Suicidal thoughts are one of the most important areas of research and intervention in Psychology. Many of the public health initiatives have to do with the prevention of this problem, with making available to people in need of care services that avoid as much as possible that they move from ideas to action.

Throughout this article, we’ll see what’s most widely known about suicidal thoughts understood as part of the action of considering ending one’s life, either through a plan or a way of fantasizing about suicide.

Suicide ideation

E here are a great many situations and contexts that can cause us great pain : the death of loved ones, the experience of sexual, physical and psychological abuse, the feeling of guilt in the face of responsibility (real or not) for an event such as a road accident, losing everything you have fought for, fighting in a war or the prospect of enduring a disabling illness or disorder (whether physical or psychological) are some examples.

In some cases, the pain suffered is such that the person is unable to cope, feeling no control over his life and coming to believe that he can do nothing to improve his situation. In short, they lose hope.

In this context it is not uncommon to think of a definitive way out of such suffering, and the idea of ending one’s life may arise. In other words, suicidal thoughts would appear .

Suicidal thoughts: what are they?

Suicidal thoughts are all those thoughts that an individual has regarding taking his own life in an intentional and planned way . These thoughts may range from the mere desire to die to the active realisation of concrete plans for the implementation of autolysis. The latter, in which the subject has elaborated the how, where and when, is the most dangerous and prone to carry out the act.

Although thoughts and desires of death may appear on a single occasion, in general when talking about suicidal ideation or suicidal thoughts, reference is made to a recurring pattern of thinking in which the desire to die appears. They may be purely cognitive, although more often than not there is some emotional or motivational longing or desire.

Most suicidal thoughts are held at times of intense emotional pain and suffering. The individual feels that no matter what he does, he will not be able to change the reason for his suffering. He does not feel capable of finding a solution, but feels powerless and uncontrolled. The person with these thoughts of loss tends to suffer a deep sense of hopelessness. In general, the underlying idea , the objective of the suicidal ideation is not to end one’s life in itself , but to end this state of pain and helplessness.

Apart from this, there are other types of suicidal thoughts that are more linked to the attempt to harm other people or achieve specific goals. For example, in some cases it may be possible to think of using one’s own death or suicide attempt in an instrumental way to get good for oneself (such as care for others or in the case of vicarious violence) or loved ones (such as collecting insurance) or to cause guilt and suffering to someone who is considered responsible for the individual’s pain.

Possible causes and risk factors

The causes of the presence of suicidal thoughts can be many and very different, depending on the concrete case . As has been indicated, this type of thoughts usually occur after the experience or notification of some painful event or a loss in which profound feelings of pain, guilt and/or shame appear that are beyond the control of the individual and plunge him/her into a state of desperation in which no solution is possible.

The presence of abuse, loss of loved ones (whether due to death or break-up), or an anxious situation from which there is no escape are often the most frequent triggers. Examples of these would be the experience of a rape, prolonged isolation, physical incapacitation, having caused and/or survived an accident, continued bullying, bankruptcy, the diagnosis of diseases such as cancer, dementia or HIV, or the suffering of some mental disorders with psychological suffering.

Neurobiology of the Suicidal Idea Person

At a biological level, a decrease in the level of serotonin in the brain of people with this type of suicidal thinking has been observed, with most drug treatments focusing on increasing this level. Other hormones such as dopamine and noradrenaline are also of great importance, as their absence or presence contributes to depressive and anxious states that can lead to attempts at autolysis.

Risk factors for moving from thought to action include being male, being older (more common after age 40), past suicide attempts or death of a loved one, a mental disorder that clouds or skews judgment, substance abuse, chronic medical problems and high impulsivity.

Isolation and the absence of social support are also very relevant factors that can seriously damage the mental state of individuals (the presence of social support being an important protective factor).

Psychological evaluation and diagnosis

Although the presence of suicidal ideation does not necessarily imply a real attempt to take one’s own life, it is a very important risk factor that must be treated urgently . In fact, on a therapeutic level it is essential to assess the existence of suicidal thoughts and if so, these become the first therapeutic objective.

When assessing the subject’s mental state, it is necessary to do so calmly and directly, whether or not risk factors are present. If the suicidal thoughts have not occurred, asking about the subject will not induce it, while in the affirmative the approach to the case should focus on its existence. When evaluating the responses, it should be noted that the individual may not want to directly explain his or her thoughts.

Attitudes that try to minimize the risk or importance of this type of ideation may be trying to hide the true thoughts about it. They may also be indicative of sudden calm states after deep agitation, a possible warning that the individual has made a decision to take action.

You should explore the presence or absence of suicidal thoughts, the origin of such ideas, their degree of activity and elaboration and the existence or not of a plan to carry out. How, when and why are necessary questions that give an idea of the seriousness of the situation. The greater the planning and concreteness of the answers, the greater the risk that the thought will be put into practice.

Treatment: how to deal with a possible suicide

In cases of suicidal ideation a rapid treatment is necessary that allows to act effectively on the core of the problem. It should be taken into account that, contrary to the widespread myth, in most cases the person who thinks about committing suicide and believes that there is a possibility of ending up choosing this option, warns or advises his or her friends or family.

If suicide is imminent and the patient’s safety may be seriously compromised, it is recommended that the patient be admitted to hospital immediately so that he or she can be controlled and receive appropriate treatment.

Psychopharmacology

Although the presence of suicidal thoughts does not necessarily imply the existence of a mental disorder, since they usually appear in contexts where there are associated depressive symptoms, psychotropic drugs, in the form of different types of antidepressants, tend to be used. Specifically, one of the most common subtypes in these cases is tricyclic antidepressants, which in the face of atypical depression or suicide attempts have shown greater efficacy than other types of antidepressants.

However, these drugs usually take several weeks to work. This is why initially the treatment of choice is the application of anxiolytic drugs , reducing the anxiety and tension that usually induces suicidal thoughts.

On the other hand, it must be clear that context plays a very important role in suicidal ideation. That’s why psychotropic drugs can be a useful patch, but not a definitive solution. It is necessary to intervene on the social circles through which the person moves, as well as on the material means with which they live.

Associated mental disorders

In cases where suicidal thoughts are linked to mental disorders, it is common for them to appear in patients with bipolar disorder (the thought usually appears in the depressive phase while the attempt at autolysis is usually more typical of manic phases). After this, which is the disorder with the highest number of suicide attempts, other disorders where suicidal ideation appears very frequently are substance addiction (especially alcohol), major depression, schizophrenia and borderline personality disorder.

Another treatment that has shown greater success at the biological level in alleviating the depressive symptoms associated with suicidal thoughts is electroconvulsive therapy. Although it is not clear why, it has been shown to quickly and effectively reduce depressive symptoms in atypical and psychotic depressions and with attempts at autolysis. This is why it is used in cases where immediate action is required.

Psychological therapy

As far as psychological treatment is concerned, given the need for early and rapid intervention in serious cases, treatment focused on the behavioural aspects is usually required first, and then the cognitive aspects are dealt with.

It is fundamental to help establish relevant and accessible objectives for the patient, by graduating a series of steps that at first may serve to diminish the interest in suicidal thoughts and direct him/her to something he/she wants to achieve. The main objectives to be worked on will be the recognition and expression of the suffering, the acceptance of the feelings and emotions of the patient, redirecting the attentional focus and the negative thought pattern towards other more effective alternatives.

Through behavioral techniques such as gradual assignment of tasks, control of environmental stimuli and behavioral experiments, the individual will try to find a motivation to endure or decrease the state of internal tension.

On a more cognitive level, decatastrophication carried out with prudence can help to combat the reason that has led the subject to desire his own death . Also Beck’s cognitive therapy allows to fight against automatic negative thoughts. Problem solving therapy, self-control therapy by Rehm or social skills training can help to regain the subject’s sense of control. The use of role-playing can be helpful in bringing relief to the patient by exposing the reason for their pain and working on their feelings.

Another useful therapy is Dialectical Behavioral Therapy, which specializes in aggressive and autolytic behaviors and contributes to improving the patient’s ability to cope while demonstrating an acceptance of the patient’s suffering.

The use of psychoactive substances such as alcohol or drugs can produce an exacerbation of symptoms , so the control of consumption is a fundamental element to take into account. Especially if there is a previous abuse or addiction. However, in the case of dependence, sudden withdrawal may cause anxiety that can be dangerous, so such withdrawal should be prescribed by a professional.

It is also important to have social support and a network that allows the individual to change his or her perspective on events or to take on new challenges and roles. Likewise, the monitoring of the individual’s mental and physical state and the fact that he or she does not remain isolated are protective elements that make autolysis difficult.

Bibliographic references:

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