In overly simple terms, suicidal thoughts and behaviors start when vulnerable individuals encounter stressful events. They become overwhelmed by the situation and decide, based on their faulty way of thinking, that suicide is the only reasonable way to stop the pain they are experiencing. Determining what makes events stressful is difficult because of the everyone copes in different ways and has different perspectives. What may seem pretty meaningless to one person may seem devastating or unbearable to another.
Both negative and positive events can be sources of significant stress. Examples of events that cause positive stress include:
- moving (when it is a desired move)
- having a child
- changing jobs (when that is desired).
Examples of negatively stressful events include:
- losses related to health, significant relationships and jobs
- peer pressure to be thin and beautiful,
- similar difficult or challenging situations.
Some suicidal people never developed the skills necessary to successfully cope with stressful situations. They may also have personalities that are sensitive to becoming overwhelmed by negative circumstance. Other suicidal people may have had reasonable coping skills in place at one point, but find themselves worn down by circumstance to the point where they can no longer manage.
The most frequent stressful event leading up to suicide (what is often called a precipitating event) today is mental illness. It is estimated to account for about 90 percent of all suicides. As we discussed earlier, a newly diagnosed and/or poorly treated mental illness can trigger a suicide in some cases. In addition, a change in someone's existing mental illness (for the worse or better) can function as a precipitating event for suicide. Most people incorrectly assume that only deteriorating conditions should be monitored. However, as was previously discussed, people who have been severely depressed and are now starting to regain their energy may suddenly find themselves with enough energy to carry out suicide plans.
Depression is the most common mental illness in people who commit suicide, so we will briefly detour from the topic of suicide to discuss this common disorder, which is discussed in significant detail in our Depression topic center. According to the DSM-5 (the latest version of the manual used by clinicians to diagnose mental disorders) you must meet the following criteria in order to qualify for a diagnosis of Major Depression:
At least five of the following symptoms are present during the same period. At least (1) depressed mood or (2) loss of interest or pleasure must be present. Symptoms are present most of the day, nearly daily for at least 2 weeks.
- Feelings of sadness, emptiness, or hopelessness (in children, this may be irritability)
- Having no interest or feeling no pleasure in all or almost all activities
- Weight loss or weight gain by greater than 5% when not trying to lose or gain weight OR a change in appetite nearly every day
- Sleeping too little or too much
- Physical agitation or restlessness that is observed by others
Being tired and having a lack of energy
- Feelings of worthlessness, self-hate, and guilt
- Not being able to concentrate, think clearly, or make decisions
- Ongoing thoughts of death or suicide - either thinking about suicide without a plan for how it would happen, having a specific plan or attempting to commit suicide
- Never having a manic or hypermanic episode (being very excited or energetic which would be possible symptoms of bipolar disorder)
It's helpful to know the criteria that professionals use to diagnose depression, but it is not a good idea to attempt to diagnose yourself. One reason why this is true is that the consequences of getting the diagnosis wrong can be quite negative. Depression is a serious condition that is associated with significant suicide risk and does end up being a lethal disorder sometimes. However, it is also a very treatable disease which can be addressed by either medical or psychological methods (or both). If you wrongly conclude that you are not depressed when you are, you might very well miss out on treatment opportunities that a diagnosing clinician could offer you.
Don't assume that you must feel sad and depressed in order to qualify for a diagnosis of major depressive disorder, as this is not the case. You may experience irritability during the required two-week period of symptoms. Or, you may experience your depression as physical pain. If you even meet one of the symptoms listed above (particularly the suicide symptom), it would be a very good idea to consult with a mental health professional. If you have several symptoms, you definitely should schedule an appointment.
In addition to major depressive disorder, depressive symptoms may also be caused by bipolar disorder, or may happen with another condition. Bipolar disorder is typically characterized by alternating moods and energy levels happening over months, weeks or days. Symptoms may include periods of hyperactivity, fast speech, hyper sexuality, lack of need for sleep, feelings of inflated-well-being; and corresponding periods of depression where some or all of the symptoms listed above are present. Extensive information concerning bipolar disorder can be found in our Bipolar Disorder topic center.