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Understanding Thoughts of Death and Suicidal Ideation

Writer's picture: dr.ssa Elizabeth Mooredr.ssa Elizabeth Moore

Un uomo di spalle con le mani sulle spalle, osserva il sole all'orizzonte, simboleggiando il peso emotivo e la ricerca di speranza nei momenti piĆ¹ bui

Thoughts of Death and Suicidal Ideation

Recurring thoughts about ending oneā€™s own life and the very idea of suicide are deeply painful experiences that can arise in moments of extreme vulnerability. These thoughts are not merely abstract fears but often take the form of an inner dialogue saturated with suffering. They may range from a wish to disappear to a concrete plan to end oneā€™s life, serving as an alarm bell for underlying distress.


These thoughts are multifaceted and often stem from an interplay of factors, including psychological conditions like depression or PTSD, social dynamics such as isolation or strained relationships, and even biological aspects tied to brain chemistry. They reflect profound suffering, often hidden behind silence or the inability to express oneā€™s pain. Recognizing these thoughts and addressing them without judgment is the first step toward providing genuine support and building a network of care around those who experience them.


How They Manifest

  1. Intrusive Thoughts Repeated mental images or ideas about oneā€™s death. These can be vivid and disturbing, interfering with daily activities and causing emotional distress. For example, a person might envision detailed scenes of their funeral or imagine harming themselves.

  2. Desire for Death Feeling that life is no longer worth living. This can present as a persistent sense of hopelessness and meaninglessness, where the individual believes there is no future or hope. Often, such thoughts come with the belief that their absence might ease the burden on themselves and others.

  3. Suicidal Ideation Actively thinking about suicide, with or without a specific plan. These thoughts vary in intensity, from fleeting ideas to detailed plans. Suicidal ideation might involve planning how, when, and where to end oneā€™s life. For instance, a person may consider methods or set a specific time for their suicide.

  4. Suicide Attempts Taking concrete actions to end oneā€™s life. Suicide attempts represent a dangerous escalation of suicidal thoughts, where an individual carries out a plan to harm themselves. These attempts range from less severe (low lethality) to more critical, requiring immediate medical intervention, such as overdosing on medication or inflicting severe physical harm.


Effective Psychological Therapies


1. Dialectical Behavior Therapy (DBT)

Developed by Marsha Linehan, DBT is an effective approach for addressing suicidal thoughts. It focuses on emotional regulation, self-acceptance, and teaching behavioral skills to manage intense emotions and thoughts.

Key aspects include:

  • Skills Training:Ā DBT teaches specific skills through structured modules, such as distress tolerance, emotional regulation, and interpersonal effectiveness. Patients learn to recognize and accept their thoughts and feelings without judgment.

  • Crisis Coaching:Ā Patients can access immediate, guided support during moments of crisis, ensuring they feel less isolated and more capable of managing intense situations.

DBT promotes a balanced approach to emotional regulation, self-acceptance, and the development of practical coping strategies, helping individuals move toward a more fulfilling life.


2. Cognitive Behavioral Therapy (CBT)

CBT focuses on the interplay between thoughts, emotions, and behaviors. It helps patients identify and modify distorted thoughts that contribute to their distress.


Key elements include:

  • Identifying Negative Thoughts:Ā Helping patients recognize dysfunctional thoughts like "I'm a failure" or "People would be better off without me."

  • Cognitive Restructuring:Ā Replacing negative thoughts with more realistic ones, such as, "Iā€™m going through a tough time, but this doesnā€™t define my worth."

  • Problem-Solving Techniques:Ā Developing strategies to address stressors contributing to suicidal thoughts.

  • Coping and Stress Management:Ā Using mindfulness, progressive muscle relaxation, and deep breathing to manage anxiety and intense emotions.


A critical component is creating a safety plan, which includes:

  • Support contacts: Friends, family, or mental health professionals to call during a crisis.

  • Safe places: Locations where the individual feels secure.

  • Self-care activities: Engaging in hobbies or practices that promote well-being.


3. Mentalization-Based Therapy (MBT)

Originally designed for borderline personality disorder, MBT is also effective for addressing suicidal thoughts. It improves the individualā€™s ability to understand and interpret their own mental states and those of others, fostering emotional awareness and reducing suicidal tendencies.


Key strategies include:

  • Understanding Mental States:Ā Helping individuals explore the circumstances leading to suicidal thoughts and consider alternative coping mechanisms.

  • Building Empathy:Ā Enhancing the ability to perceive and interpret othersā€™ emotions, improving relationships and reducing feelings of isolation.

  • Emotional Regulation:Ā Teaching techniques to recognize and manage intense emotions.

  • Strengthening Relationships:Ā Encouraging the development of supportive, trusting relationships to reduce the risk of suicide.


MBT fosters reflection and self-awareness, guiding individuals to build resilience and healthier emotional responses.


Conclusion

Thoughts of death and suicidal ideation signal profound distress that should never be ignored. These thoughts may not always manifest explicitly; they can range from recurring, intrusive ideas to a pervasive desire to disappear. Behind these signs lie complex emotions and a sense of isolation that may feel insurmountable.

Recognizing and understanding these feelings is a vital first step. Open conversations, judgment-free listening, and creating a safe space can make a significant difference. Raising awareness about these issues not only saves lives but also helps build a support network for those who feel trapped in their pain.



Ā Written by

Dr Elizabeth Moore, Psychologist

(consultation only in Italian)

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Consultations are available in Italian only

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Bibliography

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  • Diego De Leo, Il suicidio, 2011, Il Mulino

  • Paolo Pancheri, Il suicidio e il tentativo di suicidio, 2013, Raffaello Cortina Editore

  • Mario Amore, Il suicidio. Manuale diagnostico-terapeutico, 2010, Springer


External resources

If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resour


  1. Organizzazione Mondiale della SanitĆ  (OMS)L'OMS fornisce una vasta gamma di risorse sulla prevenzione del suicidio, linee guida cliniche e supporto per la gestione dei pensieri suicidari.Link: WorldĀ HealthĀ Organization


  2. American Foundation for Suicide Prevention (AFSP)Questa organizzazione americana fornisce informazioni e risorse per la prevenzione del suicidio, comprese le ricerche sui fattori di rischio e le strategie di intervento.Link: AmericanĀ FoundationĀ forĀ SuicideĀ Prevention


  3. National Suicide Prevention LifelineOffre risorse per coloro che lottano con pensieri suicidari, insieme a strumenti per riconoscere i segnali di allarme.Link: SuicideĀ PreventionĀ Lifeline


  4. Istituto Superiore di SanitĆ  (ISS)L'ISS italiano offre informazioni sulla prevenzione del suicidio e risorse specifiche per la gestione delle crisi.Link: IstitutoĀ SuperioreĀ diĀ SanitĆ 


  5. International Association for Suicide Prevention (IASP)La IASP ĆØ un'organizzazione internazionale che offre ricerche e supporto per la prevenzione del suicidio.Link: IASP


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