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 care services available to people who need them that avoid, as far as possible, moving from ideas to action.
Throughout this article we will see what is the main thing that is 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 committing suicide.
There are a large number of 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 traffic accident, losing everything you have fought for, fighting in a war or the prospect of enduring a prolonged or chronic disabling illness or disorder (whether physical or mental) are some examples.
In some cases, the pain suffered is such that the person is not able to cope with it, feeling no control over their life and coming to believe that they cannot do anything to improve their situation. Ultimately, they lose hope.
In this context, it is not uncommon to think of a definitive solution to end such suffering, and the idea of ​​ending one’s own life may arise. In other words, suicidal thoughts would appear.
Suicidal thoughts: what are they?
They are considered suicidal thoughts all those thoughts that an individual has regarding taking their own life in an intentional and planned way. These thoughts can range from the mere desire to die to the active implementation of concrete plans to implement self-lysis. The latter, in which the subject has worked out how, where and when, is the most dangerous and prone to carrying out the act.
Although thoughts and wishes of death may appear on a specific occasion, in general when talking about suicidal ideation or suicidal thoughts, reference is usually made to a recurring thought pattern in which the desire to die appears. They may appear in a purely cognitive form, although the most common thing is that a certain longing or desire occurs on an emotional or motivational level.
Most suicidal thoughts occur during times of intense pain and emotional suffering. The individual feels that regardless of what he does, he will not be able to change the reason for his suffering. He does not feel capable of finding the solution, but instead feels helpless and in the absence of any control. The person with these losing thoughts tends to suffer a deep feeling of hopelessness. Generally the underlying idea**, the objective sought in suicidal ideation is not to end one’s own life**, but to end this state of pain and helplessness.
Aside 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 one may come to the thought of using one’s own death or suicide attempt instrumentally to achieve good for oneself (such as the attention of others or in the case of vicarious violence) or beings. loved ones (for example 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 specific case. As has been indicated, as a general rule, these types of thoughts usually occur after the experience or notification of some painful event or a loss in which deep feelings of pain, guilt and/or shame appear that escape the individual’s control and add to their feelings. a state of desperation in which they cannot find any possible solution.
The presence of abuse, loss of loved ones (whether due to death or breakup) or faculties or an anxiety-inducing situation from which it is not possible to escape are usually the most frequent triggers. Examples of these would be the experience of rape, prolonged isolation, physical incapacity, having caused and/or survived an accident, continued bullying, bankruptcy, the diagnosis of diseases such as cancer, dementia or HIV or suffering from some mental disorders that cause psychological suffering.
Neurobiology of the person with suicidal ideation
At a biological level, the presence of a decrease in the level of serotonin in the brain of people with this type of suicidal thoughts has been observed, with a large part of pharmacological treatments focusing on increasing said level. Other hormones such as dopamine and norepinephrine are also of great importance, as their absence or presence contributes to depressive and anxious states that can lead to attempts at self-lysis.
Risk factors for going from thought to action include being male, being of advanced age (they are usually more common after forty years of age), having had suicide attempts in the past or having a loved one. has died in this way, the suffering of a mental disorder that clouds or biases the ability to judge, the existence of addictions to psychoactive substances, chronic medical problems and high impulsivity.
Isolation and the absence of social support are also very relevant factors that can seriously harm 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 have to lead to a real attempt to take one’s life, This is a highly relevant risk factor that must be treated urgently. In fact, at a therapeutic level it is essential to assess the existence of suicidal thoughts and if so, these become the first therapeutic objective.
When evaluating the subject’s mental state, it is necessary to do so calmly and directly, whether or not risk factors are present. If suicidal thoughts have not occurred, asking about the issue will not lead to it, while if so, the approach with which the case will be handled should focus on their existence. When evaluating the responses, it must be taken into account that the individual may not want to directly explain his 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. Sudden states of calm after deep agitation may also be indicative, being a possible warning that the individual has made the decision to take action.
The presence or absence of suicidal thoughts, the origin of such ideas, their degree of activity and elaboration should be explored. and the existence or not of a plan to carry out. How, when and why are necessary questions that allow you to get an idea of ​​the seriousness of the situation. The greater the planning and specificity of the responses, the greater the risk that the thought will be attempted to be put into practice.
Treatment: how to act in a case of possible suicide
In cases of suicidal ideation, prompt treatment is necessary that allows us to act effectively on the core of the problem. It must 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 that option, notifies or warns his or her friends or family.
In the event that suicide is imminent and the patient’s safety may be seriously compromised, it is recommended that they be immediately admitted to hospital so that they can be controlled and appropriate treatment can be applied.
Psychopharmacology
Although the presence of suicidal thoughts does not necessarily imply the existence of a mental disorder, because they usually appear in contexts in which there are associated depressive symptoms, psychotropic drugs generally tend to be used, in the form of different types of antidepressants. Specifically, one of the most common subtypes in these cases are tricyclic antidepressants, which in the case of atypical depression or suicide attempts have demonstrated greater effectiveness than other types of antidepressants.
However, these drugs generally take several weeks to take effect. That is why initially The treatment of choice is the application of anxiolytic drugs reducing the anxiety and tension that suicidal thoughts usually induce.
On the other hand, it must be clear that the context plays a very important role in suicidal ideation. That is why psychotropic drugs can be a useful patch, but not a definitive solution. It is necessary to intervene in the social circles through which the person moves, as well as in the material means with which they live.
Associated mental disorders
In cases where suicidal thoughts are linked to mental disorders, they frequently appear in patients with bipolar disorder (it is common for the thought to appear in the depressive phase while the attempt at self-lysis 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 with great frequency are substance addiction (especially alcohol), major depression, schizophrenia and borderline personality disorder.
Another treatment that at a biological level has shown greater success in relieving depressive symptoms associated with suicidal thoughts is electroconvulsive therapy. Although the reason is not fully understood, it has been shown to quickly and effectively reduce depressive symptoms in atypical, psychotic depressions and with attempts at self-lysis. That is why it is used in cases where immediate action is required.
Psychological therapy
Regarding psychological treatment, taking into account the need for early and rapid intervention in serious cases, treatment focused on behavior is usually required first and then treating the cognitive aspects.
It is essential to help establish relevant and accessible goals for the patient, graduating a series of steps that can initially serve to reduce interest in suicidal thoughts and direct you to something you want to achieve. The main objectives to be worked on will be the recognition and expression of suffering, the acceptance of the patient’s feelings and emotions, and redirecting the focus of attention and the negative thinking 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 be encouraged to find motivation to endure or reduce the state of internal tension.
At a more cognitive level, Decatastrophication carried out prudently can help combat the reason that has led the subject to wish his or her own death. Beck’s cognitive therapy also allows you to fight against automatic negative thoughts. Problem-solving therapy, Rehm’s self-control therapy, or social skills training can help regain a sense of control on the subject’s part. The use of dramatizations can be useful so that the patient feels relief by exposing the reason for their pain and working on their sensations.
Another useful therapy is dialectical behavioral therapy, specialized in aggressive and self-harming behaviors, which contributes to improving the ability to cope while demonstrating acceptance of the patient’s suffering.
The use of psychoactive substances such as alcohol or drugs can cause an exacerbation of symptoms so consumption control is a fundamental element to take into account. Especially if there is prior abuse or addiction. However, in the case of dependence, sudden withdrawal can cause the presence of anxiety that can be dangerous, so such withdrawal must be guided by a professional.
The presence of social support and a network that allows the individual to change their perspective on events or assume new challenges and roles is also important. Likewise, monitoring the individual’s mental and physical state and the fact that he or she does not remain isolated are protective elements that make self-lysis difficult.
