Suicidal Behavior Disorder

For those experiencing thoughts of suicide, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a provider over SMS. Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Suicidal behavior disorder can manifest through a range of symptoms. These symptoms may be broadly divided into behavioral, verbal, and mood-related categories. Recognizing these signs can be crucial for support and early intervention.

Direct actions

Direct action symptoms related to suicidal behavior disorder may include the following: 

• Actual suicide attempts, regardless of the severity or method
• Engaging in self-harming behaviors without an apparent intent to die, but which can escalate to more severe attempts
• Seeking out lethal means, such as acquiring weapons, medications, or other items to use in an attempt

According to the National Institute of Mental Health, suicide attempt is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. An individual who attempts suicide might not be injured. The term ‘attempted suicide’ does not imply criminal behavior; rather, it refers to an attempt to carry out a suicidal act without success.

Preparation

Preparation symptoms may include the following: 

• Making arrangements for when they are gone, like giving away personal belongings or settling affairs
• Making detailed plans regarding how they will attempt suicide
• Writing a will or suicide note
• Isolating from friends, family, and social interactions

Risk behaviors

Risk behaviors may include the following: 

• Engaging in reckless activities without concern for personal safety
• Increasing substance use

Direct statements

People with suicidal behavior disorder may express a desire to die or kill themselves to other people. They may also talk about a sense of being trapped or being in unbearable emotional pain. 

Indirect statements

Indirect statements about suicidal behavior might include the following: 

• Making comments about being a burden to others
• Speaking about hopelessness or having “no reason to live”
• Making casual remarks about wishing they wouldn’t wake up or that others would be better off without them

Mood changes 

Below are some of the symptoms people with suicidal behavior disorder may experience in regard to mood: 

• Despair
• Persistent sadness
• Thoughts of hopelessness or worthlessness
• Agitation or restlessness
• Extreme irritability or seeming “on edge” constantly
• Social withdrawal 
• A marked reduction in interest or participation in activities they once enjoyed
• Disregarding personal hygiene or not taking care of oneself
• Rapid and extreme changes in mood, from extreme sadness to sudden calmness, especially after a period of depression

Not every individual with SBD may exhibit all these signs, and some might show signs not listed above. It can be crucial to approach anyone exhibiting these signs with compassion, understanding, and the intent to help.

The exact causes of suicidal behavior disorder are multifaceted and may differ from one individual to another. However, several common risk factors have been identified, including but not limited to the following: 

• Mental health disorders: Other mental disorders like anxiety disorders, major depressive disorder,³ bipolar disorder, eating disorders, borderline personality disorder,⁴ schizophrenia, and certain personality disorders can increase the risk.
• Substance use disorders: Substances such as alcohol or opioids can exacerbate hopelessness and impulsiveness and increase the risk of suicidal ideation.
• Family history: A history of suicide or suicidal behaviors in the family can elevate the risk of suicidal behavior disorder. 
• Previous suicide attempts: Individuals who have tried to take their own life in the past are more likely to attempt again.
• Chronic pain or illness: Conditions that bring about chronic pain or severely impact quality of life can incite suicidal behavior.
• Exposure to suicidal behavior: Knowing someone who died by suicide, especially a family member, can heighten the risk of suicide. 
• Bullying: People who experience discrimination and bullying based on race, gender, or sexual orientation contribute to the increasing trends in suicide among children and adolescents. 
• Post-traumatic stress disorder (PTSD):⁵ PTSD can result from various traumatic events like war, abuse, accidents, natural disasters, or witnessing a traumatic event.

Triggers for trauma-related conditions

In some cases, individuals with suicidal behavior disorder may experience suicidal thoughts and behaviors due to having experienced a traumatic event or living with PTSD. In these cases, triggering events may include: 

• Revisiting the location of the traumatic event
• Anniversaries or significant dates connected to the trauma
• Seeing images, news, or shows that remind an individual of the traumatic event
• Encountering people or situations associated with the trauma

Understanding the causes and risk factors for this condition may help individuals and providers identify and intervene early for those at risk of suicidal behavior disorder. It can be essential to approach these individuals with empathy and understanding to ensure they receive the necessary support and treatment.

Effective treatment for suicidal behavior disorder is multifaceted, primarily aiming to ensure immediate safety, alleviate underlying causes, and provide coping mechanisms. The goal may be to reduce the risk of future suicidal behaviors and improve overall mental well-being.

Medication

Medication may be beneficial in addressing underlying mental health conditions that may contribute to suicidal behavior. The following options might be considered: 

• Antidepressants: Antidepressants can be effective in treating depression, which is a significant risk factor for suicide. It can be crucial for a doctor to monitor clients closely after initiating therapy because there is the possibility of an initial increase in suicidal thoughts after taking these medications. 
• Mood stabilizers: These medications can be beneficial for co-existing conditions like bipolar disorder. They may prevent extreme mood swings and impulsive behavior.
• Antipsychotic medication: Antipsychotic medication may be helpful for those with conditions like schizophrenia or severe forms of bipolar disorder. They may reduce hallucinations, delusions, and intense mood episodes.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

Apart from therapy and medication, several other approaches may be beneficial:

• Electroconvulsive therapy (ECT): ECT may be beneficial for individuals who haven’t responded to other treatments. The procedure involves passing electrical currents through the brain to impact neurotransmitter levels.
• Hospitalization: In severe cases, or when there’s an immediate risk, a short-term hospital stay can ensure safety. Hospitalization provides an environment where therapeutic and medicinal interventions can be closely monitored. 
• Support groups: Support groups allow individuals to share experiences and coping mechanisms. They can offer a sense of community and understanding.

Self-care

Self-care can be crucial for long-term symptom management and well-being, including techniques like the following: 

• Routine: Establishing a daily routine can provide structure and a sense of purpose.
• Physical activity: Regular exercise can boost mood and overall well-being.
• Avoiding substance use: Substance use may increase thoughts of hopelessness and impulsiveness.
• Staying connected: Maintaining close personal ties with friends and family can provide essential emotional support.
• Open communication: Communicating about feelings and challenges may alleviate isolation and despair.

Combining therapy, medication, alternative treatment options, and dedicated self-care may significantly reduce the risk of suicidal behaviors and help individuals lead healthy lives. However, speak to a health professional when starting any treatment plan.

Therapy is a primary resource for individuals at risk. Professional counseling can provide the tools and insights to navigate difficult emotions, triggers, and experiences.

Suicide Hotline

Available 24/7, this helpline provides immediate support to those in crisis. Trained professionals offer guidance, reassurance, and information about further assistance. If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support.

Substance Abuse and Mental Health Services Administration (SAMHSA)

Websites like SAMHSA can provide valuable information on mental health, available treatments, and nearby facilities. They also offer a hotline for individuals living with substance use challenges, which can be found above. 

Support groups

The American Foundation for Suicide Prevention Group (AFSP) offers resources, support, and educational materials for those affected by suicidal behaviors. In addition, the Survivors of Suicide support groups are dedicated to helping those left behind after a loved one’s suicide, providing a platform to share stories and heal together. These resources can make a profound difference, offering hope and understanding for recovery and well-being.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Please see our Get Help Now page for more immediate resources.

For individuals with treatment-resistant depression, ketamine treatments have shown promise in reducing thoughts of suicide. A study published in Neuropsychopharmacology shows a single ketamine treatment had a strong effect, especially a week after receiving it. When given multiple times, ketamine helped even more, with 69% of people no longer having suicidal thoughts. Those who benefitted from ketamine maintained this improvement with weekly treatments. Interestingly, ketamine reduced suicidal thoughts even if it didn’t fully treat one’s depression. This research suggests that ketamine might offer a new way to help people with suicidal thoughts linked to severe depression.

Dialectical behavior therapy is a type of treatment that focuses on preventing harmful actions like self-harm. An analysis of controlled DBT trials has shown it can effectively reduce these actions and the need for emergency mental health support. These findings are consistent for different groups and ways of using DBT. However, the modality was not associated with changing harmful thoughts but was effective in supporting those who were at the highest risk of acting on their thoughts. For this reason, DBT may be a helpful treatment for people with suicidal behavior disorder.

Below are several key statistics on suicidal behavior disorder:

• The American Foundation for Suicide Prevention names suicide as the 11th leading cause of death in the United States.
• According to the Centers for Disease Control (CDC), in 2021, around 12.3 million adults seriously contemplated suicide, while 3.5 million formulated a plan, and 1.7 million attempted suicide.  
• Suicide Awareness Voices and Education says that in the United States, white males consistently exhibit the highest suicide rates, with American Indian and Alaskan Native males next, followed by black males.
• An observational review of psychotherapy on suicidal risk published in Frontiers in Psychology indicated that psychotherapy led to reduced thoughts of suicide in 97.5% of the studies.