Recognizing Suicidal Behavior

How do we know if a person close to us has risk factors for suicide? What do we look for? How do we interact or approach our loved one if we have concerns? I hope to answer these questions in this week’s blog.

There is no one single approach that works best in predicting human behavior in regards to suicide but there are several key factors to consider. The American Association of Suicidology (AAS) developed a list of 10 behaviors linked to increased risk for suicide. The mnemonic IS PATH WARM is an easy way to remember the list:

Ideation (thoughts of suicide)

Substance abuse (using drugs or alcohol)

Purposelessness (the feeling of life not having meaning)

Anxiety (intense fear or worry)

Trapped (a feeling of being stuck in a life circumstance)

Hopelessness (inability to see a positive future)

Withdrawal (isolation from others)

Anger (intense emotion)

Recklessness (dangerous choices with likely painful consequences)

Mood Changes (unexpected and drastic fluctuation in emotions)

 

Many people with suicidal thoughts will never make an attempt so how do we identify those who are more likely to act? Joiner’s Interpersonal-Psychology Theory of Suicidal Behavior has two primary indicators for risk. Coupled with the AAS list above, we get a better picture of the person at risk for suicide:

  1. Desire to die motivated by burdensomeness combined with thwarted belongingness.
  2. Capability to act on suicidal desire, developed by repeated exposure to painful and provocative experiences (self-injury, history of physical abuse, past suicide attempt, witnessing violence, etc.)

The American Psychiatric Association identified 7 factors associated with a high risk for suicide. These will round out our picture of a possible suicidal person:

  1. Any history of a suicide attempt.
  2. Long-standing tendency to lose temper or become aggressive with little provocation.         
  3. Living alone, chronic severe pain, or recent (within 3 months) significant loss.           
  4. Recent psychiatric admission/discharge of first diagnosis of major depression, bipolar disorder, or schizophrenia.
  5. Recent increase in alcohol abuse or worsening of depressive symptoms.          
  6. Current (within last week) preoccupation with, or plans for suicide.
  7. Current psychomotor agitation, marked anxiety, or prominent feelings of hopelessness.

Now that we have a picture of what our loved one would look like at risk how do we help them? We begin by starting a conversation.

  • Ask about suicidal thoughts, be open-minded and nonjudgmental, and don’t shame the person for his or her thoughts. (Asking about suicide won’t plant the thought in their mind.)
  • Encourage him or her to talk with a professional therapist or crisis line (920-459-3151 in Sheboygan) to develop a safety plan.
  • Help to develop connections, both personal and professional, with individuals who are willing to help carry out the safety plan.
  • Encourage finding meaning and purpose in life.
  • Show genuine acceptance and unconditional positive regard for his or her wellbeing.
  • If your loved one is unwilling to seek help, call your local human service department about crisis intervention and involuntary mental health treatment.
  • If there is immediate dangerous call 911.

Kindly,
JT

jonathan
JonathanTyler, MA, LPC, SAC-IT