Klonsky and May’s Three-Step Suicide Theory

Every year, around a million people commit suicide. Suicides have gradually increased and in Spain, in 2017, 3,679 people were killed. The most common theory that attempts to explain this phenomenon is the three-stage theory of suicide by researchers Klonsky and May.

Through the theory of Klonsky and May, we will know how to go from thought to suicide to attempt or finally to suicide.


    Suicide is the act by which a person he causes death deliberately. In Spain, suicide is the main cause of unnatural death, and has been for 10 years. In 2007, suicides for the first time surpassed those killed in traffic accidents, which for decades were the leading cause of death from external causes (those not caused by illness). In addition, the suicide rate increased by 3.1% in Spain from 2017 to 2018.

    Suicide has been and is a silenced problem for so many years, Which Healthcare is currently developing a suicide prevention plan.

    In contrast, 90% of people who kill themselves have some type of mental disorder, the most common being bipolar disorder, depression, and substance abuse disorder, followed by personality disorders. Most patients present with a clinical depression, which does not always coincide with the presence of a stressful event, but there are usually always suicide attempts in the past, as well as thoughts of wanting to die or a more suicidal ideation. structured.

    The theory of the three stages of suicide

    The most common theory that attempts to explain suicide is the three-step suicide theory of Klonsky and May (3rd), which postulates that suicidal ideation arises from the combination of “pain and hopelessness”, “lack of connection or attachment to other people ”,“ absence of a meaningful work or life plan ”with its own“ suicidal capacity ”.

    The theory proposes that the combination of these factors explains the transition from suicidal ideation to action (Attempts and suicides).

    From intention to action

    In the Three Stages of Suicide Theory, Klonsky and May draw a concrete pattern: “From Ideation to Action”, and believe that this should guide suicide theory, research, and prevention. According to this pattern, suicidal thoughts first develop, then move from ideation to action (attempts and suicide). These two processes (idea and action) require different explanations.

    In addition, it should be noted that in Spain it was estimated that suicide attempts are 10 to 20 times more frequent than suicide itself.

    The three stages

    The three stages established by Klonsky and May’s three-stage suicide theory are:

    • Suicidal thoughts it results from the combination of pain and despair.
    • If the connection with others and life is less than this pain, the ideation becomes stronger.
    • To take action (By attempting to commit suicide) one must acquire the capacity to attempt to commit suicide.

    Klonsky and May propose three specific categories of variables that contribute to suicidal capacity:

    • dispositional: Basically genetic in nature (e.g. sensitivity to pain)
    • acquired: Used to experiences associated with pain, self-harm, fear and death.
    • practices: Factors that facilitate the suicide attempt, such as easy access to information and methods of doing so.

    The three questions

    The three stages already explained translate into three fundamental questions in the theory (for practical effects, the affirmation of one question leads to the next):

    1. Are you in pain and hopeless?

    If the subject’s answer is no, then there is no idea of ​​suicide. Conversely, if the answer is YES, then yes, there is an idea of ​​suicide. The positive answer to this question leads to question 2.

    2. Is your pain greater than your connection?

    If the answer to this question is no, suicidal ideation is moderate; if so, however, the suicidal ideation is strong, important. Once again, the wording of this question leads to the formulation of the last question, question 3.

    3. Are you capable of attempting to kill yourself?

    If the person is not able to try, (negative answer), then we meet a person who has only thoughts of suicide. Conversely, if the answer is yes and the person is able to try, then has a real intention to kill himself.

      How to reduce the risk of suicide?

      The most important tool will obviously be prevention. This is why suicide prevention campaigns are and will be necessary, as well as specific action protocols in the face of suicidal thoughts and attempts. It will be imperative that these are applied in all mental health centers (Mainly primary care centers, hospitals, clinics, etc.) whether public or private.

      On the other hand, and following Klonsky and May’s three-stage suicide theory, whether as friends, as a family, and most importantly as health (and therefore mental health) professionals, we need to focus on:

      • Increase the person’s hope who thinks or wants to commit suicide.
      • Reduce your pain.
      • Increase your connection to life, With others, with their interests, with themselves, etc.
      • Decrease your suicidal capacity (by reducing your access to the media and information to do so) to prevent yourself from taking action.

      Bibliographical references:

      • Klonsky, E. and May, A. (2015). The theory of the three stages (3ST): a new theory of the suicide anchored in the framework of “the ideation in action”. International Journal of Cognitive Therapy, 8 (2), 114-129.
      • Klonsky, E. and May, A. (2015). Impulse control disorders. Psychiatric Times, 13-21.
      • Villar-Cap, F., Esnaola-Letemendia, E., Blasco-Blasco, T., Prieto-Toribio, T., Vergé-Muñoz, M., Vila-Grifoll, M., Sánchez-Fernández, B. and Spanish -Tejedor, C. (2018). Dimensional analysis of the personality of the adolescent with suicidal behavior. Proceedings Esp Psychiatry 46 (3), 104-111.

      Leave a Comment