Reminder from the headlines: Suicide not just about depression

The Washington Post reported yesterday that the Virginia Tech shooter had an anxiety disorder as a child.   I don't want to say much more about that, and I don't know enough about Seung Hui Cho to know whether this did or did not play a role in his actions in April.

But such news can provide a useful reminder to review the prototypes and heuristics clinicians have in our heads about suicide.  Specifically, we need to resist the temptation to only think or ask about suicide in cases of depression.  Although depression is present in a large proportion of  people who die by suicide, suicide is by no means synonymous with depression.   Anxiety disorders, personality disorders, and psychotic disorders are all associated with risk for suicide.  This begins to make sense when you think about suicide often being a response to hopelessness, despair, agitation, and a feeling of being trapped (often with an overlay of substance abuse disinhibiting the person's symptoms and behavior).   When put that way, it's not hard to see how chronic intense anxiety could lead to suicidal thinking (or action).

I think this is something many clinicians know, but old prototypes can be stubborn and often get in the way of us accessing what we know.   When we refresh our thinking, we  can more effectively remember to to ask about suicidal ideation in every case, not just when depression is prominent.

Related posts:
Murder-Suicide, Domestic Violence…Common threads in violence against self and others

Suicide turned outward: Times of London Article by Dewey Cornell

Erratum on previous post: Cornell not author, just interviewed