Compulsive: A great deal is known about suicide, but clearly, it is always better to assume that the threat is quite real. That said, I have seen more than a few patients who use suicidal threats to control friends, family, and doctors t.
However, here are some of the factors that need to be weighed when assessing suicidal threat:
1. Does the patient currently have a diagnosable mental disorder – examples include depressive disorders, substance abuse disorders, and some of the more severe personality disorders? Is the patient obsessive-compulsive.
2. Does the patient have a personal history that would lead to suicidal concerns – examples include prior suicidal attempts, aborted attempts or other forms of self harm?
3. Does the patient have a current medical diagnosis – examples would include orthopedic and pain disorders?
4. Is there a family history of suicide, suicidal attempts or mental disorder?
5. What are the patients individual strengths as well as vulnerabilities?
6. What are his/her coping skills, personality traits, past responses to stress, capacity for reality testing and history of tolerance of emotional pain?
7. What is the patient’s current psychosocial status – for example are there chronic and acute stressors, a recent change in status, the quality of the support system and the patient’s religious beliefs?
8. What is the nature of the suicidal ideation, plan, behaviors, intent, and method being considered (Eg. do they have access to a firearm)? Is the patient joyless, anxious and does the patient believe that they have a reason for living? Are they currently substance abusing? Do they also have homicidal ideation?
This is the briefest of overviews, but suffice it to say that despite the use of such threats as a form of malingering, all suicidal threats need to be taken seriously and assessed professionally.