"Life doesn't make any sense without interdependence. We need each other, and the sooner we learn that, the better for us all."
-Erik Erikson
Why
Would a Person Often Think About Ending Their Lives?
There are common factors which contribute to chronic suicidality across physical and mental health conditions. Being aware of these variables can help healthcare providers know when to assess for risk, and in the case of counseling, what the focus should be in therapy.
EMOTION DYSREGULATION
In the emotion regulation module of Marsha Linehan's (1993) manual for DBT, goals of emotion regulation training are outlined as: understanding your emotions, decreasing emotional sensitivity, and slowing down any emotional escalation. Southward and Cheavens (2020) noted that emotion regulation depends upon how often one uses coping skills and the skill with which they implement them. Non-suicidal self-injury might be an attempt to regulate intense emotions for the short-term, with suicide attempts being intended to completely eliminate the emotional pain.
LACK OF SOCIAL SUPPORT
In their model of Therapeutic Risk Management, Wortzel et al. (2014) highlight that unstable relationships and occupational and economic difficulties make up some of the common risk factors for individual considered to be at high chronic risk. Stigma and self-stigma of seeking mental health treatment can prevent individuals from getting clinical social support. Isolation can be a symptom of certain mental health conditions or arise from adversities like victimization. This in turn can lead to loneliness, and individuals who are lonely may begin to think that no one cares about them.
HOPELESSNESS AND PAIN
"Will it ever get better?"
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Hopelessness is fueled by the fear that it never will. Emotion dysregulation, or a difficulty dealing with intense emotions, can make certain situations or moments seem unbearable when those emotions do arise. So how can a person feel hopeful about the future when this is their experience? Hopelessness and perceived lack of social support can lead to thoughts such as, "No one cares about me and no one ever will".
Yager and Feinstein (2017) said that the culmination of hopelessness along with lost sense of purpose, mental or substance use disorders, and the other factors listed on this page leads to a "psychic pain", or unbearable psychological state. Chronic physical pain is a well-known risk factor as well, which can feel insurmountable.
SENSE OF ENTRAPMENT
Feeling trapped can result from numerous circumstances, such as when one feels stuck in a relationship, has a fear of not being good enough or able to meet the expectations of others, or experiences mental and/or physical conditions with perpetual symptoms. Suicide may be viewed as "a way out" and why someone who decides they want to die might exhibit positive emotions or affect leading up to their attempts or deaths.
SELF-DESTRUCTIVE THOUGHTS
In their article about the connection between developmental trauma and chronic suicidality, Chalfin and Kallivayalil (2017) explained the cumulative nature of self-destructive thoughts and behaviors as contributing to one's chronically low self-worth that began in childhood due to trauma. Use of interventions such as CBT to interrupt the current of self-deprecating thoughts can be crucial here.
