What it is:
Suicidality involves the thoughts, urges, and behaviors associated with a wish or plan to take one’s own life. Suicide is a major public health problem among pre-teens and teens: it is the second leading cause of death for adolescents in the US. The CDC recently released a report showing that suicide rates are on the rise nationwide for both children and teens (CDC, 2018). A similar yet distinct behavior is called nonsuicidal self-injury and includes any behavior that causes damage to the physical self without the intent to die (e.g., cutting, burning).
Suicidality and suicidal thoughts are diverse experiences and it is worth differentiating a few different types. Adolescents can have what we call intrusive thoughts of death or suicide. Intrusive means that teens have these thoughts, but do not want them. The teen has no desire, intention, or plan to harm themselves. Intrusive thoughts are considered separate from other kinds of suicidal thoughts and are most associated with Obsessive-Compulsive Disorder (OCD).
Other adolescents have thoughts of death and suicide that are more consistent with how they feel or what they want. We often speak of three different types of these thoughts:
- Passive suicidal thoughts. These are thoughts that involve a teen’s desire to die without an intent to make that happen. These can be thoughts or wishes to die by natural causes or an accident.
- Ambivalent suicidal thoughts. These are thoughts where an adolescent feels conflicted between wanting to die and wanting to live at the same time. Ambivalent thoughts can come with a plan to harm oneself or there may be no plan to do so.
- Acute suicidal thoughts. These are thoughts where the teen both wants to die and has an intent to act on this- either now or in the near future. These thoughts may extend into planning, writing suicide notes, or may include behaviors such as making a suicide attempt.
Having suicidal thoughts or experiencing suicidality is often a consequence of emotional distress, but suicidal thoughts are not a stand alone mental health disorder. Some adolescents find their suicidal thoughts very distressing and want to get rid of them, while others find them soothing or comforting. However these thoughts are experienced, we believe that it is possible to target the source of suffering that may cause a teen to consider death as an option. Treatment is most often geared at these underlying reason that the adolescent is considering suicide, which can include environmental circumstances (e.g., bullying or trauma), physical circumstances (e.g., a chronic health condition), and/or mental health concerns like depression or mood concerns.
Does This Sound Familiar?
- My teen will threaten to harm or kill themself when feeling particularly upset.
- I have been told that my adolescent has made posts about their death or suicide to social media that their friends or other parents find concerning.
- We have needed to hospitalize my adolescent child related to their suicidal thoughts or attempts.
- I have seen my teen looking at content on the Internet or social media related to suicide or wanting to die.
- I found messages on my child’s phone to friends or peers related to suicide or wanting to die.
- My child has said they wish they could just go to sleep and never wake up or that we would be better off without them.
- My teen has researched or used suicide-support resources on the Internet because they are scared for their ability to keep themselves safe.
- I watch my teen carefully because I worry that they will try to kill or harm themselves.
Associated Concerns:
Suicidality in children and teens often co-occur with depression, anxiety and stress, shame, or traumatic experiences. Other associated difficulties include chronic difficulties with mood concerns and emotional avoidance.
When adolescents have trouble coping with these symptoms, they may also develop difficulties with substance abuse, anger, or other high risk behaviors.
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