CEHL:

Suicide and the Self-Destructive Child

Pamela Cantor, PhD
January 2009 (updated)

A note from Dr. Howard King, Founder of CEHL.org:
Suicide is the second leading cause of death among 15 to 19 year olds. 100 to 200 attempts occur for every “successful” event. Nine out of ten adolescents give warning signs before suicide attempts. Are there trigger events that should alert parents, schools, and pediatricians to increase their vigilance? I asked Dr. Pamela Cantor, a national expert on suicide, to provide some insight about this serious national problem for both parents and pediatricians.

In this article, Dr. Cantor considers two questions:

  • How can parents tell if their child is at risk for suicide?
  • If they think their child is at risk, how do they get help?

 

  Many parents aren't aware of the signs of trouble. Sometimes we (I am a parent, too!) don't look or we look but comfort ourselves that this depression or anxiety or odd behavior will just go away. We do that not because we are callous or unconcerned, but because we are scared that we will be held responsible or that we won't be able to help.

Parents often feel responsible for their children's unhappiness. Our society tends to blame parents for every ill that befalls children. (Unfortunately, parents often don't get the credit for the good things, just the blame for the bad.) Since parents anticipate they will be blamed, they hesitate to seek help for their troubled children.

Many factors contribute to anxiety and depression

Anxiety and depression are sometimes symptoms of mental illness. Genetics, the genes we pass on to our children, are largely responsible for serious mental illnesses. We know that genetics may predispose a person to develop schizophrenia, manic-depressive illness, anxiety disorders and depressive disorders. We know that certain infections can exacerbate a tendency to obsessive-compulsive disorder, and that stressful living conditions can trigger symptoms in children who are already vulnerable to anxiety.

We approach emotional problems differently than physical problems

If a child has abdominal pain, we take him/her to the doctor because we don't feel responsible for the pain and because it could be something serious, even life threatening. If, however, the pain is psychological (and psychological pain can as debilitating and life threatening as physical pain), we hesitate to take our child to a doctor.

It is important to remember that your child's depression or anxiety is not your fault, that you are not responsible for his/her emotional illness, but it is your responsibility to get him/her help.

  What should you look for?

Sudden changes in your child's behavior – such as your daughter crying a lot, not wanting to leave her room, refusing to take phone calls and not going out with her friends – indicate that she is trying to cope with emotional pain. This often means something has changed at school, she is suddenly being ostracized, someone has spread a rumor about her or her girlfriends have turned on her. It will pass as soon as the situation has been corrected.

Mood changes in adolescence are normal. Hormones bounce kids “up and down” while social and academic pressures bend them out of shape. But sudden changes that don't disappear with a new boyfriend or better test scores or renewed friendships should call for your attention.

There is a distinction between normal depressed or anxious feelings and a child or adolescent's clinical depression, which requires a therapist's or psychiatrist's help. The distinction centers on the severity and persistence of the symptoms. If dramatic changes in your child's behavior last beyond a reasonable period of time – a few weeks on the average – that should be a cause for concern.

Some symptoms of depression and anxiety

Sleep problems – Some depressed or anxious children and adolescents are unable to fall sleep; they toss and turn all night. Others fall asleep easily but awaken at 3:30 a.m. , unable to get back to sleep. Some sleep for as many as fourteen hours a day to escape from their worries.

Eating problems – Some adolescents gorge themselves to fill the “empty” feelings of depression or to relieve their anxiety. Others won't eat at all and starve themselves. Others eat and then vomit to relieve psychological pain by causing a physical release. Fatigue – You often hear a depressed adolescent say, “I'm tired all the time. I can't cope any more.”

Apathy – They lose interest in activities, which used to bring pleasure, like sports, clothes, friends and social activities.

Withdrawal – They don't want to communicate with anyone. They don't take or return phone calls. They isolate themselves, to prove they are unlovable or unacceptable.

Lack of concentration – Homework or hobbies no longer hold their interest or attention.

Self-deprecation – They don't like themselves. They say things like, “I am ugly, fat, skinny, worthless, stupid. No one cares about me.”

Self-harm – Some adolescents cut or burn themselves to release the natural opiates in the body that can induce calm and relieve emotional pain and distress.

Sadness – They cry without apparent reason. They cannot express joy.

Feelings of doom – They think about, write about and talk about dying.

Avoidance – They cannot get up for school, they refuse to leave the house.

When you need to become involved

Seeing one or two of these symptoms for a limited period of time does not suggest a clinical depression. But if you see several of these signs, and they seem intense and seem to last, you need to pay attention.

The scary thing about depression is that the young person believes the depression will never end. The scary thing about intense anxiety is that it is intolerable. Often the young person thinks they would rather die than endure this pain.

The fear that life will never be any different (the hopelessness) and the fear of not being able to make it any different (the helplessness) makes them unable to do anything that would help them feel better; it is here that you need to step in and do something.

How can I tell if my child is truly in danger?

Even if your child is suffering from depression, it does not mean he/she is about to kill him/herself. All adolescents who are clinically depressed do not kill themselves, and young people who kill themselves are not necessarily depressed. However, there is a significant overlap between the two.

Depression does alert us to start looking for factors, which could put a young person at greater risk for suicide.


What are the risk factors?


A young person may be at risk for suicide who has:

Made a suicide attempt or gesture in the past

Talked about or threatened suicide

Made a specific plan to take his/her own life and has given away things he/she likes.

Shown a preoccupation with death

Known someone who has committed suicide – Kids may emulate someone who has committed suicide and model their actions on his or her behavior.

Recently experienced a loss – This could be the loss of a person through death, leaving town or a quarrel. Or it could be the loss of self-esteem through failure or rejection.

Been abusing alcohol or drugs – Depressants and stimulants can be attempts at self-medication. Kids abuse alcohol or drugs to escape problems and block out feelings of sadness. It never works. The temporary relief wears off and the adolescent feels more depressed and less able to cope than before.

Shown a tendency to act impulsively or violently

Shown no motivation to tackle any problem and seems blind to any solution

Held perfectionist standards that cause him/her to be very critical of him/herself

Talking with your child

If you are worried about the presence of these symptoms, talk to your child. Or, better yet, listen to your child. Your child may be quite uncomfortable talking to you about these things and no doubt you will feel anxious too. You can both talk about how anxious you feel, but do pursue your concerns in spite of the discomfort.

If you ask directly about suicidal thoughts and your child denies any, remain watchful. Offer to help think through the problems he/she does talk about. Perhaps you can offer some potential solutions, but expect your suggestions to be rejected.

If your child is depressed, he/she cannot think of options. A depressed person can only see black or white, “all or nothing,” life or death, and any suggestions may fall on deaf ears. But they will be stored in the brain for future retrieval and you will have planted the seeds for solutions and shown support.

If he/she says, “Yes, I have been thinking about running away or killing myself,” ask for more specifics. Try to avoid asking, “Why?” as your child may not know. But do ask, “When,” “Where,” and “How?” If he/she refuses to talk to you, share your concerns with someone else, someone who might have your child's trust.

How to find help if I see these signs?

If you are worried about your child's safety, stay with him/her. It helps to let your child know that he/she is not alone and that you will stay involved. Think about what you can do to stall him/her until he/she can be more rational. Tell him/her that two heads are better than one when it comes to working on difficult problems.

Suggest that you seek help together because you may be too close and care too much to be sufficiently objective. Then call a psychologist, a psychiatrist or a mental health professional and ask for an immediate appointment. If you do not already have the name of a mental health professional you can call, ask your pediatrician for a recommendation.

If you are really scared that your child is unsafe, do not hesitate to take your child to an emergency room or call the police.

Be alert to potential sources of immediate danger

Most important, if you are concerned for your child's safety, remove potential lethal weapons from reach. Youngsters often act on impulse and use what is readily available. With the restricted vision common to suicidal thinking, adolescents will focus on the methods available in the kitchen cabinet or the garage. If they are thwarted, they usually do not shift to another idea.

Remove guns from your house. Take the car keys away. Do not leave sleeping pills or other medications around for someone who may see peace and relief in them. Set limits.

This is the time to be a protective parent, not a friend. I once had a patient who asked her mother for sleeping pills. Her mother refused, but her daughter pleaded with her to trust her and treat her like an adult. Fearing that she would undermine her daughter's love for her, she gave her the bottle of sleeping pills. The mother's desire to be her daughter's friend, when her daughter needed her as a parent, allowed the child to take an overdose of the sleeping pills.

Summary

If your child shows any of these signs or symptoms – be concerned, act concerned, and “do something.” Anything is better than nothing. Tomorrow may be too late. Trust your instincts and protect your child.

A third question parents ask is, “How can I raise a child who won't be at risk?” The companion article by Dr. Cantor, “Raising A Child Who Wants to Stay Alive,” addresses that concern.

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Support

I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.


- Dr. Howard King, M.D.