The invisible suffering: Suicidal thoughts in those affected by childhood trauma.

Introduction

Victims of childhood trauma are more likely to have suicidal thoughts or to attempt suicide compared to the general population. The relationship between childhood trauma and suicidal ideation is complex.

The impact of childhood trauma on mental health is significant, leading to depression, anxiety and complex post-traumatic stress disorder (cPTSD), which can increase the likelihood of suicidal thoughts. 

Pete Walker’s “Four F Model” of trauma responses can help explain the link between childhood trauma and suicidal thoughts. In contrast, Arielle Schwartz’s approach to healing from trauma and suicidal thoughts emphasises the importance of building self-esteem, developing healthy coping mechanisms, and creating a sense of safety and stability.

If you or someone you know is struggling with suicidal thoughts, it is vital to seek support and treatment. Many support services are available for people struggling with suicidal thoughts, such as crisis hotlines, therapies, and support groups. A safe and supportive environment is essential for those struggling with suicidal thoughts. Take the courage to seek help. If everyone understands the link between childhood trauma and suicidal thoughts, we can better support those affected and reduce suffering.

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Childhood trauma: Self-defeating Coping Strategies Worksheet

Suicidal thoughts – definition

Suicidal thoughts are depressive thoughts or fantasies about wanting to die. They can range from active suicidal ideation to passive suicidal ideation. 

Myths

Modern suicide research has been able to refute persistent myths in recent years. The most important claims that have been proven false are:

– People who talk about suicide will not commit it.

– Suicide happens without omens.

– Suicide is hereditary.

– All those who commit suicide are mentally ill.

The last false assertion also includes the widespread assumption that every suicidal or parasuicidal act is reportable or must result in hospitalisation, and that is not true.

The levels of suicidality are often presented on a scale from 0 to 5, with each level reflecting the severity of the suicidality. The following are the general levels:

1. no suicidality: no thoughts or plans to harm or kill oneself.

2. suicidal thoughts: thoughts about death, desire to die, without a specific plan.

3. suicidal intentions: A desire to die accompanied by a plan without a clear intention to carry it out.

4. suicidal actions: An act or specific preparation aimed at hurting or killing oneself, but still without a clear intention to do so.

5. suicide attempt: a concrete attempt to harm or kill oneself, not resulting in death.

6. suicide: a successful suicide.

Types of suicidality:

Some of the most common types, which can be distinguished according to the circumstances and motivations of the person involved, are:

1. acute suicidality: a sudden and acute deterioration in an emotional state that may increase the risk of self-harming behaviour or suicide.

2. chronic suicidality: recurrent or persistent suicidality due to trauma, mental disorders, or other factors.

3. covert suicidality: a state in which an individual hides suicidal thoughts or intentions, often by avoiding talking about the subject or by pretending to be happy or content.

4. impulsive suicidality: an action that occurs quickly and without warning, often without precise planning or preparation.

5. loss of control suicidality: a state in which an individual feels that they are losing control of their life and sees suicidality as the only way out.

6. parasuicidal acts: The term meaning intentional, non-fatal acts of self-harm or self-mutilation intended to relieve emotional pain or convey distress to others. These behaviours are sometimes referred to as self-harm. Examples include scratching, burning or other forms of self-harm that do not result in death. Nevertheless, they can be dangerous and are always signs of mental pain that must be treated. 

Stages of suicide:

1. consideration

2. ambivalence

3. decision

In the 1st stage, both psyche and external cues play a significant role. The struggle between self-preservation and self-destruction characterises the 2nd stage. Appeals can also occur here, which outsiders must recognise as such. It is not until stage 3 that there is usually a phase of calming down and, finally, a decision.

Suicidal thoughts have specific characteristics:

– Constriction

o Situational constriction

o Dynamic constriction with a one-sided orientation of perceptions, associations, affects, behavioural patterns and the weakening of defence mechanisms

o constriction of interpersonal relationships

– Aggression

o Inhibited aggression directed against one’s person

o Reversal of aggression

– Suicidal fantasies

o the idea of being dead

o preoccupation with the choice of remedy

Passive suicidality

In active suicidality, sufferers actively work towards taking their own lives. Passive suicidality is much more common in the cPTSD sufferers I have met. It ranges from wanting to be dead to fantasising about how to end your life. When sufferers of cPTSD lose themselves in passive suicidal thoughts, they may pray to be delivered from this life, or dream of redemption through some sinister act of fate. Some seem downright obsessed – without being serious – with throwing themselves in front of a car or jumping off a building. However, the fantasy usually ends without a serious intention to kill oneself. Passive suicidality is usually a flashback to early childhood when the child was so abandoned that it was natural for them to wish that someone or something would just put an end to it. For trauma victims, suicidal thoughts are a sign of psychological pain and a particularly intense emotional flashback. 

I. Understanding the connection between childhood trauma and suicidal thoughts.

Several mechanisms can explain the complex relationship between childhood trauma and suicidal ideation. The type of childhood trauma experienced, including physical, sexual, and emotional violence, abuse, or neglect, will impact mental health differently, further complicating the link between childhood trauma and suicidal ideation.

Emotional dysregulation

Emotional dysregulation is one mechanism through which childhood trauma can contribute to developing suicidal thoughts. Those affected by childhood trauma may have difficulty managing their emotions. Dealing with stress and stressful situations becomes more complex, and the risk of suicidal thoughts increases. 

Hopelessness

Similarly, childhood trauma can lead to feelings of hopelessness and worthlessness, which can also contribute to suicidal thoughts. 

Warning signs

To appropriately support and treat those affected by childhood trauma struggling with suicidal thoughts, it is essential to recognise the signs of suicidal thoughts and behaviour, such as withdrawal from loved ones, changes in behaviour and increased alcohol or drug use. Suicidal thoughts and behaviour must be taken seriously, and early intervention can decisively reduce the danger: this creates space for a safe and supportive environment and support.

In summary, childhood trauma can contribute to the development of suicidal ideation through emotional dysregulation and feelings of hopelessness and worthlessness. Early intervention, a safe and supportive environment, and appropriate treatment tailored to the individual’s experience can reduce the risk of suicidal thoughts and behaviour. 

II. The Four F’s and suicidal ideation.

It may be helpful to refer to Pete Walker’s “Four Fs” model of trauma response, which includes Fight, Flight, Freeze and Fawn, to shed light on the relationship between childhood trauma and suicidal ideation. This model can be used to explain why those affected by childhood trauma may develop harmful coping mechanisms that ultimately contribute to feelings of hopelessness and worthlessness and eventually to suicidal thoughts. One example of such self-harming coping strategies is withdrawal (freeze), and another is the idealisation of loved ones (fawn). Those who know their 4 F‘s can actively address the underlying problems and develop healthier coping strategies. It is hugely important to recognise and examine negative thoughts that can become suicidal thoughts while supporting the development of coping mechanisms such as mindfulness, self-compassion, and problem-solving skills. 

Fortunately, not everyone affected by childhood trauma necessarily experiences these specific trauma responses, as everyone can respond to trauma in different ways. Nevertheless, the Four F model provides a valuable framework for understanding the relationship between childhood trauma and suicidal ideation, which can ultimately guide treatment and support for those affected. 

III. Healing trauma and suicidal ideation.

Arielle Schwartz’s approach to healing trauma and suicidal ideation emphasises the importance of developing self-awareness, creating a sense of safety and stability, and developing healthy coping mechanisms. This approach includes practices such as mindfulness, self-compassion, and trauma-focused psychotherapy.

In this process, sufferers learn to recognise triggers and deal with their emotional dysregulation. Developing a sense of safety and stability lays the foundations for personal growth for those affected by childhood trauma.

Grounding techniques such as deep breathing and progressive muscle relaxation can help trauma victims feel more connected to their bodies and reduce the risk of dissociation and suicidal thoughts. 

Mindfulness and self-compassion practices can help sufferers become more aware of their thoughts and emotions so they are no longer stuck in negative thought patterns. Self-acceptance and self-compassion also thrive in this soil. They are essential for anyone who did not have a chance in childhood to learn that they are lovable, that life can be worth living, and that the world can be beautiful. 

Through a holistic approach that addresses the individual trauma consequences, therapy helps those affected by childhood trauma to gain a sense of security, self-confidence, and self-compassion.

In summary, building self-awareness allows for developing healthy coping mechanisms and creating a sense of security and stability.

IV. An action plan for sufferers and their families.

1. get support: contact a therapeutic facility, a crisis hotline, or a support group to seek support. It is important to remember that help is available and that there is no shame in seeking help.

2. Create a safe environment: Victims should create a safe and supportive environment for themselves. That includes removing items that could be used to self-harm, such as weapons or pills, and building a support system of close people who can provide emotional support and check on them regularly.

Develop healthy coping strategies: Victims of childhood trauma can develop healthy coping mechanisms to manage the emotional dysregulation contributing to suicidal thoughts. These can include mindfulness practices, self-compassion and grounding techniques.

4. Participate in therapy: Psychotherapy can help them overcome the underlying issues contributing to suicidal thoughts.

Here are some you can help ways loved:

1. Provide emotional support: Relatives should provide emotional support and create a safe environment for the sufferer of childhood trauma.

2. Encourage therapy: Relatives can encourage the trauma victim to seek therapy.

3. Look for warning signs: Relatives should watch for signs of suicidal thoughts and behaviour, such as withdrawal from close people, changes in behaviour, and increased alcohol or drug use.

“I want to kill myself.” 

These four horrible words come as a shock. Whoever says them is a friend or family member you don’t want to lose. You recoil at the thought. How can anyone want to die?

As terrible as these words sound to your ears, your loved one has given you a gift. They are sharing something important with you. Whoever tells you that they want to die allows you to help.

What you say now is crucial, and it will result in your friend or family member taking you into their confidence even more or closing the door. Understandably, you will be subject to strong feelings, and many thoughts will run through your mind, some of which will be helpful and others will not.

Ten things you can say to someone who tells you they are thinking about suicide:

1. “I’m so glad you told me you were thinking about suicide.”

When someone expresses suicidal thoughts, some parents, partners, friends, and others react with anger (“Don’t be stupid!”), hurt (“How could you think of hurting me like that?”) or disbelief (“You can’t be serious.”). Some “freak out”. Affected people may then feel the need to comfort the other person, defend themselves or withdraw inwardly. They may regret having spoken of suicidal thoughts at all.

The message: “I’m glad you told me”, on the other hand, conveys what you indeed feel: that you welcome and encourage the disclosure of suicidal thoughts and that you can deal with so.

2. “It makes me sad how much you are struggling.”

This simple expression of compassion acknowledges the person’s pain and eases and sense of being alone. But no: “It’s not that bad”, “You don’t really mean that”, “But you have so much to offer”, nothing that denies or downplays the sufferer’s pain.

3. “What’s wrong that you don’t want to live anymore?”

This invitation for sufferers to tell their story can be validating, create a sense of connection and shows that you really want to understand. Let them tell you the whole story and listen. Really listen. And then let them tell you more, e.g., “Tell me more”. Also, show your concern: “That sounds terrible” or “I can understand why that’s bad.”

4. “Do you plan to act on your suicidal thoughts? When?”

Even without medical expertise, anyone can ask basic questions to understand suicidal ideation. Asking when, will determine whether you need to get help immediately or whether you can continue to talk calmly with the person.

5. “How are you going to kill yourself?”

This question is also used to assess risk. The answer provides information about the seriousness of the situation. Someone who has thought in detail about suicide methods is at greater risk than someone with only a vague desire to kill themselves.

Knowing the suicide methods will help you in your efforts to protect the person, e.g., lock up or throw away all potentially dangerous drugs. 

6. “Do you have a gun?”

This information is always essential, even if you think the person does not have or cannot get hold of a gun. If the answer is “yes,” ask the person to consider giving the weapon (or an essential part of the gun) to someone, lock the gun away, and give someone the key until the suicide risk has decreased. 

7. “Help is available.”

Telling victims about the help available can help them feel less alone, helpless, or hopeless. 

8. “What can I do to help you?

Be sure to point out help options to affected people, but make it clear that you are also available to help if possible. It is often best to involve others as well.

9. “I care about you, and I hope you stay.”

Be careful here. Affected people often already feel terribly guilty. Creating guilt does nothing to reassure or make them feel understood and does not invite them to share more.

At the same time, simply saying how much you care or love them can help create a sense of connection if your statement is not an attempt to discourage them from talking further about suicide.

10. “I hope you will continue to talk to me about such thoughts in the future.”

You do not want sufferers to feel ashamed or guilty for sharing their suicidal thoughts with you. Often someone with suicidal thoughts is expected to “get over it already”. By inviting the other person to continue sharing suicidal thoughts with you in the future, you prevent isolation and secrecy.

Here are ten common responses that can prevent sufferers from telling you more: 

While these statements generally represent judgement and rejection, depending on the context, some people may respond positively to at least some of these responses.

1. “How can you even think about suicide? Your life is not so bad after all.” 

Outwardly, the person’s life may not seem “that bad”. But there is pain, and understanding rather than disbelief and condemnation is essential. 

2. “Don’t you know I would be devastated if you killed yourself? How can you hurt me like that?” 

Affected people already feel terrible. If you now also create feelings of guilt, sufferers will neither feel reassured nor understood and will certainly not tell you more. 

3. “Suicide is selfish”. 

That leads to even more feelings of guilt. Two points are important here. First, those who seriously consider suicide believe they will be a burden to their partner and family if they stay alive – especially sufferers of cPTSD. So in their desperate state, they want to help loved ones and relieve them of this burden. Secondly, is it not natural to want to escape unbearable suffering? 

4. “Suicide is cowardly.” 

That arouses feelings of shame, and it is also illogical. Most people are afraid of death. While I hesitate to call suicide brave or courageous, overcoming the fear of death is not cowardly, in any case.

5. “You don’t mean that. You don’t really want to die.” 

This statement is often simply a result of fear for the person concerned. But it downplays and devalues. Assume that sufferers mean what they say, especially on this subject. It does more harm to dismiss someone who is genuinely suicidal than to take seriously someone who may not be.

6. “You have so much to live for”. 

That may be a reassuring reminder of success and hope. But for many people who are thinking about suicide and don’t feel at all that much is holding them back in life, this comment can express a profound lack of understanding. 

7. “It could be worse.”

It could always be worse, but this knowledge does not inspire joy or hope. Even though the lives of people who think about suicide could be much worse, those affected still experience a situation that is unbearable for them, forcing them to die. 

8 “Other people have worse problems and don’t kill themselves because of it”. 

That is true, and affected people have precisely considered that and probably feel deeply ashamed. People who want to die often compare themselves to others and do not come off well. Especially those affected by cPTSD, feel “different”, “wrong”, or like failures. Comparing themselves to others who are coping better or who were just lucky enough never to have suicidal thoughts will only reinforce this self-judgement. 

9. “Suicide is a final solution to a temporary problem”. 

I know people, especially young people, who this statement has helped, and it could get through to them. But it mainly conveys to sufferers that their problems are temporary while they may be anything but. Instead of showing that dealing with issues can make for a meaningful life, this sentence conveys in the first place that suicide is a “solution” and a permanent one. At the very least, I recommend replacing the word “solution” with “reaction” simply to avoid this problematic statement. 

10. “Suicide is sin”. 

If your loved one is a believer, they have probably considered this possibility. Perhaps they don’t believe in hell. They may also think the God they believe in will forgive their suicide. Regardless, none of these beliefs changes the desire to die, and pointing out the sinfulness of suicide is just a rejection.

At the end of all days, you are human. We all feel angry, hurt, and betrayed. We cannot control the thoughts and feelings that come over us. But we choose what to say or do in response to our thoughts and feelings.

V. Resources for help:

Many online resources in English and German can help people with complex post-traumatic stress disorder (cPTSD) and acute suicidal ideation:

– National Suicide Prevention Lifeline (US): 1-800-273-8255

– Crisis Text Line (US): Text HOME to 741741

– Samaritans (UK): 116 123

– Lifeline (Australia): 13 11 14

– Deutsche Gesellschaft für Psychotraumatologie, Traumatherapie und Gewaltforschung e. V. (DGPT): The DGPT is a professional association for trauma therapists and researchers in Germany. Its website offers resources and information for people seeking help with trauma-related problems. https://www.degpt.de/servicebereiche/wichtige-links-und-telefonnummern/  

– TelefonSeelsorge: TelefonSeelsorge is a 24-hour helpline offering free, anonymous emotional support for people in crisis. It can be reached on 0800 111 0 111 or 0800 111 0 222. https://www.telefonseelsorge.de/Selbstmordpraevention/  

– Hospital for psychiatry and psychotherapy: Many hospitals in Germany have psychiatric departments that offer special treatment for people with acute suicidal thoughts. A list of hospitals with psychiatric departments can be found on the website of the Clinics for Psychiatry and Psychotherapy: https://klinikradar.de/psychiatrie/kliniken/ 

– Deutsche Depressionshilfe: The Deutsche Depressionshilfe is a non-profit organisation that provides information, resources and support for people with depression and related mental health problems. https://www.deutsche-depressionshilfe.de/regionale-angebote/nuernberg/hilfe-und-beratung  

– German Society for Suicide Prevention (DGS): The German Society for Suicide Prevention (DGS) is a professional organisation for suicide prevention in Germany. Their website offers information and resources for people and their relatives who have suicidal thoughts or have been affected by suicide. https://www.Selbstmordprophylaxe.de/hilfsangebote/hilfsangebote/  

– Nummer gegen Kummer for children and young people (Germany): 116-111 https://www.nummergegenkummer.de/kinder-und-jugendberatung/kinder-und-jugendtelefon/

For those affected by childhood trauma and their relatives, it is essential to remember there is hope for healing and that they are not alone. Even seeking support and treatment can significantly reduce the risk of suicidal thoughts and behaviour.

In addition to the resources listed above, there are many online communities and support groups for those affected by childhood trauma and people with suicidal thoughts. These groups provide a safe and supportive space where those affected can share their experiences and interact with others who may be going through similar challenges.

VII. Summary:

Childhood trauma can have long-lasting effects on mental health, including an increased risk of suicidal thoughts and attempts. However, with the proper support and treatment, those affected by childhood trauma can begin to heal and reduce the risk of suicidal thoughts.

Understanding the complex relationship between childhood trauma and suicidal thoughts is critical to addressing the unique challenges that those affected by childhood trauma face. Strategies and techniques developed by experts such as Pete Walker and Arielle Schwartz can provide a framework for healing, including building self-awareness, developing healthy coping mechanisms, and creating a sense of safety and stability.

For those affected by childhood trauma who struggle with suicidal thoughts, seeking support and treatment to learn healthy coping strategies to deal with emotional dysregulation is vital. Family members also play an essential role by providing emotional support and encouraging participation in therapy.

Online resources and helplines are available for people struggling with mental health issues, including suicidal thoughts. Take the courage to use these resources.

Remember that overcoming childhood trauma is a growth process that takes time and effort. The first step towards seeking support is a brave and necessary step towards a better future.

Sources:

Preston, J. D. (2006). Integrative Treatment for Borderline Personality Disorder: Effective, Symptom-focused Techniques, Simplified for Private Practice. New Harbinger Publications.

Schwartz, A. (2016). The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole. Althea Press. 

Schwartz, A. (2020). A Practical Guide to Complex Ptsd: Compassionate Strategies to Begin Healing from Childhood Trauma. Rockridge Press.

Walker, P. (2013). Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. CreateSpace. 

Walker, P. (2015). The Tao of Fully Feeling: Harvesting Forgiveness Out of Blame. Createspace Independent Publishing Platform.

https://www.speakingofsuicide.com/2017/10/03/10-things-to-say/

https://www.speakingofsuicide.com/2015/03/03/what-not-to-say/

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Childhood trauma: understanding and overcoming toxic shame and cPTSD. Childhood trauma: the Importance of Self-Care in cPTSD Breaking the vicious circle: toxic relationship and childhood trauma Toxic shame: understanding and overcoming its effects