Suicidal ideation, or suicidal thoughts, is the thought process of having ideas or ruminations about the possibility of dying by suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life circumstances without the presence of a mental disorder. On suicide risk scales, the range of suicidal ideation varies from fleeting thoughts to detailed planning. Passive suicidal ideation is thinking about not wanting to live or imagining being dead. Active suicidal ideation involves preparation to kill oneself or forming a plan to do so. Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor. During 2008–09, an estimated 8.3 million adults aged 18 and over in the United States, or 3.7% of the adult U.S. population, reported having suicidal thoughts in the previous year, while an estimated 2.2 million reported having made suicide plans in the previous year. In 2019, 12 million U.S. adults seriously thought about suicide, 3.5 million planned a suicide attempt, 1.4 million attempted suicide, and more than 47,500 died by suicide. Suicidal thoughts are also common among teenagers. Suicidal ideation is associated with depression and other mood disorders; however, many other mental disorders, life events and family events can increase the risk of suicidal ideation. Mental health researchers indicate that healthcare systems should provide treatment for individuals with suicidal ideation, regardless of diagnosis, because of the risk for suicidal acts and repeated problems associated with suicidal thoughts. There are a number of treatment options for people who experience suicidal ideation.
Definitions The ICD-11 describes suicidal ideation as "thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans". The DSM-5 defines it as "thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death". The U.S. Centers for Disease Control and Prevention defines suicidal ideation as "thinking about, considering, or planning suicide".
Terminology Another term for suicidal ideation is suicidal thoughts. When someone who has not shown a history of suicidal ideation experiences a sudden and pronounced thought of performing an act which would necessarily lead to their own death, psychologists call this an intrusive thought. A commonly experienced example of this is the high place phenomenon, also referred to as the call of the void, which is a sudden urge to jump when in a high place. A euphemism for suicidal ideation is internal struggle, while voluntary death and eating one's gun are a synonym and a euphemism, respectively, for suicide itself.
Risk factors
The risk factors for suicidal ideation can be divided into three categories: psychiatric disorders, life events, and family history.
Mental disorders Suicidal ideation is a symptom of many mental disorders but can also occur in response to adverse life events without the presence of a mental disorder. There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation. For example, many individuals with borderline personality disorder exhibit recurrent suicidal behavior and suicidal thoughts. One study found that 73% of patients with borderline personality disorder have attempted suicide, with the average patient having 3.4 attempts. The following list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. These are not the only disorders that can increase the risk of suicidal ideation. The disorders where the risk is increased the greatest, in arbitrary order, include:
Mood disorders Major depressive disorder Persistent depressive disorder Bipolar disorder Premenstrual dysphoric disorder Anxiety disorders Neurodevelopmental disorders Autism spectrum disorder Attention deficit hyperactivity disorder Post-traumatic stress disorder Complex post-traumatic stress disorder Personality disorders Borderline personality disorder Psychosis (Detachment from reality) Paranoia Schizophrenia Substance use disorders Nightmare disorder Gender dysphoria Conduct disorder Learning disorders Specific learning disorder Obsessive compulsive disorder Eating disorders Anorexia Binge eating disorder Bulimia
Life events Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previously listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar, and for this reason, the list of events that increase risk can vary in adults and children. The life events that have been shown to increase risk most significantly are: Recent sociological work has increasingly emphasised meaning, culture, and meso-level mechanisms in explanations of suicide.
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