For those who do not suffer from a psychological or psychiatric disorder, the behaviors that result from them can be difficult to understand. The paradigmatic example are those that lead people to harm themselves or even end their life, contrary to what we are taught that it is the most basic ultimate instinct that governs human behavior.
And yet, today suicide is the leading cause of unnatural death in Spain. In 2019 there were 3,671 victims of this tragedy, and the pandemic has only multiplied the number of attempts registered. For its part, self-harm, when it is not intended to end one’s life, is tremendously difficult to quantify, but the Madrid College of Psychologists estimates that they have grown by around 250% since the end of confinement.
“Both suicide figures and self-injurious behaviors without intention of death constitute an important public health problem,” explains Rubén Sanz Blasco, professor of psychology at the Complutense University of Madrid and director of the Quartz Center for Scientific Psychology , to 20Minutos. also that the nature of these behaviors is complex.
“There are a large number of variables behind these behaviors”
Sanz explains that it is difficult to explain why people resort to harming themselves without being simplistic. “There are a large number of variables that operate in its manifestation”, he argues, “some are not modifiable (for example, it is more frequent in women), others have more to do with some personality traits (such as impulsivity), consumption of substances, depressed mood , a general emotional dysregulation, certain negative cognitive styles based on guilt and internal responsibility, a poor self-image … “.
Self-harm, a dangerous escape route that is increasing in adolescents
“What we could say is that, with greater complexity and negative affective intensity , it would be more likely that some of these behaviors appear,” he concludes.
Sanz details that these two types of behaviors are not homogeneous and have some root differences: “Although in clinical reality there may be some ambivalence and overlaps between the two, and sufficient evidence indicates that self-injurious behaviors are an important predictor of suicide.” , he points out, “there are three important parameters to differentiate both concepts: repetition, the level of lethality of the associated behaviors and the intention or objective. A suicide attempt would have the objective of ending life, in self-harm where the ends can be very particular and diverse “.
Some of these objectives, he adds, are “to regulate negative emotional states, influence the affections or behaviors of others, such as self-punishment or the search for sensations”, compared to suicidal behaviors “in which the person, defenseless and hopeless, considers death as a viable option to stop suffering “.
“Sadness and depression are constant in both of us”
In any case, “sadness and depressed mood would be constant in both,” says this expert, which does not mean that some general differences between them cannot be established .
“As for other risk factors that interact in suicidal behavior, we know a good number of them, such as previous attempts, low social support, consumption of substances and alcohol, a family history of suicide, having experienced bullying situations , encountering barriers to accessing aid resources or having recently suffered a significant loss, “Sanz lists.
On the other hand, “certain self-injurious behaviors such as cuts on the arms or burns without intention of death are very frequently associated with certain psychopathological conditions such as borderline personality disorder (which is fundamentally characterized by significant affective and interpersonal instability, micro episodes -psychotic, impulsivity and difficulty regulating emotions). It can also occur in other problems characterized by high emotional reactivity or in neurodegenerative pathologies, but less frequently “, he concludes.
“Adolescence is especially vulnerable”
Often, when this problem has been publicly addressed, it has been emphasized the increasing incidence that both behaviors have among the youngest. “Adolescence is a stage of transition between childhood and adult life, of learning and changes”, comments Sanz in this regard.
Depression remains a great unknown.
“It is especially vulnerable, since people do not have enough maturity or sufficient skills to deal with our negative emotional states in a satisfactory way and this means that, under certain conditions, some dysfunctional behaviors can appear. If a dysfunctional environment is added or negligent with low socio-emotional support, the presence of a pathology without adequate treatment, problems in social relationships or any other factor, the risk multiplies ” , he continues.
In conclusion, “The sum of risk factors, more psychopathology, lack of resources or adequate treatments and the lack of a support network or that it is disorganized increase the probability of suicidal or parasuicidal behaviors”, he adds.
“Speaking it minimizes the possibility of the idea becoming an act”
Along these lines, even for professionals each of the cases that come to the clinic pose a great challenge. “Self-harm behaviors with or without suicidal intent are a complex reality and, therefore, their approach is also complex, ” develops Sanz.
“Carrying out a thorough evaluation of what is happening is essential, since the way of dealing with self-injurious behavior with the intention of death will not be the same as with the purpose of emotional regulation or of another type. If we are talking about a person in which we detect suicidal ideation, the most important thing is to create a climate of listening and security “, adds this expert.
Regarding this, Sanz dismantles a very widespread myth: “Despite what is often thought, talking about it allows the person to air their emotions and feel relieved, and that we can offer alternative plans of action, minimizing the probability of that the idea becomes an act “.
“We must never underestimate what they are telling us”
However, this does not mean that at any given time it may not be necessary to use other strategies: “You have to prioritize the safety of the person. If necessary, even reaching more restrictive measures such as hospital admission until the patient is overcome. the most acute phase of the clinical picture “.
In any case, he sums up, “what we will never have to do is underestimate what a person is telling us in relation to suicide ideas, we will always have to take them very seriously and assess them carefully. When in doubt, it is much better to support acting with prudence and caution “.
“The first step is to communicate that you are suffering”
For all those people who at any given moment may feel the impulse to hurt themselves or even end their life, Sanz argues that what they should do depends on the help network they have: “If you are already in the circuit of a therapeutic service, it is best to communicate your feelings to the people who are helping you. Professionals will have to give the most timely support and help at all times, depending on the particular characteristics of the problem and the urgency required, generating plans for action for each situation that may occur and providing resources to turn to if necessary “.
“If, on the contrary, it is a person who is not yet under the supervision of any professional, I would recommend asking for help, expressing what is happening to you, not keeping it to yourself. If you do not know where to turn, tell your family and closest friends with Those who feel more wrapped up and understood can be a good option. The first step is to communicate that you are suffering , open up, even if it is difficult, and say “I can’t, I need help”, “he continues.
“Being alone in the face of these problems can be counterproductive”
In the latter case, it is also important to know how to act when we observe that a close person is in this situation or even asks us for help. “Knowing that a person may have suicidal intentions can be very distressing and the most common is not knowing what to do or where to go if necessary,” acknowledges Sanz.
“Although there would be many considerations to take into account, in short it will never be necessary to minimize the suffering of those who are communicating that they wish they were not alive, it is a huge mistake to think that whoever says it is not going to do so,” he explains. “A large proportion of people who commit suicide had previously reported it more or less explicitly.”
“It is a huge mistake to think that whoever says it is not going to do it”
“The ideal thing is to give him support, listen to him and encourage him to vent in order to promote sufficient emotional closeness to try to lead him to the help of professionals,” he continues, although emphasizing that “in the event of suspicion (some signs could be sudden changes in mood with sudden improvements, closing or resolution behaviors, neglect of personal care, severe sleep problems, risky behaviors …) or the evidence that a family member or friend may be thinking about suicide, it is not advisable to treat to take care of the situation on our own. “
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“Staying alone in the face of this type of problem without professional support or doing” home treatments “can be not only exhausting but also dangerous and tremendously counterproductive.”
“The most advisable thing is to give him support and encourage him to seek professional support”, develops Sanz. “In the first steps it could be good to accompany him to the first consultation or to an emergency service.” If we are facing an extreme situation where the person is developing a behavior that can clearly cause significant damage or threaten his life, it is best to put it in the knowledge of the emergency services trying not to leave the person alone. “
“Without resources in public health, everything remains in theory”
Be that as it may, Sanz defends that it is not a problem that concerns only those who suffer to hurt themselves or wish to end their life, nor only those close to them: “As a society, we must generate a greater number of resources that they take proper care of mental health problems in general and the phenomenon of suicide in particular “.
“Without money, resources and more psychologists in public health who can offer quality treatments, almost everything we know to do in the face of this type of problem will remain in mere theory and the statistics will unfortunately continue to increase,” he says.