Have you (or someone you know) struggled with thoughts of suicide? Do you (or the person you know) experience guilt, embarrassment, or withdrawal from others after disclosing suicidal thoughts?
As a therapist working with children, teens, and even adults at times who are suicidal and thinking of killing themselves, I am hardly ever prepared for the emotional roller coaster ride a session discussing suicidal ideation creates. With years of training in mental health, trauma, and self-injurious behaviors (i.e., cutting, burning, etc), I know all of the right questions to ask, all the right skills to provide, and all the right crisis supports to offer but am hardly ever prepared for the tears, the hopelessness, and the unanswerable questions that come my way. I often experience a feeling of helplessness as I watch the individual scramble to find some ounce of hope to live for.
This article will highlight important questions to ask yourself or someone you know when suicidal thoughts occur. This article will also list diagnoses that make suicidal ideations more likely to occur.
Questions around suicide are tough questions to ask, especially if you are asking yourself these questions. It is not always easy to step-back and ask yourself if you are going to do what you truly want to do. It is even more complicated to ask questions about suicidal thoughts to children or teens, especially if the child or teen is your very own. But the purpose of questions regarding suicidal ideation(s) is to learn information that can help you help the person and to also reduce the intensity of the thoughts and feelings of intent by reality. For example, some kids will tell you “I want to kill myself” but when you ask them how, they might say “by overdosing on pills.” This is likely to scare any parent but I encourage parents to ask further questions such as “where will you get the pills?” “what pills are you going to take?” “how many pills?” “when are you planning on doing this?” The more direct questions you ask, the more the suicidal thoughts and feelings are likely to be reduced by reality. You cannot overdose on vitamin C’s or 8 Motrin tablets. You cannot kill yourself during school or while at work.
For adults struggling with these thoughts, you may see odd behaviors (even in yourself) that may include: giving away prized possessions, buying expensive things such as a car/boat or home, dating multiple people at once or acting outside of one’s ethical and moral parameters, staying up and not sleeping, overeating, etc.
Believe it or not, there are diagnoses more likely to include suicidal thoughts than others. Some include but are not limited to:
- Personality disorders, primarily borderline personality disorder: borderline personality disorder often includes dysphoria, depressed and anxious mood, unhealthy emotional attachments or bonds, co-dependency, and unstable relationships. When things go wrong, the individual with borderline personality disorder may find it difficult to control their emotions which can lead to suicidal thoughts.
- Mood disorders, primarily major depressive disorder (recurrent or single episodes), bipolar disorder: Both mood disorders often include some form of helplessness and hopelessness that may escalate into suicidal thinking patterns. With bipolar disorder (1 or 2), suicidal thoughts are likely to occur during the depression stage of the illness. Suicidal ideations are less likely to occur during mania or hypomania as most people report feeling “really good” during this time and full of ideas, energy, and possibly even hope. Once mania or hypomania “wears off,” depression may begin to seep in which results in feelings of depressed mood, hopelessness, insomnia, and perhaps poor eating habits which may spiral into suicidal thoughts. Major depressive disorder, single or recurrent episode, can also result in suicidal thoughts depending on how severe the depressive state is.
- Anxiety disorder, primarily Obsessive Compulsive Disorder: Because of the obsessive nature of OCD, suicidal thoughts may flood the individual as OCD includes obsessions, compulsive behaviors, and ritualistic thinking patterns. Rumination (repeatedly thinking of something over and over again) may occur which can then trigger obsessive thoughts and maybe even compulsive behaviors. All of this can lead to frustration and depressed mood which in turn can trigger suicidal thoughts.
It is important to keep in mind that not all individuals who struggle with these disorders are (or will become) suicidal. But the possibility is there if symptoms are out of control and bothersome.
Because suicidal thoughts are not always openly shared with others, it is important to figure out a way to get another person to talk about their thoughts with others. If you are struggling with such thoughts, I encourage you to consider sharing them with someone you trust as suicide may become less “attractive” while speaking to someone who can possibly shed a different light on things.
Some common questions to ask or consider include:
- Is there intent and a plan: Someone can have suicidal thoughts but not have a plan or high level of intent. If there is no plan or high level of intent, suicidal thoughts are “passive death wishes” or reactions to stress. A passive death wish sounds like: “I wish I were dead right now.” “I’d be better off dead.”
- Is the plan feasible: Even if there is a plan, if it is not easy to carry out or is not feasible, the thoughts may begin to fade. As listed above, you cannot kill yourself at work or in school.
- Is it likely that suicide will be carried out?: Intent is a big determining factor in cases where suicidal thoughts occur. Intent is what moves everything forward. For many people, they are too afraid of the pain or the stress of arranging things or the fear of dying and going somewhere else to complete a suicide.
- Is there a reason to continue living and does it outweigh the reasons for not living?: Any ounce of hope is likely to deter suicidal actions/gestures/behaviors. If that hope is your children, your future, your spouse, etc. that is good.
- Will a therapist, crisis worker, friend, spiritual counselor/pastor, or hospital help?: Reaching out is very important. Isolation is not going to help. Despite the strong wish to isolate and “go away,” fighting back is key.
- How strong are the thoughts and impulses to act?: If suicidal thoughts are not strong enough to trigger a person to muster up strength to actually do something, the thoughts will probably dissipate. Impulsivity and an inability to consider consequences can make the thoughts challenging.
- Is a break from like (and possibly everyone) necessary to live on?: Sometimes a break from life (i.e., hospital stay, vacation, change in scenery, etc) is all that is needed to recover.
For concrete steps on how to help someone considering suicide, visit my website: anchoredinknowledge.com
As always, looking forward to hearing about your experiences.
All the best