The first thing to know is that there are three definitions of self-directed violence:
Suicidal ideation - thoughts about or an unusual preoccupation with suicide. These thoughts can include planning or considering suicide
Suicide attempt - self-directed behavior with the intent to die. Please note that an attempt does not have to result in injury.
Suicide - death caused by self-directed behavior. The goal of this behavior is the intent to die.
Factors that may increase a person’s risk for suicide include:
- Access to weapons or other means
- Family history of suicide
- Previous suicide attempt or attempts
- Alcohol, Drug or Substance abuse
- Current or previous history of psychiatric diagnosis
- Poor self control or impulsivity issues
- Hopelessness – presence, duration, severity
- Loss– physical, financial, personal
- Recent discharge from psychiatric facility
- History of abuse (physical, sexual or emotional)
- Additional health problems (especially a newly diagnosed problem or worsening symptoms)
- Age, gender, race (elderly or young adult, unmarried, white, male, living alone)
- Same- sex sexual orientation
The first three warning signs:
- Making threats to hurt or kill self
- Seeking access to pills, weapons or other means
- Talking or writing about death, dying or suicide
The remaining list of warning signs should call attention that an evaluation needs to be conducted in the very near future. Precautions should be in place right away to ensure the safety, of the individual.
- Rage, anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Feeling trapped – like there’s no way out
- Increasing alcohol or drug abuse
- Withdrawing from friends, family or society
- Anxiety, agitation, unable to sleep or sleeping all the time
- Dramatic changes in mood
- No reason for living, no sense of purpose in life
Suicide Ideation (thoughts of suicide)
In most cases, suicidal ideation is believed to be the start of suicidal planning and action.
Many individuals will initially deny these thoughts for a variety of reasons including:
- the shame that is associated with symptoms of a mental disorder;
- fear of being judged negatively;
- loss of control over the situation; and
- fear of overreaction and involuntary hospitalization
Some signs and symptoms include: profound social withdrawal, irrational thinking, paranoia, insomnia, depression, agitation, anxiety, irritability, despair, shame, humiliation, disgrace, anger and rage.
There is a myth that asking about suicidal ideation increases the likelihood of the person to engage in the behaviors - not true. In fact, most patients report a sense of relief and support when a caring, person non-judgmentally expresses interest in their pain.
What to do
Here are some ways to be helpful to someone who is threatening suicide or engaging in suicidal behaviors:
- Be aware – learn the risk factors and warning signs for suicide and where to get help
- Be direct – talk openly and matter-of-factly about suicide
- Be willing to listen – allow expression of feelings
- Be non-judgmental – don’t debate whether suicide is right or wrong
- Be available – show interest, understanding, and support
- Don’t “dare” the person to engage in suicidal behaviors.
- Don’t act shocked
- Don’t ask “why”
- Don’t be sworn to secrecy
- Do - offer hope that alternatives are available
- Take action – remove lethal means of self-harm such as pills, weapons and alcohol
- Get immediate help from others with more experience and expertise
- Be actively involved in encouraging the person to see a mental health professional
Suicide Information Web Sites:
American Association of Suicidology: http://www.suicidology.org
American Foundation of Suicide Prevention: http://www.afsp.org
Suicide Prevention Action Network (SPAN): http://www.spanusa.org
Suicide Prevention Resource Center: http://www.sprc.org
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