What is suicidal behavior?

When we want to understand a problem, it is essential to be able to define it, to have basic concepts that allow us to understand its scope and how it relates to other behaviors. In the case of suicidal behavior, this need is especially important, since even today there is no internationally agreed-upon definition.

We know we are dealing with suicidal behavior when a person exhibits some degree of intent to end their own life . This intention to end one's own life is the unique element that allows us to identify suicidal behavior; therefore, it must be established as the objective of all interventions , whether clinical, involving family or social support, formal or informal. This intention to end one's own life evolves in a gradual process, from lesser to greater severity, encompassing five elements :

• Suicidal ideation.
• Threats.
• Suicidal gestures.
• Suicide attempts.
• Death by suicide.

Suicidal threats are considered due to their importance and relevance in adolescence, and they often reveal the presence of suicidal ideation. The other four elements create a sufficient conceptual framework to define all suicidal behavior. Each element differs from the previous one because it represents a further step in the gradation of severity. Thus, suicidal gestures or preparatory acts are more serious than ideation, and attempts are more serious than gestures.

Given the explanatory power of these elements, the extensive lists of terms included in some definitions are considered unnecessary. For example, we commonly find the term "suicidal verbalization," but in this proposal, we understand verbalization to be the means or channel through which a person communicates one of the elements. That is, since we cannot read minds, the only way we can know if a person is thinking about death is if they tell us or verbalize it. Thus, if a person explains that they have carried out a specific action that could cause their death, they are not engaging in suicidal verbalization; they are explaining (verbalizing) that they have attempted suicide. Another frequently used term is "suicidal communication," an equally confusing expression, because everything in suicide is a communicative act , and it doesn't allow us to know what we are talking about.

Finally, we understand ambivalence as a process present in all human decisions. This is what gives value to " some degree of intention to end one's own life"; the degree is irrelevant, but its presence is. Thus, we do not consider any risky behavior, however dangerous, including self-harm without suicidal intent, to be suicidal behavior, nor do we use the term "parasuicide."

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An approach to the behaviors that constitute suicidal behavior:

Suicidal ideation

It encompasses all the processes of internal evaluation of the idea of ending one's own life. It results from reflection on aspects such as:

• Life situations.
• Expectations.
• The lack of a solution to a particular situation that causes discomfort.
• The lack of energy to do what one believes would get them out of the situation that generates discomfort.
• The feeling of being a burden to others.
• The satisfaction of oneself.
• Etc.

This suicidal ideation can include different phases :

• The desire or wish to be dead (passive ideation): "I wish something would happen to me"; "I'd rather be dead"...
• An internal thought about taking action against one's own life (active ideation): "I'm going to kill myself"; "I'm going to end it all"...
• Planning a suicide attempt: deciding on the day, the methods, etc. At its extreme, with the planning of the attempt, we would already be talking about a high risk of suicide.

Suicide threats

We understand them as the verbalization of these thoughts , but with an action-oriented focus, with the person's commitment to act on it. In adolescents, threats are very often the first indication we have of the presence of these suicidal thoughts, of these internal processes. It's worth remembering that adolescents can threaten us with many things, but if they threaten to end their own lives, it's because they've been thinking about it for some time.

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Suicidal gestures

Suicidal gestures refer to all the preparatory acts necessary to carry out a suicide attempt. We know it's a suicidal gesture when we understand what's happening without the person needing to verbally tell us what they're doing.

It is worth remembering that teenagers can threaten us with many things, but if they threaten to end their own lives, it means they have been thinking about it for a while.

Suicide attempt or self-harm attempt

We are dealing with a suicide attempt when a person, having prepared the situation, initiates a sequence of actions whose outcome they anticipate will be their own death. The defining element of a suicide attempt is the initiation of the sequence, regardless of when or why it ends. If the person begins the sequence and physical discomfort, fear of continuing, intervention by a family member, or any other reason interrupts it, we are dealing with a suicide attempt or self-harm attempt. These can be considered more or less lethal, if desired, but that does not negate the fact that we are dealing with a suicide attempt.

Death by suicide (completed suicide)

Death by suicide is the attempted suicide or self-destructive attempt that ends with the death of the person.