Writer’s note: Hey, Psych2Goers! This article isn’t meant for diagnosis or treatment. It is to create awareness among the general public, so if you or someone you know may be struggling, don’t hesitate to seek professional help from Psychiatrists or other trusted professionals.
Trigger warning: The following article discusses on self-harm and suicide which might be triggering to some. If you feel triggered, please know there are resources to support you:
1-800-DON’T-CUT and 1-800-334-HELP
1-800-334-HELP is a 24-hour service for a number of things.
1-800-273-8255 for the National Suicide Prevention Hotline.
In the United States, suicide is the 10th leading cause of death with almost 45,000 victims every year. Approximately 123 Americans die from suicide each day, but the amount of people who attempt suicide or being anguished with suicidal thoughts is actually more (Wu, 2019).
According to the Office for National Statistics of UK, a total of 5,691 (11.0 deaths per 100,000 population) suicides were registered in England and Wales in 2019. This remains in line with the rate observed in 2018 when there were 5,420 suicides registered (10.5 deaths per 100,000).
Let’s all delve into the 7 signs of suicide which actually can be subtle :
- Talking about existential things – “What’s the point in life?”
Alex Dimitriu M.D. who has dual board certification in psychiatry and sleep medicine (2020), stated that the existential questions of “Who am I? Why was I created? What is the meaning of life?” drove the monster, a fictional character in a Frankenstein novel on a murderous rampage. Comparing it to the real life, similar kind of apprehension incites increasing mental health crises which can eventually lead to hopelessness, depression and especially among the young, suicide.
According to statistics released a couple of years ago by Centers for Disease Control and Prevention, the suicide rate up about 25 percent since 1999, with suicide being the second leading cause of death among college students.
This feeling of dread and overwhelming emotion when contemplating life’s meaning is not necessarily exclusive to the young, gifted and the non-religious. A study published online in 2018 revealed that patients with advanced cancers often experience existential dilemmas, suffering “high rates of psychological distress, including depression, anxiety, and spiritual despair.” (Dimitriu, 2020).
2. They have socially withdrawn all of a sudden
In Japan, there is a form of extreme social withdrawal which is termed as ‘hikikomori’. The Japanese Health, Labor and Welfare Ministry defines this term as “someone who becomes a shut-in and avoids the outside world for more than six consecutive months.” Within Japanese society, the noun ‘hikikomori’ is also used in the verb form, hikikomoru (ひきこもる). The root of this verb, which means “to confine oneself indoors,” comes from hiku (“to pull back”) and komuru (“to seclude oneself”). (Bergland, 2020).
According to a paper published by The International Journal of Social Psychiatry in 2009, there was a composite sketch of a hypothetical hikikomori patient (“T.M.”) that was a synthesis of several real-life cases:
“T.M. is a 19-year-old Japanese who lives with his middle-class parents in a two-bedroom urban apartment. For the last two years he has hardly ever left his room, spending 23 hours a day behind its closed door. He eats food prepared by his mother who leaves trays outside his bedroom. He sleeps all day, then awakes in the evening to spend his time surfing the internet, chatting on online bulletin boards, reading manga (comic books), and playing video games.”
Allen Frances, M.D. (2015), recounted his recent visit to Sweden in which he found out a set of behaviours whereby a person is involved in a life confined to a bedroom, with no friends and minimal contact even with family (locally called ‘home-sitting’).
This social withdrawal can actually feed the depression and may subsequently lead to suicide.
3. Talking about wanting to die
You are a high school student and you are having a late-night deep meaningful conversation with your best friend. Casually, he admits that there is nothing that he looks forward to in life and the thought about ending his life enters his mind now and then.
Confiding in a friend about one’s thoughts of death is a cry for help. When a person talks about wanting to die or actively finding out a way to kill themselves are some of the most direct signs that a person is having suicidal thoughts (Wu, 2019).
4. Talking about being a burden to others
“I don’t want to burden my family anymore. My depression is affecting the people around me and they are pushing me away.”
Your friend uttered such phrases while you were having a phone conversation with her.
Mental health challenges often delude people into thinking that they are being a burden to the ones they love. Eventually, this would affect how we perceive ourselves, behave and allow ourselves to be treated by others (Angers, 2020). When a person whom you know expresses such feeling, there is high chance that he or she is considering suicide.
5. Behaving recklessly
You open up the door, and your significant other staggers into the house. He seemed to be driving while drunk.
Smitha Bhandari, M.D. (2020) states that people with suicidal ideation might also take dangerous and impulsive chances such as driving drunk or having promiscuous behaviour.
A study conducted by Ammerman, Steinberg & McCloskey (2016) and utilized the sample of 4843 adolescents with mean age of 15.15, with 48% (n=2315) identifying as male. The respondents gave information about suicidal thoughts / behaviours and multiple risk-taking behaviours at an initial interview and at a second interview, approximately 11 months later. Its aim is to evaluate the unique association between different risk-taking behaviours (i.e., risky sexual behaviour, tobacco/alcohol use, illicit drug use, delinquent behaviour, violent behaviour) on adolescent suicidal thoughts / behaviours. The findings imply that illicit drug use may have a stronger association with suicidal thoughts and behaviours than other risk-taking behaviour.
6. They have practiced self-harm
You notice a word ‘Loser’ etched on the upper left forearm of your child when you enter his bedroom while he is sleeping. It looks like a scar, made by a sharp object.
Self-harm or otherwise known as non-suicidal self-injury (NSSI) is classified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (2013) as a “new disorder in need of further study,” as well as a symptom of borderline personality disorder, which is characterized by emotional instability, unstable relationships and chronic feelings of emptiness.
Among the examples of self-harm are:
- Cutting, scratching, carving, branding or marking the body
- Picking at scabs so they don’t heal
- Pulling hair
- Burning or grazing yourself
- Biting, bruising or hitting yourself
- Hitting a part of your body on something hard
Does self-harm mean someone is suicidal?
Not necessarily. Self-injury may look like attempted suicide, however some who self-harm do eventually go on to attempt suicide. But many people who intentionally hurt themselves are not suicidal. On the contrary, they did that as a form of distraction or attempt to alleviate—mental anguish (Psychology Today, n.d.).
If you want to know more about the self-harm signs in teenagers, you can visit this link : https://psych2go.net/7-self-harm-signs-in-teenagers/
7. Talking about feeling trapped/suffocated/smothered (eg by responsibilities or suffering)
“I feel suffocated and trapped. I want to escape but there seems to be no exit.”
Your friend confessed to you, one day.
Suicide Trigger Scale created by researcher Igor Galynker and his colleagues aims to elicit feelings that are associated with suicide attempts. He theorized that it is a state of mind of intolerable anxiety, overwhelming negative emotions, and “frantic hopelessness”, induces people to act on suicidal thoughts.
Galynker’s theory is that there is an essential difference between what’s going on for people who are thinking about suicide and what happens for people who attempt suicide. This difference is so crucial that the Suicide Trigger Scale doesn’t ask – at all – about plans to attempt suicide. Instead, the measures include feeling:
– like your “head could explode from too many thoughts”
– as if “there is no exit”
– as if “the world is closing in around you”
“Feelings are older than thoughts,” Galynker stated. An intentional concealment of suicidal thoughts from a clinician and the thoughts of wanting to escape are connected to a wish to end one’s life. Also, many people think about suicide for years, but never attempt.
Melissa Welby, M.D. (2019) stated that these suicidal ideations can be developed early in life. When feeling overwhelmed, alone, out of control, or depressed, one might revisit such dark thoughts; which can be like a tattered, ugly, worn, old sweater that you put on. At first, it brings comfort, but then you realize it is scratchy, too hot, and stifling. Consequently, these thoughts, like the sweater, need to be discarded so that one can be free and move forward with choosing life.
If you or someone you know exhibited the above signs, do seek out professional help from mental health professionals. Remember, suicide is a permanent solution to a temporary problem. A visit to the mental health professionals enables the patient to learn how to regain control of his or her life apart from finding that inner strength, that reason to live and that light that can shine from within. It might require a strenuous effort, but with perseverance, recovery happens (Welby, 2019).
Ammerman, B. A., Steinberg, L., & McCloskey, M. S. (2016). Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use. Journal of Clinical Child & Adolescent Psychology, 47(1), 131–141. https://doi.org/10.1080/15374416.2016.1220313
Bergland, C. (2020, January 12). The Global Epidemic of Extreme Social Withdrawal. Psychology Today. https://www.psychologytoday.com/us/blog/the-athletes-way/202001/the-global-epidemic-extreme-social-withdrawal.
Bhandari, S. (2020, September 12). Suicidal Thoughts: Symptoms and Risks of Suicidal Depression. WebMD. https://www.webmd.com/depression/guide/depression-recognizing-signs-of-suicide.
Dimitriu, A. (2020, July 17). Existential Crisis: Grappling With the ‘Monster’ Within. Psychology Today. https://www.psychologytoday.com/us/blog/psychiatry-and-sleep/202007/existential-crisis-grappling-the-monster-within.
Frances, A. J. (2015, May 14). School Refusal and Severe Social Withdrawal. Psychology Today. https://www.psychologytoday.com/us/blog/dsm5-in-distress/201505/school-refusal-and-severe-social-withdrawal.
Psychology Today (n.d.). Self-hatred. Retrieved May 26, 2021, from https://www.psychologytoday.com/us/basics/self-hatred
Welby, M. (2019, October 3). Suicidal Thoughts and Suicide Prevention: How Can We Help? Psychology Today. https://www.psychologytoday.com/us/blog/transformative-healing/201910/suicidal-thoughts-and-suicide-prevention-how-can-we-help.
Windsor-Shellard, B., & Manders, B. (2020, September 1). Suicides in England and Wales: 2019 registrations. Suicides in England and Wales – Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations.
Wu, J. (2019, September 25). How to Help a Loved One Struggling With Suicidal Thoughts. Psychology Today. https://www.psychologytoday.com/us/blog/the-savvy-psychologist/201909/how-help-loved-one-struggling-suicidal-thoughts.