Suicide, defined by the NIMH as “death caused by self-directed injurious behavior with intent to die as a result of the behavior,” takes the lives of over 40,000 people in the US each year. It is the second leading cause of death among adolescents and young adults, and is the leading cause of death among people with eating disorders. In addition to those who end up completing suicide, many people struggle with suicidal thoughts, urges and attempts.
Life, with all of its wonder, is also painful. Emotional, psychological and physical pain are inevitable aspects of the human experience to which none of us are immune. With this said, that are factors that influence the ways in which we experience pain and our ability to cope effectively with it, such as biologically-based sensitivity and learning experiences we have over our lifetime. One way to understand suicide is to think of it as the ultimate escape from what is perceived as intolerable pain. It is the ultimate form of avoidance.
Many people report that thoughts about suicide provide them with some sense of relief, as it allows the mind an “out” or “escape” if their pain becomes too much to bear. Instead of expecting that your loved one is going to stop having suicidal thoughts, we encourage acknowledging that the thoughts make sense in the face of extreme pain. Our hope is that we can help people learn to cope more effectively with pain, reducing their vulnerability to harming themselves in response to it, while also building a life with more positivity in it. Additionally, suicide prevention
involves addressing underlying risk factors, such as an eating disorder
, anxiety, depression
and substance abuse
Warning Signs and Risk Factors
While we cannot predict if and when someone will attempt suicide, there are a number of suicide warning signs and risk factors
that are important to know about. In addition to those listed below, past suicide attempts and family history of suicide are important indicators of increased vulnerability to suicide.
- Talking about suicide
- Researching ways to kill oneself or acquiring means
- Giving away pets and possessions
- Saying goodbye to loved ones
- Depression or anxiety
- Anger and aggression
- Avoidance of daily life activities
- Substance use
- Mental health conditions (anxiety, depression, eating disorders)
- Recent loss (friend/family, job, pet)
- Exposure to another person’s suicide
- Stressful life events or prolonged stress (death, move, new job)
How to Help
Supporting a loved one with suicidality
can be very taxing, and we strongly encourage you to make sure you have your own support. This might come in the form of therapy, church, joining a support group or talking with close friends- whatever the medium, resourcing yourself during this frightening journey is critical.
As a supporter we recommend keeping three primary areas in mind: immediate safety, reducing vulnerability and improving or maintaining well-being/mental health.
1. Immediate Safety
When someone is actively suicidal we orient ourselves around keeping them safe. We encourage you to talk with your loved one and their treatment team about this so that you can be knowledgeable about any safety plans that are in place and clearly know your role in helping to support safety. This may mean that your loved one stays in your home, or that you keep all of the medication in the house locked up. In certain situations, for example if your loved one is saying that they have a plan to kill themselves, this may mean transporting them to the emergency room for a psychiatric evaluation or calling 911.
2. Reducing Vulnerability
Reducing vulnerability involves noticing when risk factors are present and addressing them. For example, if a celebrity dies by suicide and this is covered in the media, talk openly with your loved one about the impact that this might be having on them. Another example is removing possible means from your home (ex. Guns, certain medications, etc.) so that if your loved one’s suicidal thinking changes from passive to active they are less likely to have access to something that they could use to harm themselves.
3. Overall Well-being/Mental Health
As mentioned above, one way to think about suicide is that it is the ultimate form of avoidance or escape. In Dialectical Behavior Therapy
, which was developed to help treat people with chronic suicidality, there is an idea that in order to help people become less suicidal we must also help them “create a life worth living.” This can include things like meeting professional goals and feeling connected in one’s relationships, as well as addressing underlying mental health conditions
and helping people have the tools to cope more effectively with the challenges of life. The less pain and suffering one experiences, the lesser the need is for the mind to produce an escape.
Crissy Anderson, MS, LMFT is a Primary Therapist at Eating Recovery Center of Washington.