Suicidal thoughts: causes, symptoms and therapy

Suicidal ideations can have different causes and treatments.

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 care services that prevent, as far as possible, the transition 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 own life, either through a plan or a way of fantasizing about committing suicide.

Suicidal ideation

There are a great 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 prolonged or chronic disabling disease or disorder (both physical and psychological) are some examples.

In some cases, the pain suffered is such that the person is unable to cope with it, feeling no control over their life and coming to believe that they can do nothing to improve their situation. In short, 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 own life may arise. In other words, suicidal thoughts would appear..

Suicidal thoughts: what are they?

Suicidal thoughts are considered to be all those thoughts that an individual has about intentionally and plannedly taking his or her own life.. These thoughts can range from the mere desire to die to the active realization of concrete plans for the implementation of self-injury. The latter, in which the subject has elaborated the how, where and when, is the most dangerous and prone to perform the act.

Although thoughts and wishes of death may appear on a specific occasion, in general when we speak of suicidal ideation or suicidal thoughts we usually refer to a recurrent thought pattern in which the wish to die appears. They may appear in a purely cognitive form, although the most common is that there is a certain longing or desire at an emotional or motivational level.

Most suicidal thoughts occur at times of intense emotional pain and suffering. The individual feels that no matter what he/she does, he/she will not be able to change the reason for his/her suffering. He/she does not feel capable of finding a solution, but rather feels powerless and lacking any control. The person with these thoughts loses tends to suffer from a deep sense of hopelessness. Generally the underlying idea**, the goal of suicidal ideation is not to end one's own life**, but to put an end to this state of pain and helplessness.

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

Possible causes and risk factors

The causes for the presence of suicidal thoughts can be many and very different, depending on the particular case. As has been indicated, as a general rule, this type of thoughts usually occur after the experience or notification of a painful event or a loss in which deep feelings of pain, guilt and/or shame appear that escape the individual's control and plunge him/her into a state of despair in which there is no possible solution.

The presence of abuse, loss of loved ones (either by death or breakup) or faculties or an anxiogenic situation from which it is not possible to escape are usually the most frequent triggers. Examples would be the experience of rape, prolonged isolation, physical incapacitation, having caused and/or survived an accident, continuous bullying, bankruptcy, the diagnosis of diseases such as cancer, dementia or HIV or the suffering of some mental disorders that involve psychic suffering.

Neurobiology of the person with suicidal ideation

At a Biological level it has been observed the presence of a decrease in the level of serotonin in the brain of people with this type of suicidal thoughts, focusing most of the pharmacological treatments 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 self-harm attempts.

Risk factors for moving from thought to action include male gender, advanced age (usually more frequent after the age of forty), having made suicide attempts in the past or having had a loved one die in this way, suffering from a mental disorder that clouds or biases judgment, 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 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 an actual attempt to take one's own life, it is a very important risk factor that should be treated urgently, it is a highly relevant risk factor that should be treated urgently.. In fact, at the 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 are not present, asking about them will not induce them, while in the affirmative case the approach to the case should focus on their existence. When evaluating the answers, it should be taken into account that the individual may not want to explain his or her thoughts directly.

Attitudes that attempt to minimize the risk or importance of this type of ideation may be an attempt to conceal the true thoughts about it. Sudden states of calm after deep agitation may also be indicative of a possible warning that the individual has made a decision to take action.

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 suicidal plan should be explored. 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 case of 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 is thinking of committing suicide and believes that there is a possibility of ending up opting for that option, warns or warns his friends or family.

If suicide is imminent and the patient's safety may be seriously compromised, immediate hospital admission is recommended so that the patient can be monitored 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, psychopharmacological drugs tend to be used as a general rule, in the form of different types of antidepressants. Specifically, one of the most common subtypes in these cases are tricyclic antidepressants, which have shown greater efficacy than other types of antidepressants in atypical depressions or with suicide attempts.

However, these drugs generally take several weeks to take effect. This is why initially the treatment of choice the treatment of choice is the application of anxiolytic drugs, reducing anxiety and tension.reducing the anxiety and tension that often induce suicidal thoughts.

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 in which the person moves, as well as on the material means with which he/she lives.

Associated mental disorders

In cases in which suicidal thoughts are linked to mental disorders, they frequently appear in patients with bipolar disorder (the thought usually appears in the depressive phase while the attempt at self-harm is usually more typical of manic phases). After bipolar disorder, which is the disorder with the highest number of suicide attempts, other disorders in which suicidal ideation appears with great frequency are substance addiction (especially alcohol), major depression, schizophrenia and borderline personality disorder.

Another of the treatments that at a biological level has shown greater success in alleviating the depressive symptoms associated with suicidal thoughts is electroconvulsive therapy. Although it is not yet known why, it has been shown to quickly and effectively reduce depressive symptoms in atypical, psychotic and attempted self-harm. That is why it is used in cases where immediate action is required.

Psychological therapy

With regard to psychological treatment, taking into account the need for early and rapid intervention in severe cases, treatment focused on behavioral aspects is usually required first, followed by treatment of cognitive aspects.

It is essential to help set relevant and accessible goals for the patient, by graduating a series of steps that can initially serve to diminish interest in suicidal thoughts and that direct him/her to something he/she wants 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, redirecting the attentional focus and the negative thought pattern towards other more effective alternatives.

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

At a more cognitive level, de-catastrophizing carried out with prudence can help to combat the motive that has led the subject to desire his or her own demise.. Beck's cognitive therapy can also be used to combat automatic negative thoughts. Problem-solving therapy, Rehm's self-management therapy or social skills training may help to regain the subject's sense of control. The use of role-playing can be helpful in helping the patient feel relief by exposing the reason for their pain and working on their feelings.

Another useful therapy is dialectical behavioral therapy, specializing in aggressive and self-injurious behaviors, which helps to improve the patient's ability to cope, while at the same time demonstrating acceptance of the patient's suffering.

The use of psychoactive substances such as alcohol or drugs can produce an exacerbation of symptoms.The use of psychoactive substances such as alcohol or drugs can produce 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 lead to the presence of anxiety that can be dangerous, so that such withdrawal should be guided by a professional.

The presence of 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 is also important. Likewise, the monitoring of the individual's mental and physical state and the fact that he/she does not remain isolated are protective elements that make self-injury more difficult.

Bibliographical references:

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