Understanding Passive Suicidal Ideation

When I was about 11 years old, I would maladaptively daydream about running away, leaving everything behind and essentially disappearing. At the time, I perceived it as a way to effectively disengage from reality and create an inner world that felt safer and more manageable. Over the years, I realized that I was in fact struggling with passive suicidal ideation and was coping by the only way I knew how to, which was to maladaptively daydream. 13 years later, my chronic passive suicidal ideation has evolved and fluctuated over time. Eventually, I slowly learned how to develop healthy coping skills and have honest conversations in effort to better navigate the thoughts in my day-to-day life.

Often, when the topic suicidal ideation arises, the immediate association is of individuals with active thoughts of suicide. However, suicidal ideation exists on a spectrum ranging from passive to active. Lesser known, passive suicidal ideation is the desire to die without actively creating a specific plan to reach that outcome. The ideation and thoughts can manifest in many forms, such as:

• Wishing one was never born

• Having an indifference to being alive or thinking about the future

• Wishing for a fatal external factor (e.g. cancer, car crash) to happen

• Having persistent feelings of hopelessness, emptiness or numbness

• Doing risky behaviors (e.g. crossing the street without looking or recklessly driving)

• Isolating oneself

• Having recurring thoughts of death

Outwardly, individuals with passive suicidal ideation may say statements like, “I can’t imagine where I’ll be a year from now,” “If one more thing happens, I don’t know if I’ll be able to handle it” and “I hope someone crashes into my car”. In essence, passive suicidal ideation spans from having an indifference towards being alive to questioning one’s purpose and existence to having a gnawing feeling that life is not worth living, and is portrayed differently for each individual.

While it is not fully understood why passive suicidal ideation occurs, there are risk factors to be aware of to better understand the causes. These risk factors can include but are not limited to: 

• Mental health illnesses and/or substance use disorders

• A history of trauma, violence, abuse and/or neglect

• A family history of suicide

• A loss of a loved one

• Feelings of hopelessness, worthlessness, rejection and/or isolation

• Low self-esteem

• Barriers to accessing mental health care (e.g. transportation, finances)

• Previous history of attempting suicide

• Financial uncertainties or difficulties

• Increased stress due to work or family circumstances

• A serious health condition or disability (e.g. chronic illness)

• A lack of support and acceptance (e.g. being a member of the LGBTQ+ community)

Passive suicidal ideation can ebb and flow, remain stagnant or eventually dissipate with the proper treatment. According to a meta-analysis of 86 studies, the prevalence of passive suicidal ideation ranges from 5.8% for one-year prevalence to 10.6% for lifetime prevalence in the general population. While passive suicidal ideation is serious, some people downplay the severity due to feeling as if because they are not in immediate physical danger, their ideation does not warrant professional help. However, the reality is that passive suicidal ideation should not be taken lightly. Left unchecked, passive suicidal ideation can develop into active suicidal ideation. Likewise, passive suicidal ideation can be triggered into becoming active by events such as a decline in mental and/or physical health, a transition period (e.g. moving), a conflict with loved ones and a particularly bad day/week/month.

With that said, passive thoughts of suicide, however fleeting, should not be dismissed. Even if an individual has no intention of acting on their desires, it is impossible to predict life’s stressors. Thoughts of suicide can change in intensity and frequency without warning. While suicide risk is not as imminent, it is still there. It is crucial to utilize healthy coping skills and obtain mental health treatment.

Some of the coping skills for passive suicidal ideation are:

• Identifying and understanding underlying triggers that contribute to suicidal ideation

• Engaging in self-care, such as having a structured sleep schedule, an exercise routine and consistent meals

• Exploring activities and hobbies that allow breaks from stressors and create relaxation

• Identifying and engaging with a support system that provides unconditional acceptance, encouragement and a sense of belonging

• Challenging maladaptive thought processes to increase self-awareness and empowerment

• Finding and remembering life connections (i.e. anchors) that serve as reasons for staying alive

• Creating a safety plan to reduce the risk of future harm

For me, some of my coping skills are jamming out to music, going on scenic drives, ensuring I have things to look forward to (e.g. socializing and planning trips), getting tattoos, writing poems, trying out new cuisines, exploring new places and watching funny videos. As well, I utilize the Emmengard’s Suicide Scale with my current therapist to help me better conceptualize and articulate where I am with my chronic suicidal ideation.

Some of the following treatments for passive suicidal ideation are:

• Therapy

  • Therapy can be highly beneficial for those experiencing passive suicidal ideation. The types of therapy commonly suggested for passive suicidal ideation are: cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), motivational interviewing for suicidal ideation (MI-SI) and cognitive therapy for suicide prevention (CT-SP).

• Medication

  • For individuals with passive suicidal ideation, medication can help improve their mood, reduce symptoms and address underlying causes of suicidal ideation.

• Hospitalization

  • If an individual’s thoughts of suicide become active and they are at risk to themselves, inpatient and outpatient hospitalization is valuable in keeping the individual safe and determining the next steps towards wellness and recovery.

If you are unsure if someone is passively or actively thinking about suicide, the main difference between the two is individuals with passive suicidal ideation do not have a plan whereas individuals with active suicidal ideation have a clear intent to end their life and have a detailed plan to do so. For guidance on how to navigate when someone may be actively thinking about suicide, the following blogs provide further information:

• https://www.mhainde.org/suicide-prevention-part-1-how-do-i-know-if-someone-is-thinking-about-suicide/

• https://www.mhainde.org/suicide-prevention-part-ii-how-do-i-talk-to-someone-about-suicide/

• https://www.mhainde.org/suicide-prevention-part-iii-how-do-i-help-someone-who-is-thinking-about-suicide/

If you or someone you know is having active thoughts of suicide, please call or text 988 to reach the 988 Suicide & Crisis Lifeline. Support is also available via live chat at 988 Suicide & Crisis Lifeline. If you or someone you know is experiencing a medical emergency, has taken an overdose or has harmed themselves in any way, please dial 911 immediately.

References:

• https://www.refinery29.com/en-us/what-is-passive-suicidal-ideation

• https://www.choosingtherapy.com/passive-suicidal-ideation/

• https://www.harmonyridgerecovery.com/passive-suicidal-ideation/

Staff Blogger: Jaycee Wendell

Jaycee Wendell (they/them) is a recent cum laude graduate from the University of Delaware with dual degrees in Human Services- Clinical Concentration and Sociology. They are a Community Educator at The Mental Health Association in Delaware. Jaycee is passionate about advocacy, social issues and human rights, especially for the LGBTQ+ community and disability community. In their free time, they like to be creative, go on adventures and explore nature.