Suicidality: Causes, Symptoms, Help

Brief overview

Suicidality – Definition: Suicidality refers to the experience and behavior aimed at deliberately bringing about one’s own death. Various forms and phases possible.
Causes and risk factors: mainly mental illnesses, but also suicides or suicide attempts in the family, own suicide attempts in the past, stressful life situations or events, age, serious physical illnesses
Symptoms and warning signs: e.g. social withdrawal, expressing suicidal thoughts, neglecting food and personal hygiene, saying goodbye, giving away personal belongings, preparing a will
Dealing with suicidal people: Actively address the issue, do not condemn, remain sober and objective, organize professional psychiatric help, do not leave the affected person alone, in case of acute danger: call 911!

What is suicidal tendency?

Suicidal tendencies are when a person’s experiences and behavior are aimed at deliberately bringing about their own death – actively or passively. Such suicidal tendencies can occur once or become chronic. Chronic suicidal tendencies mean that those affected repeatedly develop suicidal thoughts and intentions and have usually already made one or more suicide attempts.

The need for peace and retreat without the desire to die
Weariness with life coupled with the desire to die, but without causing the death itself
Suicidal thoughts without acute pressure to act and concrete plans
Suicidal intentions – concrete plans to kill oneself
Suicidal impulses – occur suddenly with great pressure to take one’s own life immediately
Suicidal acts – actual implementation of suicidal intentions or impulses
Suicide attempt – a suicidal act that the person concerned has survived
Suicide – a suicidal act with a fatal end

The aim of this classification is to be able to assess the type of intervention measures required in individual cases as accurately as possible.

Suicidal thoughts arise when a person’s psychological distress gains the upper hand. Thoughts can then arise such as “What is the point of all this?”, “It would be better to be dead” or “I don’t want to go on living like this”. These thoughts can vary greatly in terms of frequency and intensity. The more often they occur and the more urgent they are, the more the person concerned loses sight of alternatives to suicide.

Stages of suicidality according to Pöldinger

The Austrian psychiatrist Walter Pöldinger’s stage model is a proven model for describing the progression of suicidality. It divides suicidal development into three phases:

Repeated suicidal thoughts and the social withdrawal of those affected are typical of the first phase. In addition, suicidal events, for example in the media or in their own environment, are perceived more strongly or more selectively. However, those affected can still distance themselves from their suicidal thoughts in this phase, they are still capable of self-control. They often send out hidden signals to draw attention to their plight.

2. ambivalence

3. decision

In the last phase, self-control is still suspended. Those affected now often appear relaxed and at ease, as the burden of the decision has been lifted. In view of this change, there is a great danger that laypeople will assume that their mental state has improved. In reality, however, those affected are making concrete preparations for suicide at this stage. They may formulate their will, say goodbye to family and friends or announce an extended trip – such warning signs should be taken very seriously!

Presuicidal syndrome according to Erwin Ringel

Constriction: Those affected see fewer and fewer options or alternatives to suicide. This narrowing of perception can be due to their own life situation or certain events (e.g. social isolation, unemployment, illness, loss of a partner). However, it can also be due to a mental illness (e.g. depression).
Aggression: Those affected have a high potential for aggression, but are unable to show their anger to the outside world and instead direct it towards themselves. This is referred to as a reversal of aggression.

Suicidality: Frequency

Around 10,000 people die by suicide in Germany every year. In addition, there are around 10 to 20 times as many suicide attempts every year. In the cause of death statistics, this puts suicide well ahead of traffic accidents with around 3,300 deaths per year and drugs with around 1,400 annual deaths.

Two out of three suicides are committed by men. Women, on the other hand, attempt suicide more often – especially young women under the age of 30.

Suicidal tendencies: causes and risk factors

Schizophrenia, certain personality disorders such as borderline and addictions also increase the risk of suicide.

Other risk factors for suicidal tendencies are, for example

Suicides or suicide attempts in the family
own suicide attempts in the past
Belonging to socially marginalized groups
unemployment
Financial problems
Experiences of violence
Separation from life partner
Death of close relatives
Increasing age
Loneliness/social isolation
Physical illnesses, especially those associated with pain

Suicidal tendencies: symptoms and warning signs

social withdrawal
Direct or indirect expression of suicidal thoughts
external changes, for example dark clothing, unkempt appearance
neglect of nutrition and personal hygiene
risky behavior
Saying goodbye, giving away personal belongings, preparing a will
Life crises

Acute suicidality is when the person concerned has intense thoughts of being tired of life and concrete suicidal intentions, so that an acute suicidal act is imminent. Acute suicidal tendencies can be recognized by the following signs. The person concerned…

persists in his suicidal intentions even after a lengthy conversation
has urgent suicidal thoughts
is hopeless
is suffering from an acute psychotic episode
has already made one or more suicide attempts

Have you noticed one or more of the above symptoms and signs in a relative, friend or acquaintance? Then you should act quickly. Raise the issue and offer your support. Accompany the person concerned to a psychiatric outpatient clinic, for example. In the event of acute suicidal tendencies, you should call the emergency number (112).

Suicidal thoughts – what to do?

You should always do something about suicidal thoughts that you have yourself or that someone else expresses! The important thing is how often and how urgent these thoughts are. As a first step, an open conversation with a close confidant can help, where the often agonizing thoughts can be expressed.

However, if the suicidal thoughts are very urgent and frequent and the person concerned can no longer distance themselves from them, rapid psychiatric (emergency) help is required.

Acute suicidal tendencies: medical treatment

Acute suicidal tendencies are usually initially treated with sedative, calming medication. Once the acute danger has subsided, psychotherapeutic discussions follow. Whether treatment is continued in hospital or on an outpatient basis depends on how high the patient’s suicide risk is assessed to be.

Important elements of treatment are, for example

Risk factors such as problematic social contacts or drug use are eliminated as far as possible.
Close monitoring of patients is ensured so that they do not have access to potential suicide tools such as weapons or medication.
Some therapists conclude a non-suicide contract with the patient. This means that the patient agrees to the treatment and declares that they will not harm themselves during the therapy. Of course, this contract is not legally binding, but it strengthens the relationship of trust and compliance – i.e. the patient’s willingness to actively participate in the treatment.
Suicidal patients often lack a fixed daily structure that gives them stability in everyday life. Treatment therefore often includes concrete structuring aids, for example in the form of jointly developed daily schedules.
Behavioral training can help patients to regulate their emotions and cope better with conflicts.
Cognitive therapy methods aim to change the dysfunctional thinking style, which is characterized by hopelessness, self-deprecation, brooding and a negative assessment of the future.
The involvement of relatives or close friends can support the success of the therapy.

Dealing with suicidal tendencies: tips for relatives

You are worried about a relative and ask yourself: What should you do if someone is suicidal? The most important advice for dealing with suicidal tendencies is: Be there! Don’t leave the person affected alone and look after them. Other important advice:

Take them seriously: Take suicidal thoughts seriously and do not judge them. Avoid making statements such as “You’ll be fine” or “Pull yourself together”. Even if the problems described do not seem serious to you, those affected will see things completely differently due to their narrowed thought and perception patterns.

Important: Take responsibility for the suicidal person by organizing help, staying by their side and giving them the feeling that you are there for them. You certainly know how important it is to have someone close to you at your side in an acute, existential crisis.

Suicidal tendencies: contact points

In addition to psychiatrists and psychotherapists in private practice and psychiatric clinics, there are other contact points for people at risk of suicide and their relatives. For example

Telephone counseling service on 0800-1110111
Social psychiatric service with local counseling and support services. Addresses can be obtained from the local health authority

Self-help groups on the topics of depression and mental illness can also help with suicidal tendencies. The addresses and contact information can be found on the Internet.