Symptoms

Suicidality - thoughts of suicide: signs and facts


Thoughts of suicide

In theory, the thought of suicide concerns almost everyone at some point in their life. We are all faced with the question of whether there is a situation for us, for example an incurable disease, in which we want to determine the time of our death ourselves. Urgent thoughts of suicide have a completely different quality, which can quickly pass into the acute plan to implement them.

Suicidal Thoughts - The Most Important Facts

  • Occasional thoughts of suicide do not mean that those affected actually commit suicide, but it becomes critical when these thoughts become urgent.
  • Urgent thoughts of suicide, combined with a real restriction of freedom of action or psychological restriction, often linked to auto-aggression, characterize the presuicidal syndrome that initiates the suicide process.
  • The most important trigger for suicidal thoughts are the escape from a situation which is perceived as unbearable and the building up of an illusory world out of the feeling that it is not up to the reality.
  • Most people who have suicidal thoughts do not want to die, but do not know how to solve their life problems.
  • For relatives, the most important thing is to turn to those affected and show them that they recognize them in order to free them from the black hole of their negative thoughts.
  • But giving friends does not replace therapeutic help.
  • Thoughts of suicide must always be taken seriously.

Escape to an illusory world

Those affected flee into the unreal from the feeling that they are not up to the reality. This illusory world is taking up more and more space, thoughts of death and suicide as a supposed way out are becoming more and more important.

Suicide - a common cause of death

Often it is not just thoughts. Worldwide, 800,000 people end their lives themselves each year. Up to 500 million other people are directly affected by these suicides, since suicide by a loved one significantly increases the risk of suicide for those around them. Suicides in particular trigger a wave of suicide fantasies in young subcultures. We are talking about the Werther effect here, after Goethe's “suffering of young Werther”, in which a literary suicide caused real suicides.

Suicide is even the second leading cause of death among people under the age of 25 in Germany. At the same time, thoughts of suicide are still a taboo subject. Young people in particular feel overwhelmed when they suspect that someone in their area has suicidal thoughts. And those affected themselves are often ashamed of their thoughts.

Seeking help yes, ashamed no

There is no reason to be ashamed. Far from heroic suicide fantasies according to the motto "Better dead than slave", which are about killing yourself rather than submitting to tyranny, the real cause of many suicidal thoughts is "terrifying" banal. Triggers are usually external crises:

  • Bullying and insults at school,
  • not meeting the performance requirements of others,
  • Death of a loved one,
  • Separation from a partner,
  • Loss of job,
  • serious diseases,
  • precarious financial situation
  • and various conflicts in relationships.

In short, a black hole that those affected think they can't get out of. It is no coincidence that suicidal thoughts are particularly common among adolescents; This is ensured not only by the adolescent chaos of feelings, but also by the lack of life experience in dealing with the corresponding situations and adjusting them so that they no longer pose a threat to life.

Accept help

Mind you: The trigger for suicidal thoughts is in the rarest of cases the wish to die, but mostly the desperation to find no way out of an unbearable situation. That is why help is immeasurably important - preferably before thoughts take on concrete forms that could initiate the process that ends in death.

Very important: Suicidal thoughts combined with fear of life, hopelessness and despair are not only no reason to be ashamed, on the contrary: seeking help is a sign of strength. Anyone who has stomach cramps and does not go to the doctor because he is embarrassed would have no understanding for him. Being emotionally on the ground so that you think of suicide and not looking for help is also incomprehensible.

Care for a person who suffers mentally or physically is an evolutionary core of healing a disease. Friends, parents, school psychologists, therapists, but also anonymous advice by phone are contact points. A one-hour conversation often helps those affected.

To listen

People around those affected are often afraid of doing something wrong. Knock that out of your head. Above all, doing wrong means doing nothing. The most important thing is: just listen. Do not give advice! Advice leads to someone thinking that they have to explain or justify themselves. But someone who feels so bad that he thinks of suicide cannot do that. When you listen to those affected, they often say that you need help. Then you can call pastoral care or seek medical help together with the person concerned.

What warning signals are there?

When someone has thoughts of suicide or is even planning to commit suicide, they sometimes send no warning signals at all. However, some signs are typical:

  • Man says that he wants to kill himself.
  • Man is tormented by self-loathing and suffers from feelings of guilt.
  • Those affected isolate themselves from friends.
  • School grades or work performance drop rapidly and abruptly.
  • Man hurts himself.
  • He doesn't care about his hobbies, pets and living environment.

What can friends do?

Don't overestimate yourself. You cannot help a person who has serious suicidal thoughts alone. Contact specialists who are specially trained for this.
You can

  • accompany your boyfriend / girlfriend to a counseling session with a doctor or therapist,
  • establish contact with professional helpers,
  • talk to parents, teachers and other local authorities.

Very important: If you are in a crisis and are thinking about killing yourself, you will relieve yourself enormously if you pass on the necessary information for him and do not leave it to him: paperwork for the authorities, registration with the therapist, apology at school and at work, information from parents and partners. Also note:

  • Convince those affected that you are there for them.
    Don't criticize them. Anyone suffering from suicidal thoughts has already got caught up in a network of self-referrals and self-depreciations.
  • On the other hand, gently inform those affected about their positive abilities.
    The discussion about shared positive experiences is particularly beneficial. They activate the memory and release other than the negative pathways in the synapses. Avoid phrases such as "life is beautiful, don't act like that." On the other hand, lead the conversation to memories that you know were beautiful for those affected and thus fuel the hope that such a beautiful experience again can come.
  • As relatives and friends, contact yourself for help offers and self-help groups.
    Why? Caring for someone who is potentially at risk of committing suicide is an enormous burden - first, because you are faced with very negative issues - second, because you are afraid of doing the wrong thing and in the end To be to blame for killing people. Questions like, "Has it come when I take care of psychiatric or clinical help and thus implicitly question the autonomy of my relative or friend?"

Causes of suicidal thoughts

In general, the most important trigger for thoughts of suicide is a situation that is considered unbearable. It doesn't matter whether the situation looks hopeless in the eyes of others! That is why well-intentioned advice like "it is not that bad" fails. Such a feeling cannot be judged “objectively”. Some people have hundreds of thousands of euros in debt, are freshly separated from their great love, at the same time learn that you have cancer and do not dream of killing themselves. Others objectively have a great relationship, look good, are in good health, do not suffer from material hardship and are plagued with suicide fantasies day and night.

Actually, it is often a cry for help. A person thinks he cannot get out of a difficult situation and fantasizes about self-determined death as a way out. It is often a fantasy to regain control, at least in determining one's own death, that was lost in life. Possible causes are:

  • An unprocessed traumatization or post-traumatic stress disorder,
  • Loss experiences,
  • Lonliness,
  • Bitterness,
  • or life crises.

Thoughts of suicide often occur in people who feel helpless in times of change and initiation - during puberty, when moving out of their parents' home or after the loss of a partner and the unusual situation of taking care of themselves.

More motifs

Motives can also be:

  • Redemption from mental or physical suffering,
  • Cry for help to the environment,
  • Blackmail to control the social environment (typical of borderline syndrome),
  • Revenge, punishment of others ("when I'm dead, you know what you did"),
  • "Last resort" to save self-esteem,
  • sober balance (a change of mind is then hardly possible),
  • Identification with an idol
  • or desire for change.

High level of suffering

People who no longer see a way out in life and who see death as a way out are under a great deal of suffering. People who develop suicidal fantasies mostly do not want to die - they can no longer stand the current state of their lives.

Latent, intense and chronic

Sometimes suicide ideas arise spontaneously, as a short-circuit reaction to an acute crisis: A 14-year-old with a strict mother has given up his testimony and is thinking on the way home, "If I jump in front of a train now, it's all over". The fear of the mother is so great that suicide appears as salvation.

However, people develop suicidal thoughts more frequently over a longer period of time. The fantasies of death come to the fore sometimes more weakly. Caution is advised here, because such fantasies can become chronic and, once they have established themselves, prepare the way to death step by step. Such people have the latent idea of ​​killing themselves and in acute crises these latent ideas come to the fore. Those who are in such thought structures usually have a long path of suffering behind them and often also many attempts to contain the suffering, which were more or less unsuccessful.

Mental illnesses - myth of self-determination

Mentally stable people sometimes act through suicide as an act of self-determination. Just as the Zealots in Massada threw themselves into the sword and showed the Roman enemies that love of freedom can be stronger than the love of life, so they imagine suicide as the last act of a self-determined life. Care should be taken with such idealizations if suicide fantasies occur in people who suffer from mental disorders.
Suicide ideas are typical of:

  • Depressions,
  • Bipolarity (between mania and depression),
  • Traumatization,
  • Anxiety disorders,
  • Psychoses, behavioral disorders
  • and borderline syndrome.

At Borderline, self-harm and thoughts of suicide are even a key symptom. In mentally ill people, factors promote suicidal thoughts, which in turn are often caused by the mental illness:

  • Unemployment,
  • Housing shortage,
  • Relationship problems,
  • financial hardship,
  • Isolation,
  • social isolation
  • or bullying.

Those suffering from suicide fantasies in connection with such an illness need professional help, psychotherapy or a combination of psychotherapy and medication. These measures have been shown to reduce suicidal thoughts.

In the gray area

A stay in a psychiatric institution is usually only pending acute actions and thoughts. But even if thoughts are not yet crying out for realization, there are forums on the Internet where those affected can exchange ideas. People who know similar problems can give valuable tips and it often helps to not be alone with such dark thoughts - because one of the driving forces behind suicide fantasies is the feeling of being lonely in the world.

Such forums have several advantages: Those affected often fear that they are not understood by friends, parents or acquaintances or are ashamed of their thoughts. They are also reluctant to submit to the control of a specialist. They remain anonymous in the forums, but exchange ideas with "like-minded people", before whom they can relentlessly tell the truth. Moderators are often psychologically trained.

Friends and relatives are also of great help if those affected can speak to them. Long walks in the open air in private, for example, have a positive effect that can hardly be underestimated. However, friends should avoid making a "diagnosis".

Why is care so important?

Thoughts of suicide are usually a reaction to an acute or long-lasting crisis in which those affected feel misunderstood. Acknowledging that people have these thoughts, feel bad and that problems overwhelm them is an essential step out of the black hole.

In terms of evolutionary psychology, symptoms of illness are also a signal of communication that prompts other people to turn to the sick. And when "being sick" means that a person is doing badly, suicidal thoughts are exactly such a signal of understanding. If those affected withdraw, lose their hobbies, even say that they want to kill themselves, then there is a conscious or unconscious request for attention. If this is prohibited to them, the thoughts become more intense and concrete and can pass into the pull of the action - into the execution of the suicide. Only the suicidal person who chooses not to talk can save his life.

Psychological circumstances - depression and anxiety

Thoughts of suicide often go hand in hand with more extensive complaints. For example, people who suffer from severe depression often develop suicidal fantasies every day. If you are sitting on the train, remember to throw yourself in front of it; shave, remember to cut your wrists; they sit in the bathtub, their gaze wanders to the hair dryer and they imagine throwing it in. At the same time, depressed people isolate themselves from the environment, have an extremely negative self-image and see the world in black colors.

Anxiety and, above all, anxiety disorders are often expressed in suicide fantasies, be it exam anxiety, fear of the future or social phobia. People who suffer from chronic anxiety often have suicidal fantasies as a fictional way to escape this oppressive fear for decades.

Self help

Those affected can do a lot to free themselves from the tormenting thoughts and prevent their possible suicide. This includes the admission "I could be at risk of suicide". Revealing yourself to others can be life-saving, especially before the risk of suicide becomes acute.

As absurd as it sounds to someone with depression or anxiety disorder: "There is no way out" - there is almost always a way out.

  • Be good to yourself.
    That sounds strange to someone who thinks it's all over anyway, but give it a try. Remember what you enjoyed in life, when you felt good. Are these hobbies? Meet certain people?
  • Take long walks in nature.
    The phrase “nature is the best therapist” is no coincidence. Not only do trees emit chemical substances that increase our immune system and well-being, but nature is life - and people communicate with other living things, whether they like it or not. This gives you different thoughts, whether you are consciously addressing it does not matter.
  • The most important thing is the answer to the question: What was good for me in the past when I was previously bad? What helps me
    Everyone knows this best of all on their own. Don't be ashamed if the answer seems ridiculous to you. Was it good for you as a child to feel depressed about eating raspberry ice cream? Then go to the ice cream parlor and get one. Read books you loved as a child, watch movies you liked. This is important because bit by bit you regain your identity, which is not just the thoughts of suicide.

Presuicidal syndrome

Thoughts of suicide become particularly critical when they transition to the presuicidal syndrome. The psychiatrist Erwin Ringel introduced this term. It consists of

  • intense suicide fantasies,
  • Reversal of aggression in which those affected direct the aggression they feel towards others towards themselves
  • and narrowing, which reduces the perception of those affected to a tunnel view towards their own death.

Ringel discovered these three characteristics in the 1950s after examining more than 700 patients who had survived an attempted suicide.

Narrowing means that the freedom of action in perception or in real terms continues to be restricted until only suicide remains possible. This can also take place in objective reality: for example, the aforementioned mass suicide of the Jewish zealots in the Massada fortress in what is now Israel was the only option left to avoid falling into the hands of the Roman enemy.

More often, however, the narrowing only occurs in the thoughts of those affected by depression or contact disorders. This also applies if the options are narrowed down in reality, whether due to unemployment, losses or illness. Psychological and social isolation are mutually dependent.

It is typical of the reversal of aggression that the aggression is at the same time becoming stronger and at the same time inhibited. Presidential "eat everything in yourself" instead of "hitting the table with your fist". In the long run, this leads to aggression directed against them. A sign of this is self-harm (such as scratching) or recurring self-destructive actions. All three symptoms together, the narrowing, the suicide fantasies and the auto-aggression are serious warning signs that there is a risk of suicide.

Thoughts of suicide and risk of suicide

Not every thought of suicide automatically implies a risk of suicide. The process that ends with suicide generally has three phases.

  1. First comes the consideration phase. Here, people concerned deal intensively with the topic of suicide and think about what it would be like to be dead.
  2. The second phase is that of ambivalence. Here, suicide has already become a real possibility for those affected to solve problems by weighing up the pros and cons. Man is still undecided, he weighs up. At the latest here, the care of friends, relatives, doctors and therapists is essential. Because now those affected are still approachable and decide, often with positive support against death.
  3. In the final decision phase, very few people notice that suicide is imminent. Even more: Many misjudge the following symptoms:
    • Affected people now often seem relieved. They are cool and calm. Anyone who previously knew her as desperate often wonders about her “positive change”.
    • Some of the suicide candidates are now visiting old friends they haven't seen for a long time to say goodbye (but they don't say so).
    • Others go back to places where you felt comfortable to say goodbye here too.

Characteristics of suicidality

Thoughts of suicide are only a sign of suicidality and only when they become urgent.
Other signs include:

  • Hopelessness,
  • deep sadness,
  • depressive moods,
  • overexcited behavior like rampant anger,
  • Withdrawal from conversations,
  • lack of interest in finding consensus with other people,
  • negatively experienced inner worlds,
  • Seeking out risky situations such as driving too fast, provocations of fights in which the victims are victims,
  • possibly drug and alcohol abuse, which can be both a consequence and a trigger of suicidality,
  • Feelings of guilt,
  • Self-loathing
  • or verbal warnings - sentences like: "Soon you won't have to endure me anymore ...", "I had a good life ...", "No longer want to live this waste life", "Why use a tomorrow if today doesn't help me?" ... "," This world is a big pile ... ".

Specific symptoms of suicidal tendencies in adolescents

Typical for young people at risk of suicide are:

  • groundless friendships and love relationships,
  • Changes in personality, change in personality that is difficult to explain,
  • Changing eating and sleeping habits,
  • Insomnia,
  • abrupt decline in academic performance,
  • Headache, exhaustion, stomach pain,
  • Rejecting gifts,
  • Indifference to honors or recognitions,
  • Giving away previously important things
  • Strange tidying up of the room or apartment: draw a line,
  • "Absurd" serenity after a severe depressive phase, while serenity is otherwise unusual for those affected,
  • Curious "old wisdom,"
  • Daydreams, "Stand by yourself", "Dawn away", dissociative states
  • and increased interest in death and suicide.

Suicidality is often not easy to determine, especially in adolescents, because the characteristics overlap with those of puberty. (Dr. Utz Anhalt)

Emergency numbers

Telephone counseling: 0800-1110111
Number against grief (child and youth telephone): 116111
Police: 110
Rescue service: 112

Education and help with suicidal thoughts offers:

http://www.frnd.de

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Dr. med. Andreas Schilling

Swell:

  • Katja Becker et al .: S2k guideline 028/031: Suicidality in childhood and adolescence, German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP), (accessed July 9, 2019), AWMF
  • Frank-Gerald Pajonk et al .: S2k Guideline "Emergency Psychiatry", German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), (accessed July 10, 2019), AWMF
  • Tobias Teismann, Wolfram Dorrmann: Suicidality, Hogrefe Verlag, 1st edition, 2014
  • Paula J. Clayton: Suicidal Behavior, MSD Manual, (accessed July 10, 2019), MSD
  • Julia Umansky: Suicidality remains an important cause of death, journal club, issue 6/2019
  • Dagmar Kraus: Suicidality: recognizing the signs in good time, CME, edition 5/2019

ICD codes for this disease: R45ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Reducing Suicide Ideation: A Potential Lifeboat. Joe Campbell. TEDxUniversityofMississippi (January 2022).