Thoughts of suicide: 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 aim to prevent this problem, by making health care services available to those who need them, avoiding as much as possible the passage of ideas into action.

Throughout this article, we will see what is mainly known about suicidal thoughts understood as part of the action of proposing to end your life, either by a plan or by a way of fantasizing about suicide. .

Suicidal thoughts

There are many situations and contexts that can cause us great suffering: 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 car accident, losing everything for what you have fought, fight in a war or the prospect of suffering a chronic or debilitating disease or disorder (both physical and mental) for an extended or chronic period.

In some cases, the pain experienced is such that the person is unable to cope, feels no control over their life, and comes to believe that there is nothing they can do to improve their situation. In short, they are losing 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 life may arise. In other words, suicidal thoughts would appear.

    Thoughts of suicide: what are they?

    They are considered suicidal thoughts all those thoughts that an individual has about intentionally and planned suicide. These thoughts can range from the simple desire to die to the active realization of concrete plans for the implementation of autolysis. The latter, in which the subject has worked out the how, where and when, is the most dangerous and the most inclined to perform the act.

    While thoughts and desires for death may appear on a specific occasion, usually when talking about suicidal ideation or suicidal thoughts, we often refer to a recurring thought pattern in which the desire to die appears. They can appear in a purely cognitive form, although the most common is that there is some desire or desire on an emotional or motivational level.

    Most suicidal thoughts occur during times of intense pain and emotional suffering. The individual feels that whatever he does, he will not be able to change the reason for his suffering. He doesn’t feel capable of finding the solution, but he feels helpless and out of control. The person with these lost thoughts tends to suffer from a deep sense of hopelessness. In general, the underlying idea **, the goal in oneself with suicidal thoughts is not to end one’s life per se **, but to end this state of pain and helplessness.

    Apart from that, there are other types of suicidal thoughts that are more closely related to trying to hurt other people or achieving specific goals. For example, in some cases one may come to the idea of ​​using one’s own death or suicide attempt in an instrumental way to achieve good for oneself (such as caring for others or in the case of vicarious violence. ).) Or for loved ones (eg insurance) or to cause guilt and suffering to someone who is held responsible for the individual’s illness.

    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 generally stated, this type of thinking usually arises after experiencing or noticing a painful event or loss in which there are deep feelings of pain, guilt and / or shame that are out of control. of the person. adds to a state of despair in which they find no possible solution.

    The presence of abuse, the loss of loved ones (through death or break-up) or an anxious faculties or situation from which it is not possible to escape are usually the most common triggers. Examples of these would be the experience of rape, prolonged isolation, physical disability, causing and / or surviving an accident, continued bullying, bankruptcy, diagnosis of diseases such as cancer, dementia or HIV. or suffering from certain mental disorders. who run with psychic suffering.

    Neurobiology of the person with suicidal ideation

    At the 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, focusing a large part of pharmacological treatments on increasing this level. Other hormones such as dopamine and norepinephrine are also of great importance, as they contribute to their absence or presence in depressive and anxious states that can lead to attempts at autolysis.

    Risk factors for moving from thought to action include being male, being in old age (usually more common from the age of 40), having attempted suicide in the past. past or a loved one has died in this way, suffering from a mental disorder that obscures or biased judgment, the existence of substance abuse addictions, chronic medical problems and strong impulsivity.

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

    Psychological assessment and diagnosis

    While the presence of suicidal ideation does not necessarily lead to a genuine attempt to commit suicide, this is a very important risk factor that needs to be addressed urgently. Indeed, at the therapeutic level, it is essential to assess the existence of suicidal thoughts and if so, they 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 there are risk factors. If suicidal thoughts were not presented, asking questions about the topic will not lead to it, whereas if so, the approach with which the case will be treated should deal with its existence. When evaluating responses, it should be kept in mind that the individual may not want to explain their thoughts directly.

    Attitudes that attempt to downplay the risk or importance of this type of ideation may try to hide real thoughts about it. Sudden states of calm after deep agitation can also be indicative, with a possible warning that the individual has made the decision to act.

    The presence or absence of suicidal thoughts, the origin of such thoughts, their degree of activity and development should be explored. and the existence or not of a plan to be carried out. How, when and why are necessary questions that give you a sense of the seriousness of the situation. In addition to planning and implementing the responses, there is a greater risk that the thought will be put into practice.

    Treatment: how to act in case of possible suicide

    In case of suicidal ideation, prompt treatment is necessary this makes it possible to act effectively on the core of the problem. It should be noted that, contrary to the widespread myth, in most cases the person who thinks about suicide and believes that there is a possibility of ending up opting for this option, warns or warns his friends or family.

    In the event that suicide is imminent and the safety of the patient may be seriously compromised, immediate hospitalization is recommended so that it 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, as they usually appear in settings in which depressive symptoms are associated, they generally tend to use psychotropic drugs, in the form of different types of antidepressants. Specifically, one of the most common subtypes in these cases are the tricyclic antidepressants which, in the face of atypical depression or suicide attempts, have been shown to be more effective than other types of antidepressants.

    However, these medicines usually take several weeks to work. That’s why at the start the treatment of choice involves the application of anti-anxiety drugs, Reduce the anxiety and stress that suicidal thoughts usually induce.

    On the other hand, it should be clear that context plays a very important role in suicidal thoughts. This is why psychotropic drugs can be a useful patch, but not a permanent solution. It is necessary to intervene on the social circles in which the person evolves, as well as on the material means with which he lives.

    Associated mental disorders

    In cases where suicidal thoughts are related to mental disorders, they often appear in patients with bipolar disorder (it is common for the thought to appear in the depressive phase while the attempt at autolysis is usually more typical of the manic phases. ). After that which is the disorder with the greatest number of suicide attempts, the other disorders where suicidal ideation appears very often are drug addiction (especially alcohol), major depression, schizophrenia and personality disorder limit.

    Another treatment that has been shown to be biologically more successful in relieving depressive symptoms associated with suicidal thoughts is electroconvulsive therapy. While it is not yet clear why, it has been shown to rapidly and effectively reduce depressive symptoms in atypical, psychotic depression and attempts at autolysis. That is why it is used in cases where immediate action is required.

    Psychological therapy

    Regarding psychological treatment, given the need for early and rapid intervention in severe cases, behavioral-oriented treatment is usually necessary first and then dealing with cognitive aspects.

    It is essential to help set goals that are relevant and accessible to the patient, go through a series of steps that can first be used to decrease interest in suicidal thoughts and direct you to something you want to achieve. The main objectives to work on will be the recognition and expression of suffering, the acceptance of the feelings and emotions of the patient, the reorientation of attention and the negative thinking model towards other more effective alternatives.

    Through behavioral techniques such as progressive assignment of tasks, control of environmental stimuli and behavioral experiences, the individual will be sought to find motivation to endure or decrease the state of internal stress.

    At a more cognitive level, the decatastroficación carried out with caution can help to fight the reason which led the subject to wish his own death. Beck’s cognitive therapy also helps fight automatic negative thoughts. Problem-solving therapy, Rehm’s self-control therapy, or social skills training can help regain a sense of control on the part of the subject. The use of dramatizations can be helpful in relieving the patient by stating the reason for their pain and working on their sensations.

    Another useful therapy is Dialectical Behavior Therapy, which specializes in aggressive and autolytic behaviors, which helps improve coping while showing acceptance of the patient’s suffering.

    The use of psychoactive substances such as alcohol or drugs can cause symptoms to exacerbate, Controlling consumption is therefore a key element to consider. Especially if there has been abuse or addiction. However, in the event of dependence the abrupt withdrawal can cause the presence of an anxiety which can be dangerous, this withdrawal must therefore be guided by a professional.

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

    Bibliographical references:

    • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
    • Appleby, L. (2000). Prevention of suicide in psychiatric patients. A: K Hawton, K van Heeringen (edited by). The International Handbook of Suicide and Suicide Attempt. Chichester: Wiley & Sons Publishers.
    • Harris, EC and Barraclough, B. (1997). Suicide as a result of mental disorder. A meta-analysis. Br J Psychiatry; 170: 205-28
    • Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.
    • Thase, ME (1992). Long-term treatments for recurrent depressive disorders. J. Clin. Psychiatry; 53.
    • Welch, Calif. (2016). Electroconvulsive therapy. A: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Comprehensive clinical psychiatry at Massachusetts General Hospital. 2nd ed. Philadelphia, PA: Elsevier.

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