The term suicide describes the act of taking one's own life. There are various kinds of suicide, so our first task is to clarify our use of the term. Within this article, we are referring to suicide in the conventional sense, in which someone plans out or acts upon self-destructive thoughts and feelings, often while they are experiencing overwhelming stress. “Assisted suicide” occurs when a physician helps a terminally ill person to die, avoiding an imminent, inevitable and potentially painful decline. Our current discussion of suicide does not address assisted suicide.
The intent of suicidal behavior, whether consciously or unconsciously motivated, is to permanently end one's life. Truly suicidal acts (or, as they are sometimes called, "gestures") need to be distinguished from other self-harming, self-injurious, or parasuicidal acts and gestures which are also deliberate, but not intended to cause death. Typical self-injurious acts include cutting or burning oneself. The intention behind these behaviors is to cause intense sensation, pain and damage, but not to end one's life. Self-injurious behaviors may lead to accidental suicide if they are taken too far, but their initial intent and goal are not suicidal.
Though self-injurious behavior is not suicidal behavior, it isn't exactly healthy behavior, either. If you engage in or have the urge to engage in self-injurious behavior it is also important that you seek mental health care. Dialectical Behavior Therapy (or DBT, as it is commonly known) is an effective and now widely available form of psychotherapy that helps people who injure themselves learn and practice alternative and safe means of coping with life stresses, and, by doing so, reduces their self-harming tendencies. Various medications, prescribed by a psychiatrist, can also be helpful in reducing the need to act out self-harming impulses.
Suicidal feelings and impulses sometimes co-occur with homicidal (i.e., murderous) feelings and impulses. Some people who feel that life is not worth living also come to feel that others' lives should not continue either. Such people may then decide to end the lives of other people prior to (or in conjunction with) killing themselves. Motivations behind suicide-homicide events can include a desire to punish some person (or people), or gain revenge over a those who have caused intolerable pain to the suicidal individual. Such events may also be motivated by religious beliefs or by military orders. Some examples of suicide-homicide include: suicide bombings, joint suicide, cult suicide, school or workplace massacres followed by suicide (such as the 2007 Virginia Tech shootings), or situations where people kill their families and then kill themselves. We aren't going to talk further about suicide-homicide events in this document. However, if you are experiencing both suicidal and homicidal impulses, for the safety of yourself and others around you, it is important that you get help for yourself as soon as possible so that these impulses can be properly and safely addressed.
Suicidal ideation is a term used by mental health professions to describe suicidal thoughts and feelings (without suicidal actions). For example, people experiencing suicidal ideation commonly report that they feel worthless, that life is not worth living, and that the world would be better off without them. The presence of suicidal ideation, occurring alone in the absence of any plans to act out actual suicide, anchors the low/less-dangerous end of the suicide risk continuum. The potential for someone engaging in suicide is still there, but the risk is not acute (i.e., immediate).
Even though suicidal ideation is considered less serious than actual suicide attempts, it can be a real cause for concern. The fact that suicidal ideation is occurring at all suggests a very real possibility that suicide could occur should circumstances become worse and stress levels mount. Anyone who has suicidal ideation is at some risk of becoming actively suicidal.
A further problem is that once suicidal ideation has become established, it can become a "cognitive habit"; something that reappears periodically and spontaneously during times of stress as an automatic and habitually negative, dysfunctional style of thinking. Such dysfunctional automatic thinking styles are especially common in people who are currently depressed or who are recovering from a previous period of depression. The continuing presence of such styles of thinking in a person who has recovered from depression can be a risk factor for further depression and for suicidal gestures.
Suicidal ideation is only dangerous to the extent that it motivates suicidal planning and actions. Moving from thinking about suicide to considering a specific suicidal plan represents an increase in the level of suicide-danger risk, no matter whether the plans made are concrete or vague; organized, or haphazard. When suicidal actions occur, the level of suicide-danger risk increases.
Actual attempts to kill yourself are labeled "suicidal gestures" or "suicide attempts" by mental health professionals, no matter how ineffective those attempts may ultimately be. Suicidal gestures may be acted out with full lethal intent, or they may be acted out half-heartedly, more as a means of communicating the depths of your pain to others around you than an actual effort to end your life. Regardless of the intent and degree of seriousness that motivates them, suicidal gestures are often dangerous events. Even ambivalent, half-hearted suicidal gestures can result in a completed suicide.