There are three types of suicidal thoughts and behaviors: suicidal ideation, nonsuicidal self-injury, and suicide attempts.
Suicidal ideation (referred to as “suicidal thoughts” throughout this workbook) is having thoughts about ending your life with some desire for death. Suicidal thoughts can be experienced in many different ways. Some people have frequent suicidal thoughts (e.g., daily, multiple times per day) while others experience them less often (e.g., once every few years, only in times of intense distress). Suicidal thoughts also range from fleeting thoughts that last seconds or minutes to more intense, persistent thoughts that last hours, days, or longer.
Therapists often note the difference between passive suicidal thoughts (e.g., If I were in a life-threatening situation, I wouldn’t go out of my way to survive or I wouldn’t mind getting into a bad car accident or falling asleep and never waking up) and active ones (e.g., I’ll kill myself when I get a chance or I want to end my life). Passive suicidal thoughts tend to reflect a desire to die without intent or plans to kill yourself, while active suicidal thoughts involve some level of planning or intent to kill yourself.
Passive suicidal thoughts can persist for long periods of time, never becoming active suicidal thoughts. Suicidal thoughts can also switch between passive and active depending on distress levels and situational circumstances. There are people who experience suicidal thoughts in all kinds of different ways. How frequent are your suicidal thoughts? Do they tend to be passive, active, or both? Have you noticed certain patterns for when they tend to emerge (e.g., high stress times, following sleep deprivation, during certain parts of the menstrual cycle; Owens and Eisenlohr-Moul, 2018)? Reflecting on those patterns, perhaps in your journal, can help you better understand yourself and times of vulnerability.
Sometimes images, urges, or thoughts of suicide flash into people’s minds even though they don’t want to die. In one study, 431 college students were asked if they ever imagined jumping when in a high place. Around half of the respondents reported that they had imagined it at least once in their lives (Hames et al., 2012). While the experience was more common among people who had considered suicide at some point in their lives (74 percent) than those who hadn’t (43 percent), people who never considered suicide said they imagined jumping from a high place too. Why do these thoughts pop into our minds? Scientists are unsure, but some think that our brains are trying to warn us to step back and stay safe (Hames et al., 2012).
For most people who are not suicidal, these thoughts pop into their minds and then pop right back out. However, some people with obsessive-compulsive disorder (OCD) continue to have more persistent, unwanted thoughts of self-harm (e.g., an image of driving into oncoming traffic). These are called “intrusive thoughts” or “obsessions.” They cause distress for the person having them and often lead to repetitive behaviors (compulsions) to reduce the distress (e.g., avoiding knives, pills, high places, or driving). This workbook does not focus on these types of thoughts. If you’re having those experiences, please see appendix B for a workbook suggestion specifically for overcoming OCD with thoughts of self-harm (Hershfield, 2018) and seek professional help. There are effective treatments available.
Nonsuicidal self-injury (NSSI) is intentionally damaging one’s body tissue (e.g., by cutting or burning) without any intent to die as a result. Because people with NSSI commonly experience suicidal thoughts, we will explore this a bit. However, it’s important to seek more comprehensive care for NSSI through a therapist or a workbook specifically designed for it (see appendix B for information about Gratz and Chapman, 2009).
Suicide attempts include nonfatal potentially self-injurious acts with some intent to die as a result. The term is purposely broad so that it includes suicide attempts that range between less and more medically dangerous and low and high levels of intent to die.
If you or someone you love is dealing with a crisis right now, please call 1-800-273-8255 to reach the National Suicide Prevention Lifeline. You can also text HOME to 741741 to reach a crisis counselor at the Crisis Text Line.
Kathryn Hope Gordon, PhD, is a clinical psychologist specializing in CBT. She has published more than eighty scientific articles and book chapters on suicidal behavior, disordered eating, and related topics. Gordon cohosts the Psychodrama podcast, blogs for Psychology Today, and shares mental health information at kathrynhgordon.com.