risk of healthy people their age, according to an analysis of the medical literature by Jon Arcelus, MD, PhD, of the University of Leicester, England, and colleagues.

The study found anorexia to carry twice the death risk of schizophrenia and three times the death risk of bipolar disorder, WebMD reports. Although anorexia is by far the deadliest eating disorder, death rates are also higher than normal in people with bulimia and “eating disorder not otherwise specified” (EDNOS, a common diagnosis for people with a mixture of atypical anorexia and atypical bulimia), according to WebMD.

“Mortality rates in individuals with eating disorders are high not only for those with anorexia but also for those with EDNOS and bulimia, which highlights the seriousness of these conditions,” Arcelus and colleagues conclude in the July issue of Archives of General Psychiatry.

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