How can you recognize suicidal thoughts. What should you do if you’re experiencing suicidal ideation. How to prepare for a conversation with your doctor about suicidal thoughts. What can you expect when discussing suicidal thoughts with a healthcare professional. How do doctors assess suicide risk. What treatment options are available for individuals with suicidal thoughts. How can you create a safety plan to manage suicidal thoughts.

Understanding Suicidal Thoughts: Recognizing the Signs

Suicidal thoughts, also known as suicidal ideation, can manifest in various ways and intensities. They range from fleeting thoughts that life isn’t worth living to concrete plans for ending one’s life. Recognizing these thoughts is crucial for seeking timely help.

Common signs of suicidal thoughts include:

• Feeling hopeless or trapped
• Experiencing intense guilt or shame
• Believing you’re a burden to others
• Feeling extreme sadness or rage
• Enduring unendurable emotional or physical pain
• Withdrawing from friends, family, and activities
• Talking about suicide or death frequently
• Acquiring means to harm oneself
• Experiencing dramatic mood swings

Are these thoughts always obvious? Not necessarily. Sometimes, suicidal thoughts can be subtle or disguised as general feelings of hopelessness. It’s important to pay attention to any persistent negative thoughts about your life or future.

Breaking the Silence: Overcoming Stigma to Seek Help

Despite the prevalence of suicidal thoughts, many people hesitate to seek help due to the stigma surrounding mental health issues. Dr. Sterling N. Ransone Jr., president of the American Academy of Family Physicians, emphasizes that breaking this silence is crucial.

Why is seeking help challenging for many? The fear of judgment, misunderstanding, or potential consequences often prevents individuals from opening up about their struggles. However, healthcare providers are trained to handle these sensitive discussions with compassion and professionalism.

Steps to Overcome Stigma:

1. Recognize that seeking help is a sign of strength, not weakness
2. Educate yourself about mental health to dispel myths and misconceptions
3. Connect with support groups or online communities to share experiences
4. Practice self-compassion and avoid self-stigmatizing thoughts
5. Remember that mental health challenges are common and treatable

Preparing for the Conversation: What to Consider Before Talking to Your Doctor

Before discussing suicidal thoughts with your doctor, it’s helpful to prepare. This preparation can make the conversation more productive and less daunting.

Key Points to Consider:

• Write down your thoughts and feelings
• Note any changes in your mood, behavior, or daily routines
• List any medications you’re taking, including over-the-counter drugs
• Prepare questions you want to ask your doctor
• Consider bringing a trusted friend or family member for support

Is it necessary to have all the answers before the appointment? No, your doctor is there to help you navigate this process. The most important thing is to be honest about your experiences and concerns.

The Conversation: What to Expect When Discussing Suicidal Thoughts with Your Doctor

When you talk to your doctor about suicidal thoughts, they will likely ask you a series of questions to better understand your situation. This assessment helps them determine the best course of action to support you.

Common Questions Your Doctor May Ask:

• How long have you been experiencing these thoughts?
• Have you ever attempted suicide before?
• Do you have a plan to harm yourself?
• Are you using drugs or alcohol?
• How is your sleep and appetite?
• Are you experiencing any major life stressors?
• Do you have a support system?

Remember, your doctor’s primary concern is your wellbeing. They are there to help, not judge. Be as open and honest as possible to ensure you receive the most appropriate care.

Risk Assessment: How Doctors Evaluate Suicide Risk

When you disclose suicidal thoughts to your doctor, they will conduct a thorough risk assessment. This evaluation helps determine the level of immediate danger and guides the treatment plan.

Factors Considered in Risk Assessment:

• Severity and frequency of suicidal thoughts
• Presence of a specific suicide plan
• Access to means of self-harm
• History of suicide attempts
• Presence of mental health conditions
• Recent life stressors or losses
• Substance use
• Family history of suicide
• Availability of social support

How does this assessment impact treatment decisions? The results help your doctor determine whether you need immediate intervention, such as hospitalization, or if outpatient treatment is appropriate.

Treatment Options: Addressing Suicidal Thoughts and Underlying Issues

After assessing your situation, your doctor will discuss treatment options. These may include a combination of therapies and interventions tailored to your specific needs.

Common Treatment Approaches:

1. Psychotherapy (e.g., Cognitive Behavioral Therapy, Dialectical Behavior Therapy)
2. Medication (e.g., antidepressants, mood stabilizers)
3. Crisis intervention services
4. Support groups
5. Lifestyle changes (e.g., exercise, sleep hygiene, stress management)

Can medication alone solve the problem? While medication can be helpful, it’s often most effective when combined with therapy and lifestyle changes. Your doctor will work with you to find the right treatment plan.

Creating a Safety Plan: Strategies for Managing Suicidal Thoughts

An essential part of treatment is developing a safety plan. This plan outlines steps to take when experiencing suicidal thoughts, helping you stay safe during crisis moments.

Key Components of a Safety Plan:

• Warning signs that indicate a crisis may be developing
• Internal coping strategies
• People and social settings that provide distraction
• People you can ask for help
• Professionals or agencies to contact during a crisis
• Steps to make your environment safe

How often should you review your safety plan? It’s recommended to review and update your plan regularly, especially after any major life changes or if you find certain strategies aren’t working effectively.

Follow-up Care: The Importance of Ongoing Support

After your initial conversation with your doctor, ongoing follow-up care is crucial. This continuous support helps monitor your progress and adjust treatment as needed.

Elements of Effective Follow-up Care:

1. Regular check-ins with your healthcare provider
2. Consistency in attending therapy sessions
3. Medication management (if prescribed)
4. Participation in support groups
5. Ongoing assessment of suicidal thoughts and overall mental health

Why is follow-up care so important? Recovery is often a gradual process, and ongoing support helps maintain progress and address any new challenges that arise.

Supporting Loved Ones: How to Help Someone Experiencing Suicidal Thoughts

If you’re concerned about a friend or family member who may be experiencing suicidal thoughts, there are ways you can provide support and encourage them to seek professional help.

Ways to Support Someone with Suicidal Thoughts:

• Express your concern and willingness to listen without judgment
• Ask directly about suicidal thoughts
• Take their feelings seriously
• Encourage them to seek professional help
• Offer to accompany them to appointments
• Help them create a safety plan
• Remove potential means of self-harm from their environment
• Stay connected and check in regularly

Is it your responsibility to “fix” their problems? No, but your support can be invaluable in encouraging them to seek professional help and reminding them that they’re not alone.

The Road to Recovery: Understanding the Journey Beyond Suicidal Thoughts

Recovery from suicidal thoughts is a unique journey for each individual. It often involves developing new coping strategies, rebuilding self-esteem, and rediscovering joy and purpose in life.

Key Aspects of the Recovery Process:

1. Building a strong support network
2. Developing healthy coping mechanisms
3. Addressing underlying mental health issues
4. Practicing self-care and self-compassion
5. Setting and working towards personal goals
6. Learning to manage stress effectively
7. Rebuilding relationships and social connections

Does recovery mean never having suicidal thoughts again? Not necessarily. Recovery often involves learning to manage these thoughts effectively when they occur and knowing when to seek help.

Breaking the Cycle: Preventing Future Suicidal Crises

While it’s not always possible to prevent suicidal thoughts entirely, there are strategies that can help reduce their frequency and intensity.

Preventive Measures:

• Maintaining regular mental health check-ups
• Practicing stress-reduction techniques (e.g., mindfulness, meditation)
• Engaging in regular physical exercise
• Maintaining a consistent sleep schedule
• Avoiding alcohol and drug misuse
• Building and maintaining strong social connections
• Participating in activities that bring joy and purpose

Can these measures guarantee prevention of suicidal thoughts? While they can significantly reduce risk, it’s important to remain vigilant and seek help if suicidal thoughts resurface.

Resources and Support: Where to Turn for Help

Numerous resources are available for individuals experiencing suicidal thoughts and their loved ones. These range from immediate crisis intervention to long-term support services.

Key Resources:

• National Suicide Prevention Lifeline: 988 (US)
• Crisis Text Line: Text HOME to 741741 (US)
• Local mental health clinics and hospitals
• Online support communities
• Mental health apps for mood tracking and coping skills
• Books and educational materials on suicide prevention and mental health

Remember, help is always available. If you’re experiencing suicidal thoughts, don’t hesitate to reach out to these resources or speak with a healthcare professional.

Discussing suicidal thoughts with your doctor is a crucial step towards recovery. While it may feel daunting, remember that healthcare professionals are trained to provide compassionate, non-judgmental support. By seeking help, you’re taking an important step towards reclaiming your mental health and rediscovering hope. Remember, you’re not alone in this journey, and with proper support and treatment, it is possible to overcome suicidal thoughts and build a fulfilling life.

How to Talk With Your Doctor About Suicidal Thoughts

If you’re having suicidal thoughts — which can range from despair, hopelessness, and a sense that life’s not worth living to having a concrete plan for ending your life — now’s the time to get help.

If it’s an emergency or you feel that you’re in immediate danger, call a suicide prevention hotline. (The number for anywhere in the United States is 988.)

If you feel that it’s not an emergency, talking with a trusted physician or getting mental health counseling from a trained therapist, psychologist, or psychiatrist can be a lifesaving step that can help you feel good again, says Doreen Marshall, PhD, vice president of mission engagement at the American Foundation for Suicide Prevention (AFSP).

“We know from people who’ve gone through treatment and gotten to the other side of feeling suicidal that when they look back, they’re surprised to realize they were in such a dark place. In the intensity of that pain, it’s hard to see a world outside it,” Dr. Marshall says. Talking to someone about it is worth it, she says. “Treatment is worth it.”

And though such thoughts can feel isolating, they come up more commonly than you may think, Marshall says.

According to the American Psychological Association (APA), 44,800 Americans died by suicide in 2020. But the number of people who had serious thoughts about taking their own lives in 2020 was 12.2 million, according to estimates from the federal government’s Substance Abuse and Mental Health Services Administration. According to Mental Health America (MHA), estimates suggest more people are reporting having suicidal thoughts than in years past.

Breaking the ice to talk about it can be difficult. “There’s a stigma around mental health problems and especially around admitting you have suicidal thoughts,” says Sterling N. Ransone Jr., MD, a family physician in Deltaville, Virginia, and president of the American Academy of Family Physicians (AAFP).

But know that your healthcare providers have effective ways of helping and can connect you with those resources, Dr. Ransone says. “Seeing someone you trust to talk about it is an important step.”

People going through this may feel hopelessness, helplessness, and despair first, says psychologist Daniel J. Crampton, PsyD, cofounder of the Colorado-based organization Status Code 4, which provides mental health services, crisis counseling, and suicide prevention help to first responders.

Suicidal thoughts may come along with intense feelings of guilt, shame, feeling you’re a burden to others, feeling trapped and empty, extreme sadness, extreme rage, and unendurable emotional or physical pain, according to the National Institute for Mental Health.

“We want people to know that talking about it makes all the difference, and you don’t have to wait until you see no other options,” Crampton says. “You can get back to all the good stuff that we as human beings love, value, and find enjoyable in life.”

So how do you start the conversation with your doctor or another healthcare professional? We’ll walk you through it.

How Do I Know if I’m Having Suicidal Thoughts? 

The American Psychological Association defines suicidal ideation (another term for suicidal thoughts) as “thoughts about or a preoccupation with killing oneself, often as a symptom of a major depressive episode.”

Other definitions are less succinct. “As there is no ‘typical’ suicide victim, there are no ‘typical’ suicidal thoughts and ideations,” according to a review published in 2022 in StatPearls.

Suicidal thoughts come in various levels of intensity, Marshall says. They may be passing thoughts that are a warning your brain is trying to find a way out of a temporarily stressful or overwhelming situation, or you may have more frequent yet usually passive thoughts that don’t involve planning to take your life.

Any thoughts, even if they’re fleeting or infrequent, that life isn’t worth living or about how you will end your life are suicidal thoughts, Marshall says. All of those thoughts are worth seeking help for, Marshall says.

According to Mayo Clinic, other signs that can be signs you’re struggling with your mental health or suicidal thoughts that warrant seeking help include:

• Talking about suicide
• Getting the means to take your own life (such as buying a gun or pills that could be lethal)
• Isolating yourself from friends, family and things you once enjoyed
• Using sleep or substances like drugs or alcohol as an escape
• Thinking a lot about dying
• Feeling trapped or hopeless
• Dramatic personality changes, such as being severely agitated or anxious

Mental health conditions, such as depression, anxiety, substance abuse disorders, bipolar disorder, and schizophrenia, can increase risk of having suicidal thoughts, according to the American Foundation for Suicide Prevention.

Having a serious medical condition (like chronic pain, a traumatic brain injury, or another chronic illness) or history of childhood abuse and trauma can also increase risk of having suicidal thoughts.

Coping with an ongoing stressor (such as bullying, harassment, relationship troubles, or job loss), a death of a loved one, divorce, or a financial crisis can also increase risk, as can exposure to another person’s suicide or to media reports of suicide. A family history of suicide or your own previous attempts also increase risk.

In addition, research shows that people taking certain medications may also face higher odds for experiencing suicidal risks.

Where to Turn for Immediate Help if You’re Having Suicidal Thoughts

If you feel you’re in a crisis, extreme distress, or at immediate risk for taking your own life, get help right now by dialing 988 (from anywhere in the United States) or visiting 988lifeline.org. This connects you to the toll-free Suicide and Crisis Lifeline (formerly called the formerly known as the National Suicide Prevention Lifeline) for people in suicidal crisis or emotional distress.

You can also text 741741 or visit crisistextline. org to reach a trained volunteer crisis counselor at the nonprofit Crisis Text Line.

Or go directly to your local emergency room.

9 Things You Should Know About How to Talk With Your Doctor About Suicidal Thoughts

If you need help but aren’t sure whether it’s an immediate crisis, talking to someone at a hotline, such as the ones above, can help you sort out what you need and how urgent your situation is, Marshall says.

Additionally, talking to any medical professional you see is an option. Depending on what you’re struggling with, they may not be able to address all of your needs, but doctors and other healthcare providers are trained to help connect you with the resources you need — and that includes for mental health care, says Marshall. This could include a specialist you see for a chronic health condition, your ob-gyn or another practitioner.

“Any touch point in the healthcare system can get you the help you need,” Ransone says.

And remember that discussing these and other mental health concerns with your doctor is common; they’ve heard things like what you’re going through before, Marshall says. Though you might be feeling guilt and shame around having these feelings, your healthcare providers are not judging where you’re at, they’re your allies.

And most of the time, these thoughts don’t require emergency treatment; more often treatment starts with counseling, medications, building a support system, learning stress management strategies, and more so you can get back to enjoying your life, Marshall says.

Here’s some advice on reaching out and starting the conversation:

1. Start With a Provider You Know

Talking about suicidal thoughts can be a difficult conversation. Starting it with a healthcare provider you know and have an ongoing relationship can be a good place to start, Ransone says. They can be an important mental health ally for you, he adds.

And a healthcare provider you’ve seen before may be more accessible to you than a mental health professional. Research shows that about 62 percent of people who attempt suicide never see a mental health practitioner, but most see their primary-care doctor for some reason in the month or so before an attempt.

2. Your Doctor May Ask You About Your Mental Health — if Not, Bring It Up

Routine visits for an annual physical or other exam likely won’t include questions about suicidal thoughts. But many providers, as recommended by the United States Preventive Services Task Force for primary care visits, will ask if you’ve had any signs of depression.

If you say yes, your provider will likely ask more questions about your mental health, and those should include ones about suicidal thoughts.

Even if a provider doesn’t ask about depression or mental health, bring it up, Ransone says. If you’re struggling with how to broach the topic, he suggests: “I’ve been having these thoughts that are concerning to me. What do you think and is it something that should worry me?”

3. Remember There’s No Wrong Way to Start the Conversation

It can certainly be a difficult conversation to start, Ransone says. “There’s a certain amount of stoicism. There’s a stigma around mental health issues that keeps people isolated and thinking they can tough it out.”

But remember that there’s no right or wrong way to have the discussion, Ransone adds. Bringing it up and having the conversation is the right way, he says. “We can’t help you if you don’t bring it up.”

4. Expect to Feel Vulnerable

Be open. “It just takes a little vulnerability,” says Caitlin Caviness, a licensed professional clinical counselor and program coordinator for Pikes Peak Suicide Prevention Partnership in Colorado.

You can mention you’ve noticed you’re having a decline in your mental health that you’d like to take care of, she says.

5. Writing Down Notes Ahead of Time Can Help

It may be helpful to write down key information ahead of time, such as symptoms, how your thoughts and feelings affect your life, any events in your life that seem to contribute to your current situation, and medical information including all medications you take and all medical conditions you have, the AAFP recommends.

You’ll find a printable list of questions you can ask yourself with spots for filling in important details before your appointment on the AAFP website.

The American Foundation for Suicide Prevention (AFSP) has printable guides with steps you can follow for talking with a loved one or a practitioner, too.

6. If You Need to See a Mental Health Care Provider, Your Doctor May Help You Find One

If you live in an area with a shortage of mental health providers or long waiting lists for an appointment, your family doctor may also be able to help you get an appointment sooner if needed, Ransone says.

Your primary care practitioner or specialist physician may be able to refer you to a nearby mental-health practitioner who accepts your health insurance. If not, or if you want to look further, try the Substance Abuse and Mental Health Services Administration’s online treatment locator services tool.

7. Your Family Doctor (or Another Specialist) May Take Steps Right Away That Can Help

After telling a healthcare provider about suicidal thoughts, he or she may refer you to seek additional mental health counseling. But other steps that that provider may take may start to immediately address the problem, such as evaluating whether you have a physical condition or are using medication that may be affecting your mental health. If appropriate, a doctor might prescribe medication that can help. Your doctor may also recommend lifestyle steps that help relieve anxiety and stress and ways to use your support system such as family and friends, Ransone says.

8. Looping in All Your Healthcare Providers Can Help

Ransone says it’s also important to tell your family doctor and other specialists if you’re already receiving mental health counseling or other treatment so he or she can help keep tabs on your mental health, and so your doctor can rule out health conditions or medications that may be contributing to or triggering an emotional health issue.

“It’s important for a primary care provider and mental health provider to work as a team,” he says. Your family doctor and other specialists will help assess whether you have any physical health conditions or are taking medications that may be contributing.

9. Ask a Friend or Family Member for Help

Talking with your doctor or a mental health practitioner as soon as you realize you’re feeling depressed, anxious, overwhelmed, or burned-out can stop your thoughts and emotions from spiraling further, says Ann Rush, PhD, a counselor and co-founder of Status Code 4.

Don’t be afraid to ask a friend or family member for support as you seek help — or to accept support if someone close to you asks how you’re doing, she says. “It’s easy to think everyone else is feeling wonderful except you, but it’s not true,” she says. “You don’t have to feel isolated and alone. Social support can help.”

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September 6-12 Is Suicide Prevention Week. If I Tell My Doctor I Have Thoughts of Suicide, What Will Happen?

By Dr. David Woo – August 29, 2020

Many people who struggle with thoughts of suicide are afraid to tell a healthcare provider because they’re worried they’ll immediately be involuntarily committed to a psychiatric facility. This is not the case. 

Suicidal ideation is a symptom of a mental health disorder, and just like any other symptom, it’s important to tell your doctor about it so that you can get the care you need. Your doctor can help you address the underlying cause of suicidal thoughts. So, what will happen if you tell your doctor that you’re having thoughts of suicide?

Your Doctor Will Ask You Questions to Understand the Extent Your Feelings

Whether you speak with your primary care physician or a mental health professional, expressing your feelings is a positive step towards getting depression treatment in NYC. To fully understand how you’re feeling, your doctor will ask you some questions, which might include:

• Have you recently experienced an emotional loss? (Have you lost a loved one? Your job? Or have gone through a divorce?)
• What life circumstances have brought you to thinking suicidal thoughts?
• Are you currently using drugs or alcohol?
• Do you have a plan for how you would commit suicide?
• Have you ever attempted suicide in the past?

Your Doctor May Refer You to a Mental Health Professional

If you’re talking to your family doctor or general practitioner, they’ll probably recommend that you start seeing a mental health professional in addition to continuing treatment with them.   Because depression and suicidal thoughts are sometimes related to an underlying medical condition, depending on your health history, your GP may also wish to perform a general physical exam and order some lab tests, just to check that you’re in good physical health.

If you’re already seeing a mental health professional (such as a psychiatrist, therapist, or counselor) and you discuss your suicidal thoughts with them, they will work with you to create a treatment plan together. Mental health professionals are trained to help patients work through suicidal thoughts. They’ll help you recognize certain situations and/or emotions that may trigger suicidal thoughts. This allows you to identify warning signs early on and take steps to minimize the risk of suicidal thoughts. 

If you’re seeing a mental health professional who can prescribe medication, such as a psychiatrist or a nurse practitioner, they may recommend antidepressant medications to help stabilize your moods and keep you safe. But whether to take medication is always a discussion between you and your care team. If you prefer not to take antidepressants, tell this to your psychiatrist or nurse practitioner. There’s still a lot they can do to help you conquer your suicidal thoughts, even if you don’t want to take meds.

What

Would it Take to Get Someone Involuntarily Committed?

Involuntary commitment to a psychiatric facility does sometimes occur – but it’s more rare than what most people think, and it only happens in extreme cases. Each state has different requirements for what can prompt an involuntary commitment, but essentially, a patient can only be admitted to a psychiatric hospital against their will if they pose an immediate danger to themselves and/or others. This typically means that they have made threats and have a weapon on hand, or that they’ve already hurt themselves. If you’re sitting in your doctor’s office and calmly discussing your thoughts, you clearly don’t pose a danger to yourself or to them. Your doctor or therapist does not have the power to have you committed if you simply have a conversation with them about your thoughts of suicide. 

In most states, if someone is admitted as an involuntary patient, they’ll be held for 72 hours. During this time, patients receive medical treatment and have time to find some relief from feelings of distress. After 72 hours, the patient can choose to stay in the hospital under voluntary care (meaning that they’re there by choice and have the freedom to leave whenever they want), or they can go home and continue with mental health treatment on an outpatient basis.

How Do You Know if You’re Having Suicidal Thoughts?

Many people who experience suicidal thoughts are suffering from clinical depression, but thoughts of suicide may also be brought on by extremely stressful situations or life events. Suicidal thoughts may include:

• Thinking about death and/or dying frequently (do you often think that you’d be better off dead?)
• Thinking about harming yourself or wanting to kill yourself
• Having an idea of how you would commit suicide

A person may be at risk of having suicidal thoughts if they:

• Are feeling trapped or hopeless
• Turn to drugs and alcohol to find relief 
• Have a family history of a mental health disorder such as depression
• Have a history of physical or sexual abuse
• Have recently experienced an emotional loss, such as the loss of a loved one 

Your Life Matters.

Ask for Help. 

As part of National Suicide Month and National Suicide Week, I’d like to encourage people who are having suicidal thoughts to talk to their doctors. It can be scary to open up to your doctor about these types of feelings, but talking to a professional is the first step in getting the help you need. Your life matters and there are people who want to help you.

If you are experiencing distressing thoughts and feelings, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support from a trained counselor. The National Suicide Prevention Lifeline is available 24 hours a day, every day of the year.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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Author: Polina

06/21/2023 10:59

Poor USE results

For two years in a row I was diligently preparing for the USE, did not sleep and hardly ate (I dropped from 55 to 45 and still keep on this weight). All the time before and after the exam, I found it difficult to breathe because of the excitement and fear. At the exam itself, there were fairly easy tasks, but at all the exams I felt dizzy and felt insanely bad .. After the results arrived, it got even worse. Now I can’t do anything relaxing without feeling guilty or wanting to disappear. Anxiety, headaches, paranoia all haunt me and more and more often I have to control my breathing so that my parents do not know that I have a Panic attack and I am suffocating. Mom says that I have “depression” and everything that happens because of the phone and laptop. Dad says it’s all because I’m lazy and don’t do anything “useful”. Things get worse when I talk to them. I really want to just finish this.

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Answer: Service Consultant

21.06.2023 16:47

Polina, hello!

Thank you for asking for help at a difficult moment in your life – it is very important not to leave yourself, your physical and mental health to the mercy of fate. You realized in time that you need help and were able to ask for it, you are great. Do not abandon yourself in the future, this is important.

It is very unfortunate that such a situation has developed in your life. It would seem that after passing the exams, one could expect at least some relief, but it did not come. You’ve gone through so much stress in preparation, put all your energy into passing exams, that you even undermined your health because of it, as evidenced by weight loss, headaches, anxiety, breathing difficulties, inability to relax. Of course, such stress could not but affect the psychological state. To some extent, it really looks like a depressive state, because you have lost so much strength, you feel guilty, empty, powerless. This is suffering that I would like to end. Apparently, not only the exam is stressful for you – after all, there is still a difficult period of admission, adaptation to study. In the meantime, these periods have not come, it would be just good to take a rest, to recuperate a little.

Now, most likely, nothing can be done with the results of the exams, unless, of course, there are reasons to request a recheck due to possible errors in the calculation of points. You passed your exams, you got through it, you worked hard for two years to get over it. Haven’t you tried? Even as they tried, they even put health along with them, they themselves remained to sit at the student’s desk, but health is gone! You were so nervous, so worried, isn’t that worthy of praise? Of course it’s worth it. It was a difficult ordeal, one of the most disruptive for adolescence. It is, frankly, horrific. It’s scary to remember. And, of course, it was such that when the results came, there was a feeling of guilt, and thoughts that I didn’t try hard enough, that I could do better, but didn’t do it, that I was worried too much, couldn’t cope, let my parents and teachers down. But over time, I decided for myself, consciously decided that the results of the exams do not show my efforts, my successes, they do not show me. I know that I tried. It happens that even putting all your strength on the table, you can not achieve the desired result. Unfortunately. This poses new problems for us and the main thing is how we will solve them.

Now I recommend that you take care of your health. This is necessary and should be on the first place in the list of just very useful things. First, on our website in the section Activities-Psychological Education – Articles, find an article about panic attacks. There is an explanation of why they occur and some self-help methods. Secondly, it is important to get high-quality support from your inner circle. You tried to talk about it with your parents, but apparently it only made it worse that you even have to hide some of the symptoms from them. Parents often look at things a little differently, based on different feelings, knowledge, often not understanding the psychological state of their child very well. Therefore, it makes sense to contact the person who can understand and feel your condition. It can be a close friend, another close relative, maybe a teacher, a school psychologist, if possible, a mentor, maybe a person with whom there are common interests, a good friend. In any difficult situation, it is very important that there is a person with whom you can share your feelings, throw out emotions, and ask for emotional support. It’s good to have someone who can tell you, against your negative thoughts, that you’ve tried your best, done your best, and that you need to take care of yourself.

Thirdly, you need to improve sleep and nutrition. No matter how trite it may sound, but these are the foundations for restoring internal balance, the foundations for improving the condition. It is also useful to organize optimal physical activity for yourself (dance, exercise, yoga, outdoor games – everything that will be available to you and give you extra strength).

I can assume that the uncertainty of the future also brings some anxiety into your state. In this case, I recommend sketching on a piece of paper an approximate plan of action in various cases. When there is at least a small plan of what to do, what first steps to take, it will already be somewhat calmer. Various options for admission, options for universities, non-admission, faculties, specialties, what to do, what documents to collect, how to get out of difficulties – create a list of possible problems and sketch out possible solutions next to it.

Don’t force yourself to do something if you don’t have the strength yet. They will recover over time and you will be able to do what you need.

If anxiety, panic attacks, paranoia, headaches bother you more, you should seek help from a specialist. Maybe it makes sense to start with a general practitioner or pediatrician. Your condition now resembles a disease, and if you do not start treatment, it may become worse. Track your condition.

On my own behalf, I want to add: you did everything you could! You tried hard and tired. Very much. And they deserve to recover a bit. What happened is what happened, it cannot be fixed, but you can prevent it from affecting your condition and your future. And then what causes suffering now will end.

Best regards, Maria.

Author: Arthur

06/20/2023 18:54

I am struggling with the desire to kill myself, I am very tired and looking for help I cut all the skin on my arm, I could have done it in a more inconspicuous place, but it turned out that my hand is not so sensitive and it’s not so painful to cut it, so it can be cut properly). Time has passed, I have not cut myself for half a year, but now I have reached such a state that I already want to kill myself more actively, I ate a copious amount of pills a couple of times, I got only poor health, I lie down and every night I feel that there is no need for me to live. My friends and relatives love me and do not want my death, I love them madly, but I have already reached such a stage that I am very badly stopped by the fact that I will break their heart and therefore I do not cut myself, I do not eat pills. But I constantly try to kill myself gradually, sometimes I don’t even notice it, I starve myself, I don’t work, sometimes I go out at night for a walk in the hope that someone will beat me or stab me with a knife, lying in my bed I hope that I will die one day in the morning, I don’t want to get up, I don’t want to eat, I stopped taking care of myself. I am also writing here at the request of a friend, I myself am very, very tired, nothing in my life is holding me back, I didn’t care at all. The last night I just lay and tried to understand why I still exist, I felt a strong emptiness and meaninglessness of my life, even if I imagine that I will have a lot of money, I will be successful, I still don’t see the point in it, I just want to die. But for now, the love of friends keeps me going, even though it’s already hard to hold on to this

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Answer: Service Consultant

06/21/2023 11:27

Hello Arthur!

Unfortunately, you did not write about your current life situation. It is important to understand the causes of this condition and how long you have been in it. Is it long term stress? Is it a depressive state? A crisis? Difficulties in relationships with others? You seem to have lost the ability to live something as valuable. Of course, in order to understand how to bring changes, it is necessary to understand what caused the problem.

Artur, at certain periods of life each person, for various reasons, has a question about the meaning of existence. This question can turn a person’s gaze to whether he lives life in accordance with his own values, whether he likes it, or whether changes are needed that will change the quality of life, will replenish strength, resources and return the opportunity to enjoy life.

Artur, try to start with what questions can you ask yourself in search of meaning? – What am I missing? What am I deficient in? What can I do to make up for it? What is up to me, and what can I not influence? What can I rely on in this matter? How do I want to see my life? How can I get closer to this? What is valuable to me and what is not? By answering these questions and acting in harmony with yourself, you will gradually begin to look at what is happening from a different angle and you will have the strength to set and achieve your goals. The main thing is to try, because if you don’t try, then it will not be completely clear whether I need it or not; it is mine or not mine; what I can do and what I can’t.

Artur, the possible causes of the problematic condition you report could be a long period of chronic stress, negative events that could have a traumatic effect on the psyche. With prolonged exposure to these factors, the internal resources of the body are depleted. In the future, this can manifest itself in the form of increased anxiety, panic states, obsessive thoughts, sleep disturbances, appetite, apathy, etc., which can lead to a depressive state.

Also Artur, medical specialists deal with problems with similar symptoms. This may be a neurologist, a psychotherapist, a psychiatrist – depending on the cause of the changes in your condition. Very often people are afraid to go to an appointment, but it is this step that can be most useful, because. doctors can correctly assess your physiological state. For example, to diagnose disruptions at the hormonal level or any other changes in the body, as well as to prescribe treatment, if necessary, that is right for you and will alleviate your difficult psycho-emotional state

Your condition really needs attention. Sometimes when people are faced with difficult experiences, painful memories, situations that are hard to endure, their pain can be very strong. Not knowing other ways, a person, drowning out emotional pain, inflicts physical pain on himself. It’s called self-harm. After inflicting damage, people sometimes feel better, feel that they can cope with life’s difficulties. But the causes of stress do not go anywhere. It is important to understand what causes emotional pain. When and under what circumstances, in what situations does the desire to harm oneself arise? Self-harm often causes hard feelings and worsens well-being. This may be dangerous for you.

Unfortunately, there is very little information in your application. Please describe the situation in more detail. Tell us about yourself, about your activities, hobbies, about your loved ones. In cases where support is needed immediately, you can contact the online psychological assistance service: +7 (495) 989-50-50. If you are a child / teenager, I recommend calling the children’s helpline 8-800-200-01-22. Also, you can start a dialogue with the psychologist of our service in the Personal Account. (free, anonymous).

I would like to note, Artur, that you are a very strong, strong-willed person. At this moment, it is very important that you do not give up, work to create the future that you want to see.

Take care of yourself! Please do not delay visiting a specialist and your call!

Sincerely, Service Advisor.

Author: Daria

06/20/2023 10:57

Suicide

I was diagnosed with an anxiety and depressive disorder.

June 22, I will have a diploma.

I am very scared to take my diploma, because the teaching staff at the institute say about me that supposedly I did not write it myself. And I wrote my own work. They say that I have poor progress, although I study well! But this is not the core of the problem!

It’s very hard for me, I’m very desperate, I’ve had suicidal thoughts for a year already, I told my relatives, but they can’t believe that I’m telling the truth!

I don’t know what to do, I’m very afraid of speaking in public, I can’t tell, I have to keep my eyes down, and I know that there will be questions and I’ll be overwhelmed for lack of confidence!

I cannot cope with despair, I am mentally exhausted, I cry so much that it hurts a lot!

Please help me!

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Answer: Service Consultant

20. 06.2023 16:19

Hello, Daria.

In your appeal, you write that you will soon be defending your diploma and you are experiencing a certain tension and anxiety about this, because you are not used to speaking in public, you experience uncertainty in such situations, in connection you are worried that you can fail at this test, in connection with which you have certain negative thoughts.

Daria, I understand that it is very difficult for you now, and I will try to help you in this situation. To begin with, I want to tell you that you are not alone in your experiences. Many people experience anxiety, especially before important events in life, such as defending a diploma, for example, which is a stressful situation. Excitement in the process of preparation and before defending a diploma is a natural reaction that speaks of the significance of this event for a person. This does not mean that you are doomed to failure or unable to cope with this situation.

It is important to understand that other people’s opinions and comments do not always reflect reality, because people tend to make mistakes sometimes. But you know that you wrote your work yourself, which means that you have a good understanding of the topic under study in your final qualification work and will be able to explain everything that is incomprehensible to the examination committee. After all, they ask certain questions not to somehow offend you, but to better understand the course of your thoughts.

To reduce the level of anxiety before the defense itself, I can recommend the following:

– deep breathing that can be done anywhere and anytime. Ideal conditions are peace and quiet, but in an acute situation you can do without them. Sit or stand comfortably. It is advisable to “ground” the legs (so that they feel supported). Breathe according to the following pattern: at the expense of “one-two-three-four” – inhale; at the expense of “one-two-three-four” – pause; at the expense of “one-two-three-four” – exhale; at the expense of “one-two-three-four” – pause again. Repeat 1-3 minutes. It is advisable to breathe in the stomach. There is no significant difference in how you inhale and exhale: through your nose or mouth. Experiment and find your own comfortable version of this exercise;

– form positive thinking. As soon as you have negative thoughts, try to replace them with positive affirmations. Repeat these affirmations to build your confidence;

– Grounding exercise, which will help you switch from disturbing (negative) thoughts to bodily sensations. Put your feet on the floor, lean back against the back of the chair, feel the support;

– choose phrases that can help you in this situation, for example, “Since it’s hard for me now, it won’t always be. It will be easier for me soon. Yes, I absolutely do not know everything, but everything that is written in my diploma is familiar to me, since I wrote it myself, so I can answer the questions posed to me.

In your application, you also write that you were diagnosed with an anxiety and depressive disorder, but do not write when this happened and what you were prescribed for this. And this information is very important, since it depends on building a plan to improve your condition and reduce the level of anxiety. If you have not undergone any treatment, then I recommend that you contact a psychiatrist at the place of residence and again undergo examinations to clarify the diagnosis, prescribe treatment and undergo it. I can also recommend that you contact a psychotherapist to work with him in a full-time format of your anxiety and depressive thoughts. In this format, it will be easier for you to process your thoughts and emotions, as well as learn techniques for managing your own state. The most effective approach may be complex treatment, which includes both drug therapy and psychotherapeutic methods. It is also important to remember to take care of your physical and emotional health in order to reduce your stress and anxiety levels.

I want to emphasize that it is important to remember your value as a person. You are a unique and valuable person, with your own strengths and weaknesses. You deserve respect and support and I am sure you will find a way to overcome your difficulties.

In the event of a crisis, you can always seek help from a specialist on the hotline (8-800-200-47-03) and discuss all your questions.

Take care of yourself.

Best regards, Christina.

Show more

Suicide as a social problem

Suicide is a frightening topic, it is not accepted and not very pleasant to discuss. Therefore, faced with either direct threats from his loved one to commit suicide, or suspecting such a development of events, a person often finds himself at a loss, does not know how to deal with this: whether to ignore the threats, not paying attention to them, considering them empty talk, or rush to save a loved one at any cost? Indeed, often the reaction of loved ones, their ability to recognize the threat in time, their actions, their sincere desire to support a person, perhaps his life depends.

In Soviet times, there was a belief that suicide was a clear sign of mental illness. That is, each suicide posthumously received the title of abnormal, and those who managed to be pulled out were registered with a psychiatrist for life (with all the ensuing consequences).

In general, thoughts about suicide are most often a sign not of the absence, but, if you like, of an excess of mind (that same “woe from the mind”, which we have already spoken about more than once).
Almost all people think about suicide at one time or another. 80% of people admit they have “played” with suicidal ideas.

Suicide is never spontaneous – although sometimes it looks quite unexpected. Such a suicide is always preceded by a depressed mood, a depressive state, or simply thoughts of passing away. And those around. Even the closest people. Often, a person does not notice such a state (especially if they frankly do not want this). And a kind of test for readiness for true suicide – a person’s thoughts about the meaning of life. Therefore, in a kind of “risk group” for suicides are teenagers and the elderly.

Who is suicidal?

The risk of suicide is very high in patients who drink alcohol. This disease is related to 25 – 30% of suicides; among young people, its contribution can be even higher – up to 50%. Long-term alcohol abuse contributes to increased depression, guilt, and mental pain, which are known to often precede suicide.

Chronic use of drugs and toxic drugs.

Drugs and alcohol are a relatively lethal combination. They weaken the motivational control over human behavior, exacerbate depression, or even cause psychosis.

Affective disorders, especially severe depression (psychopathological syndromes).

Chronic or fatal diseases.

Loneliness, bereavement, such as the death of a spouse (parent), especially during the first year after the loss.

Family problems: leaving the family or divorce, financial problems, etc.

Suicide risk assessment

People may be at risk, which does not mean they are suicidal. It must be emphasized that there is no single reason for suicide. However, all hints of suicide should be taken seriously. Special vigilance should be taken into account when the combination of dangerous signals persists for a certain period of time. There can be no doubt that a cry for help needs a response from a person who has the unique ability to intervene in a crisis of loneliness.

The main “tool” for assessing suicidal risk is a conversation with a person, observation of him, information received from third parties.

Suicide is preventable.

There is an opinion that if a teenager decides to end his life, then it is impossible to stop him. It is also believed that if a teenager fails to commit suicide the first time, he will make suicide attempts again and again until he achieves his goal.

In fact, young people usually try to commit suicide only once. Most of them pose a danger to themselves only for a short period of time – from 24 to 72 hours. If someone intervenes in their plans and provides assistance, then they will never encroach on their lives again.

Not all teenage suicides are due to unhappy love. It’s just that “a young man thinking about life” (or, accordingly, a girl) did not find an answer for himself, what is his purpose in this world, and it is still very difficult for him to accept the answer “to live in order to live” due to teenage maximalism. And the main percentage of suicides “because of love” is not because the teenager was impatient to start an intimate life or his hormones are raging. It’s just that most often, children’s love is nothing more than a reflection of the need to be needed by at least someone: if not parents, then Him or Her. And when reciprocity does not arise, often comes the feeling that NO ONE NEED YOU IN THE WORLD.

Old people pass away if they suddenly realize that they have lived all their lives in vain. Yes, if an elderly person is sure that he has done at least something significant on his way (at least for himself), then he begins to love life. But those who are convinced that their entire existence has been wasted can commit suicide even in old age.

The most common mental illness in adulthood is depression. Depression in adulthood is often associated with suicide. Along with physical changes come mental changes. Parents who used to support their children are now becoming dependent on them. Children leave the parental home forever. The suicide rate among aging people is higher than at any other age.

The loss of the meaning of life can look like anything – it all depends on who sees this meaning in what. Lack of money can push to a fatal step the one for whom all life comes down to wealth; unhappy love can cause suicide if the lover cannot imagine a future without his beloved; and a woman, convinced that her destiny is only in motherhood, can commit suicide due to discovered infertility. Although, of course, in any of these cases, you can find another way out.

The main part of suicides is nothing more than an attempt to conduct a dialogue: only, in such a peculiar and completely unsuitable method for this.

Most suicides, as a rule, did not want to die at all – but only to get through to someone, to pay attention to their problems, to call for help.

Signs of suicidal behavior

1. Conversations about suicide, death, dreams with a catastrophe plot, dreams about the death of people or one’s own death, increased interest in the instruments of self-destruction, reasoning about the loss of the meaning of life, letters or conversations of a farewell nature.
2. Having a history of suicide, having an example of suicide in close circle, especially parents and friends; maximalist character traits, a tendency to uncompromising decisions and actions, dividing the world into white and black.
3. Objective severity of life circumstances: childhood spent in a dysfunctional family, bad relationships with loved ones in this period, loss of a dear person, social rejection, serious illness, etc.
4. Reducing the resources of the individual to withstand difficulties: depression, stressful conditions, helplessness, illness, violence in the close environment, exhaustion of the physical or mental plane, the need and inability to overcome difficulties.

What if you suspect Anyone in suicidal intentions

If you suspect that one of your acquaintances, friends or relatives may have a desire to commit suicide, you need to do with it talk about it.

Do not be afraid that such a conversation will lead him to “idea suicide.” If such a thought already exists, it exists regardless of your conversations. By questioning him, you give him the opportunity to talk about his feelings and intentions. People are often ambivalent in their desire for death. Even if someone denies such intentions, but you still suspect, you can gently return to the conversation after a while.

How to help

LISTEN—”I hear you.” Do not try to console with general words like “Well, it’s not so bad”, “You will feel better”, “You shouldn’t do this”. Give him a chance to speak. Ask questions and listen carefully.

DISCUSS – open discussion of plans and problems relieves anxiety. Don’t be afraid to talk about it – most people feel uncomfortable talking about suicide, and this manifests itself in denial or avoidance of the topic. Conversations cannot provoke suicide, while avoidance of this topic increases anxiety, suspicion.

BE CAREFUL about proxy indicators for suspected suicide.

Every jocular mention or threat must be taken seriously. Adolescents often deny that they were serious, try to make fun of your excessive anxiety, and may pretend to be angry. Say you take them seriously.

ASK QUESTIONS – generalize, reframe – “It sounds like you’re actually talking…”, “Most people have thought about suicide…”,

“Have you ever wondered how to do it?” If you get a response, get specific. Gun? Have you ever shot? And where will you take it? What will happen then? What if you miss? Who will find you? Have you thought about your funeral? Who will come to them? The unsaid, hidden, you must make clear.

Help to speak openly and think about your ideas.

EMPHASIZE THE TEMPORARY NATURE of the problems – acknowledge that his feelings are very strong, the problems are complex – find out how you can help, as he already trusts you. Find out who else could help in this situation.

Listen carefully to what is being said to you. Try at all costs to remain calm and not give out moral assessments: “abnormal”, “terrible person”, and the like. This will not help, but only restore the interlocutor against you. You cannot advise a person how he should feel. You can sort out his problems with him and “break” them into more specific issues that can be solved step by step. Emphasize that there are other ways to solve problems other than suicide. Suggest going to a psychologist or therapist and talking about your problems.

DON’T AGREE TO KEEP THE SUICIDAL THOUGHTS AND PLANS OF YOUR INTERVIEWER SECRET! Even if you agreed, there is no sin in breaking your word. It will be much worse if your interlocutor dies and you will execute yourself all your life. Especially often teenagers fall for this “bait”. What do they have to do after their friend or girlfriend commits suicide, and they knew about the intentions of friends and did not prevent! Don’t be afraid to lose a friend, but be afraid to lose a person!

Do not let your interlocutor out of sight and try to select and hide the means with which he wanted to commit suicide.

What to do if you have suicidal intentions

Remember that some people with whom you shared your thoughts do not know what to do and in their temper and inability can say a lot of hurt to you, and it will hurt you even more . Do not be offended by them for this, but try to seek support from those who will help you.

Do not think that your crisis is only your problem, which you have to deal with alone. Seek help from a psychotherapist, doctor, friend who will listen to you carefully and help with advice.

Give yourself time. What you are feeling right now is a feeling that may subside in a day or a week.