Suicidal thoughts: causes, symptoms and therapy

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 who need it, care services that avoid as much as possible 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 your own life, either through a plan or a way of fantasizing about commit suicide.

Suicidal ideation

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 before the responsibility (real or not) of an event such as a traffic accident, losing everything you have fought for, fighting in a war or the prospect of enduring a disabling illness or disorder (be it physical and mental) on a long or chronic basis 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 her life and coming to believe that he cannot do anything to improve his situation. Ultimately, they lose hope.

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

• Related article: "Suicides: Facts, Statistics, and Associated Disorders"

Suicidal thoughts: what are they?

Suicidal thoughts are considered all those thoughts that an individual has about taking their own life in an intentional and planned way. These thoughts can range from the mere wish to die to the active realization of concrete plans for the initiation 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 the thoughts and wishes of death may appear on a specific occasion, in general when talking about ideation Suicidal or suicidal thoughts is usually referred to a recurring thought pattern in which the desire to To die. They may appear in a purely cognitive form, although the most common is that a certain desire or desire occurs on an emotional or motivational level.

Most suicidal thoughts occur in times of intense emotional pain and suffering. The individual feels that regardless of what he does, he will not be able to modify the reason for his suffering. He does not feel capable of finding the solution, but feels powerless and in the absence of all control. The person with these losing thoughts tends to suffer from a deep sense of hopelessness. In general, the underlying idea **, the objective that is sought in itself with suicidal ideation is not to end one's own life **, but to end this state of pain and defenselessness.

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 you can come to the thought of using your own death or the attempt suicide in an instrumental way to achieve good for himself (such as the attention of others or in the case of vicarious violence) or loved ones (for example, collecting insurance) or to cause guilt and suffering to someone who is held 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 they appear deep feelings of pain, guilt and / or shame that are beyond the control of the individual and plunge him into a state of despair in which no solution is found possible.

The presence of abuse, loss of loved ones (either due to death or rupture) or faculties or an anxious situation from which it is not possible to escape are usually the most frequent triggers. Examples of them would be the experience of a rape, prolonged isolation, physical disability, having caused and / or survived an accident, continued bullying, bankruptcy, diagnosis of diseases like cancer, dementia or HIV or suffering from some mental disorders that are suffering from psychic suffering.

Neurobiology of the person with suicidal ideation

At the biological level, the presence of a drop in serotonin level in the brain of people with this type of suicidal thoughts, focusing a large part of the pharmacological treatments on increasing this level. Other hormones such as dopamine and the noradrenaline They also have great importance, as their absence or presence contributes to depressive states and anxious that attempts at autolysis may entail.

As risk factors for moving from thought to act, the most important are belonging to the male gender, having an advanced age (they tend to be more frequent after 40 years of age), have had suicide attempts in the past or that a loved one has died in this way, the suffering of a mental disorder that clouds or biases the judgment, the existence from psychoactive substance addictions, chronic medical problems and high impulsivity.

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

Psychological evaluation and diagnosis

Although the presence of suicidal ideation does not have to lead to an actual attempt to kill oneself, it 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 assessing the mental state of the subject, it is necessary to do it calmly and directly, whether or not risk factors are present. If suicidal thoughts have not occurred, asking about the subject will not induce it, While in the affirmative case, the approach with which the case will be handled should focus on its existence. When evaluating the responses, it must be taken into account that the individual may not want to directly explain 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. Sudden states of calm may also be indicative after deep agitation, 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 the concreteness of the responses, the greater the risk that the thought will be tried to put into practice.

Treatment: how to act in a case of possible suicide

In cases of suicidal ideation, prompt treatment is necessary that allows to act effectively on the core of the problem. It must be borne in mind that, contrary to the widespread myth, in most cases the person who thinks about commit suicide and believe that there are possibilities of ending up opting for that option, warn or warn her friends or family.

In the event that suicide is imminent and patient safety may be seriously compromised, it is his immediate hospital admission is recommended so that he can be controlled and a proper treatment.

Psychopharmacology

Although the presence of suicidal thoughts does not necessarily imply the existence of a mental disorder, due to a that usually appear in contexts in which there is associated depressive symptoms, as a general rule, they tend to use psychotropic drugs, in the form of different types of antidepressants. Specifically, one of the most common subtypes in these cases are tricyclic antidepressants, which in the face of Atypical depression or suicide attempts have been shown to be more effective than other types of antidepressant.

However, these drugs generally take several weeks to work. That is why initially the treatment of choice involves 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 on the social circles through which the person moves, as well as on the material means with which he lives.

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 autolysis tends to be 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 addiction to substances (especially alcohol), the major depression, the schizophrenia and the borderline personality disorder.

Another treatment that on a biological level has shown greater success in alleviating depressive symptoms associated with suicidal thoughts is electroconvulsive therapy. Although the reason is not fully understood, it has been shown that it rapidly and effectively reduces depressive symptoms in atypical and psychotic depressions and with attempts at autolysis. 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 cases severe, a treatment focused on the behavior is usually required in the first place to later treat the aspects cognitive

It is essential to help establish relevant and accessible objectives for the patient, graduating a series of steps that may initially serve to decrease interest in suicidal thoughts and to be directed to something you want to achieve. The main objectives to work on will be the recognition and expression of suffering, the acceptance of feelings and emotions of the patient, redirect the attention focus and the negative thought pattern towards other alternatives more effective.

Through behavioral techniques such as gradual assignment of tasks, control of environmental stimuli, and experiments Behavioral issues will ensure that the individual finds a motivation to endure or reduce the state of internal tension.

At a more cognitive level, Catastrophication carried out wisely can help combat the motive that has led the subject to wish his own demise. Also the Beck's cognitive therapy allows you to fight automatic negative thoughts. Problem-solving therapy, Rehm's self-control therapy, or social skills training can help regain the subject's sense of control. The use of dramatizations can be useful in order to relieve the patient by exposing the reason for his pain and working on the sensations of it.

Another useful therapy is dialectical behavioral therapy, specialized in aggressive and autolytic behaviors, which contributes to improving coping capacity while showing an acceptance of the suffering of the patient.

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

The presence of social support and a network that allows the individual to change their perspective of events or take on new challenges and roles is also important. Likewise, the vigilance of the mental and physical state of the individual and the fact that they do not remain isolated are protective elements that make autolysis difficult.

Bibliographic references:

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