The popular image of someone who is in danger of suicide goes like this: A person has suicidal thoughts. It’s a crisis. The person gets help, and the crisis resolves within days or weeks.
That’s the popular image, and thankfully it does happen for many people. But for others, suicidal thoughts do not go away. Their suicidal thoughts become chronic.
The pattern of chronic suicidal thoughts is similar to that of a person with any other kind of chronic condition: For some people, there are flare-ups where the condition is far worse than normal, and then the symptoms subside, but only temporarily. And for other people, the symptoms never subside. Those people live with their symptoms – in this case, suicidal thoughts – every day.
Who Is Prone to Chronic Suicidal Thoughts?
Chronic suicidal thoughts are especially common in people with borderline personality disorder, an illness characterized by unstable emotions and identity; impulsive, often self-destructive actions; and turbulent relationships. The psychiatrist Joel Paris notes that, for many people with borderline personality disorder, “suicidality becomes a way of life.”
However, chronic suicidal thoughts can occur in concert with other mental illnesses, such as recurrent episodes of depression, or with no illness at all.
Many people who regularly have suicidal thoughts have considered suicide for so long that it feels normal to them. Some have thought of suicide ever since they were young children. And some have made multiple suicide attempts, sometimes so many that they lost track long ago.
Why Chronic Suicidal Thoughts Persist
Often, intense, ongoing psychological pain fuels chronic suicidal thoughts. But even seemingly minor challenges can intensify the wish to die.
Frank King captures this dynamic well in his TedX talk, A Matter of Laugh or Death. Although King is a comedian, he provides this example in all seriousness:
“See, people don’t understand. Let’s say my car breaks down. I have three choices: Get it fixed, get a new one, or I could just kill myself. I know, doesn’t that sound absurd? But that thought actually pops into my head… It’s always on the menu.”
Some people say it comforts them to know they can die by suicide if ever the pain of life gets to be too much for them. The soothing nature of having an escape has led some experts to refer to “suicide fantasy as life-sustaining recourse.”
As the philosopher Friedrich Nietzsche stated, “The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.”
The Danger of Chronic Suicidal Thoughts
Even if suicidal thoughts provide some form of escapism and relief, it does not mean that chronic suicidal thoughts are harmless. The more someone thinks of suicide, the more they might get used to the idea. This can weaken their inhibitions and fears about suicide.
Also, chronic suicidal thoughts typically indicate that an unhealed wound needs healing, whether that wound arises from past trauma, mental illness, grave loss, or some other cause.
Even for people who do not view their recurrent suicidal thoughts as a problem, it certainly is better if they can come up with other escape fantasies besides death. Better yet, they can be helped to develop problem-solving abilities, coping skills, hopefulness, and reasons for living that will make the option of suicide unnecessary.
Therapy for Chronic Suicidal Thoughts
For someone with chronic suicidal ideation, therapy tends to take longer than it does for someone in an acute crisis. The goals of therapy are not only to keep a person safe, but also to help them develop the skills and resources that will weaken suicide’s allure. Dialectical behavior therapy has been effective at reducing suicide attempts and suicidal ideation in people with borderline personality disorder and chronic suicidality.
Often, it is not a realistic goal for a person with longstanding suicidal thoughts to stop thinking of suicide. Suicidal thinking has become a habit. And nobody can control what thoughts come to them, only how they respond to the thoughts.
One way for someone to respond constructively is to observe their suicidal thoughts with curiosity and detachment. Some of my therapy clients say to themselves something like, “That’s not my real self talking. That’s my depression (or stress, or post-traumatic stress, or some other condition) talking.”
Mindfulness can be especially useful. The psychologist Marsha Linehan, PhD, developed DBT, which essentially is a form of cognitive behavior therapy combined with principles from Zen Buddhism. She uses a metaphor of a train passing by: You can sit on a hill and watch the cars of the train pass, or you can jump onto one of them and get carried away by it.
When to Panic – and Not to Panic – about Chronic Suicidality
So if you know someone with chronic suicidal thoughts, you don’t need to respond as though it is an emergency every time they think of suicide. That would be a lot of emergencies. Chronic suicidal thoughts often are manageable and the person stays safe in spite of them.
Danger occurs when the suicidal thoughts have intensified to such a degree that the person is intent on acting on their suicidal thoughts within hours or days. That is an emergency.
If the person is simply having the same thoughts that they have had for many years, don’t panic. Instead, compassionately listen and empathize with the person. Ask how you can be of help. Talk with the person about resources they can use, like the 988 Suicide & Crisis Lifeline (988 or 800-273-8255) or the Crisis Text Line (741741). Also talk about how they can keep their environment safe, like by removing firearms from the home.
Chronic suicidal thoughts are not ideal, but they also are not a crisis if there is no intent to kill oneself soon. As odd as it sounds, the option of suicide might be the very thing that helps some people to stay alive.
This post originally appeared in slightly revised form at insurancethoughtleadership.com/understanding-person-with-suicidal-thoughts/.
Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide.. All Rights Reserved. Updated Feb. 12, 2023.
So much bullshit about the borderline diagnosis. It is so dangerous and unhelpful to do that. We all have traits. And what is with being disrespectful to people.
I’ve had suicide thoughts for many years. I don’t know what to do. I am no longer sure how to ask for help. Psychiatry, therapy and fitness haven’t really helped. I know what is wrong, but it’s hard to explain because people don’t really understand it. I’m lonely. I’m 26 and has never had a boyfriend or anything close to it. The “right now” is pretty good – I have many friends, goes to university, loving and supportive family – but the thought that I will never fall in love (with someone who loves me back) and start a family of my own is so devastatingly, soul-crushingly horrifying that I can hardly breathe. I usually don’t think about it during the day, so I enjoy myself in the “right now”, but the nights…I have trouble sleeping. I just exist several hours in the dark, alone, increasingly stressed because I have to get up so soon and the thoughts start coming. It would be so easy to just end it. People say “don’t focus so much on the future”, but I don’t see how I’m supposed to do that. I don’t understand “mindfulness” or “happiness from within”. I am sick and tired of my life being like this. Meanwhile, my friends are settling down and having kids and I’m just over here still a virgin. Before you ask, no guys have ever shown interest in me, so I’m not just “picky”, I’m not boring either. I don’t know what to do differently.
Hi Nina, I hope you’re doing ok. I have similar worries as you about romantic relationships and some other areas that I struggle with.
I don’t want to patronise you. But – what sometimes helps me to quiet painful thoughts is to tell myself that I don’t need to achieve anything great like doing the most meaningful work or having a partner and a family for life to be worth it. I’m alive just to be alive. Existing, using my senses, all of that is the purpose of my life.
I’m sure you know that there are all kinds of love and many people who never have sex or a partner in their lives. And plenty of people do have those experiences for the first time when they’re in their thirties, forties, fifties… The other day I heard about a 67-year old who’s been having his first romantic relationship for the past five years or so. He sounded very happy.
It’s understandable to worry about these things. But, in my opinion, no particular experience is necessary for your life to be worth living.
Hi Charly, thank you for your reply. It means a lot to me that you took the time to share your thoughts. It actually made me really happy to read about the 67-year old.
Everyone tells me that many people don’t get their first partner before late twenties or thirties. But I just…I have never in my life met anyone in a similar situation as mine. And that is what makes it really hard, I think. Everytime someone talks about relationships or whatever, it feels like a knife in the heart. I know that it is okay to not get married and have a family, but I just desperately want one. That’s just me. And it’s the worst feeling in the world. It’s like having a heartbreak for no reason all the time.
I’ve been apart of this thread for a long time now.. I’m 36 .. I’m blessed with borderline personality and major depression so suicide is no stranger in my life I’ve struggled deeply for a very long time.. I literally was just talking about how I feel so lost at night time because I don’t have anyone and then I read ur post.. I also have no children or partner . I just wanted you to know I experience hurt for those reasons too.. hope ur ok
Hi A.Rose. I’m not sure if you get a notification for this, but I couldn’t really reply to your reply…I hope you see this. I understand your feelings – completely. It’s probably gonna be me in 10 years…and it sucks. I’m so sorry that you’re feeling like this. You’re probably a great person who deserves better – especially after you’ve been struggling. I really hope that you meet someone or find happiness alone. It helps to know that I am not the only one feeling this way…the others are out there. In my imagination it could be nice if we made a “loneliness community” to combat said loneliness. Obviously, members would have to be able to prove in some way that they are REALLY lonely (singles only obviously). And then we would have meetings and summer camps and it would be so absolutely epic that everyone else in the world would think to themselves “Wow. They’ve really turned it around. I’m kinda jealous. It looks like they’re having fun”. And to be clear – this would not just be an app or something, it would be a real thing. Like the Freemasons or something like that. Yeah. I’d like that.
I wake up every day and try of think of reasons not to kill myself. I have to convince myself that my wife and kids are indeed not better of without me. It gets harder and harder every day to win that internal argument.
I know how I’d do it, it would look like an accident, and they’d be spared the shame and anger that comes with a suicide.
I tried to talk to my wife about all if this and she just yelled at me to stop talking like that. I have very few friends, but no one I can talk to like that. Counselors do little except reiterate that I am special and my family needs me.
My family hasn’t needed me in a long time, they would miss me, sure, but they definitely don’t need me for anything other than my paycheck.
I have insurance, they’d be financially taken care of. They wouldn’t have to put up with my bullshit personality disorder crap anymore and my PTSD symptoms which have helped ruin every relationship in my life. My wife is only with me for the kids, whether or not she admits it, or not. I haven’t felt love or passion from her in years.
Career wise, I have a job, post military, but it’s unrewarding, and my manger is awful. My career in the military was a couple bright moments surrounded by decades of disappointment, abuse, exploitation, and just generally be shit on and marginalized.
I really struggle because I want to talk to someone to help find reasons to live, but I also don’t want to cause anyone to question whether my death was an accident or not if/when I ultimately lose that argument with myself.
I don’t know what to do, but this has to change.
Since my mother died in October 2018, I really hit rock bottom and the ensuing legal hell that began in 2019 with my sister on the property, the Will, the Trust, all the stressful court hearings and surviving 4 hellish evictions (I won each one) in the past 3 years has caused me to take medication for my anxiety attacks and I’ve also developed Atrial Fibrillation which caused me to go to the ER nine times in 2.5 years . The Meds have helped. I didn’t go once in 2021
However the massive legal problems are still ongoing. I hope and pray it ends this year with some type of settlement. But it still won’t help in keeping me here. It will just delay it for a couple years perhaps.
In the meantime In the past 3 years, I’ve thought of suicide many times. I even called the “hotline” twice It was useless for me. Talking about it just offers a temporary reprieve. But the problem hasn’t gone away and I don’t think ever will.
Look here’s the bottom line. I DON’T HAVE ANYONE ANYMORE IN LIFE THAT GIVES ME A REASON TO STAY HERE IN THIS PHYSICAL EXISTENCE! THE ANCHOR IS GONE! That anchor was my mom. Actually all my family is gone. All there is now is me. I’m all alone now. The tragedy is I have no wife or kids. If I had that I would be able to handle life much better. My friends cannot fill that empty void. The future to me looks fearful and ominous. There’s this weekly feeling of hopelessness and despair. I’m fed up with life and it’s constant, continuing problems that never seem to stop! Whatever alternatives there are that may influence me to hang in there and stay ARE NO LONGER THERE. Without my meds, I don’t know how I could function on a daily basis. I may just stop taking them entirely.
I have absolutely no doubt that death is not the end. We just transition to another existence. There is so much evidence on this if you just seek it out! That’s where I want to go! I want a different way. I don’t really care to hang around here anymore. I made my choice. IT IS AN ALTERNATIVE CHOICE. I DECIDED THIS IS WHAT I WANT TO DO. People may say I need professional help (I don’t!) They mean well, but it doesn’t apply to me. I JUST WANT TO MOVE ON NOW. IT’S THAT SIMPLE FOR ME.
When it’s going to happen, I don’t know. The problem for me is I don’t want any pain in trying to do this. I want to take a pill and never wake up. That’s beautiful!
[This comment was edited to abide by the Comments Policy. – SF]
I understand.
I’m really starting to lose hope. I’m almost 32 and have been suicidal since I was 10. My first legitimate attempt I was 12. I’ve been through so much abuse and I’ve been raped more times than I can count. The mental health system ignored my abusive father I reported and blamed me and told me I was exaggerating for attention when so reported I’d been raped several times times by the time I was 16. So they labelled me as being BPD and told me it was due to my “attention seeking.” I’ve had horrible things done to me in hospital, I was homeless and being sexually abused or in domestic violence situations as the victim from 16-18. I was trafficked by a bf to his friends. I’ve tried to kill myself so many times. I was put on disability at 18 and told I’m a write off and will never handle school or work. I’ve had so many people I thought were friends rape me over the years then lost friends because they breadcrumbed the truth to our mutuals and I was a mess. Im about to graduate with my BSc but it’s taken me 8yrs to get it when I was considered an exceptionally gifted child (placement tests). I just messed up my application to my masters in a really stupid technicality. I feel like I’ll never get off disability and will be stuck choosing between rent and my meds. I’ll never get into a program despite my grades being excellent due to some really frustrating tests that don’t actually assess the skills they state they do, but rather seem to assess how neurotypically you think. I don’t have BPD according to recent trauma therapists, but I definitely have CPTSD and ADHD. I can’t stop the intrusive thoughts. I’m in physical pain a lot from my fibro and I hate myself. I got out of shape with the pandemic, I haven’t seen any of my actual friends since September (it’s almost March now) and I’m just so hopeless. I’m a burden, will never succeed and am just garbage. I feel like all my abusers were right.
Brittany,
How awful that you’ve endured so much pain, abuse, and disbelief when you’ve needed so very much to be believed and helped. I’m sorry. I’m also impressed you’ve managed to get your Bsc – which you seem to discount by saying it’s taken 8 years, but with all you’ve been through it’d be a miracle for there to be no delay.
I hope you won’t give up. I hope you wrote here because there’s a part of you that recognizes things can change, and that there is some hope (even if it hides very, very well sometimes), and that your abusers were wrong. And I hope that part of you recognizes, too, you’re not garbage or worthless or whatever else your mind tells you right now. I know these might sound like platitudes, and I apologize for that. I’m not expecting you to believe instantly change your mind about yourself based on my words here. Rather, I’m hoping that part of you already disbelieves the self-condemnations, and that part of you is who commented here.
Thank you for sharing. May you experience hope and healing soon.
Too everyone that comes across this post on this thread please take the time too watch this YouTube video I came across it today because just like so many of us I try too make sense and understand what’s happening too me and why ..
https://youtu.be/UbN8Nd1eSDM
Hello Brittany,I would like to start off by saying you are not garbage, God does not create trash. No matter what you have been through, it does not define who you are as a human being.You are someone with a purpose in life, always know that.I wish you many Blessings.
“Chronic suicidal thoughts are not ideal, but they also are not a crisis if there is no intent to kill oneself soon. As odd as it sounds, the option of suicide might be the very thing that helps some people to stay alive.”
that pisses me off!!!!! I have been suicidal for 2 weeks now and hospitals have not accepted me!!!!! I will kill myself ASAP!!! I dont have money. It is locked up. I live in a group home cause of disabilities mental and physical. I have staff here with me and they make me worse by ignoring me….it’s like the proof I need to disappear!!!!