Wednesday, November 23, 2011

What Is 'Suicidal Ideation' (Warning: Post Has Disturbing Contents)

This blog discusses what are already difficult subjects (BPD and Body Dysmorphia), but this post is about something I find particularly uncomfortable.  However, I find it necessary to clarify the distinction between suicide and "suicidal ideation."  The topic of Borderline Personality Disorder is difficult to begin with, and I already had to tread carefully to begin with.  However, I have to be even more careful with this one.

One of the nine criteria for diagnosing Borderline Personality Disorder (BPD) is the presence of "suicidal ideation." Now, most of us know what suicide is, but ideation is not a very familiar term.  What is suicidal ideation? explains, "Strictly speaking, suicidal ideation means wanting to take one's own life or thinking about suicide without actually making plans to commit suicide. . . . Suicidal ideation is one of the symptoms of both major depression and bipolar depression."

About.Com gives this example:  "Alice often imagined ending her own life in some dramatic way, like jumping off the highest bridge she could find - but it was only suicidal ideation because she really had no intention of actually doing any of the things she imagined."

Thus, to consider the possibility that someone possesses suicidal ideation, it is not necessary that this person actually sincerely plans to commit suicide.  If this person repeatedly contemplates how much sadness or pain would be ended by death or suicide, that is enough grounds to consider the possibility that this person suffers from suicidal ideation.  That applies even if you have a hard time imagining that this person actually would go through with killing her- or himself.

Now suppose that you know someone who has repeatedly and seriously mentioned, "I have a strong feeling that I am not willing to exist."  Suppose this person has made very visible self-destructive gestures, such as having a past of cutting her or his own wrists with a blade.  Suppose this person envelopes her- or himself in morbid imagery and -- absent of giving you any sort of coherent context for the behavior -- puts up self-disfiguring self-portraits in which this person is made to look like a pallid, gray-skinned dead body.  Now imagine that, when you talk with this person and people who know this person, it seems very hard to imagine this person would actually go through with suicide.  That last factor -- that it's hard to imagine the person going through with suicide -- does not preclude the possibility that the person in question is experiencing suicidal ideation.

In short, if someone continually fixates on morbid, self-destructive, self-disfiguring, or suicidal imagery, there is a chance that this person fits the "suicidal gestures" criterion of the BPD diagnosis, even if everyone in this person's circle finds it unlikely that this person would actually commit suicide.  (Of course, only a trained mental health professional can offer an official diagnosis.)  Should someone have suicidal ideation, that might fit one of the nine diagnostic criteria for BPD.

Now I will explain why this blog post requires even more caution than usual:  I must emphasize that I do not want to downplay the suicide risk of those who have BPD.  Out of those diagnosed with BPD, 1 in 10 actually do commit suicide. I neither want to overstate nor understate such dangers.  That rate is significantly larger than that of the general population. 

Even if you find it unlikely that you would ever commit suicide, I have the strong conviction that if you experience suicidal ideation -- or have experienced suicidal ideation over the past nine years -- it could be very important to return to psychiatric care.  Your life and long-term happiness are of profound significance.