Suicide Risk

This guide explains the treatment of suicide risk based on the interpersonal theory of suicide, which was developed by Thomas Joiner. The interpersonal theory of suicide proposes that for a person to die by suicide, they must have both the desire to die and the capability to act on that desire. The desire to die can develop when someone experiences both thwarted belongingness and perceived burdensomeness. Thwarted belongingness is a profound sense of loneliness and feeling disconnected from others. The person feels isolated and believes they are not an integral part of any social group, family, or community. Perceived burdensome-ness usually includes self-hatred and the belief that one is a liability to others. The person feels that their existence is a drain on their loved ones financially, emotionally, or otherwise, and that “everyone would be better off if I were gone.” When people are hopeless about their feelings of loneliness or burdensomeness changing, they are at risk of developing the desire to die. People may have a dangerous risk of suicide if they have the desire to die and have acquired the capability to enact lethal self-harm. This capability develops over time through repeated exposure to painful, provocative, or fear-inducing events (like self-injury, trauma, pain, or combat), which increases a person’s pain tolerance and reduces their fear of death. When people have the desire to die and have acquired the capability to carry it out, they are at risk of making a lethal or near lethal suicide attempt.