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Managing Suicidal Ideation

By Danielle Gordon LMFT

Suicide is the second leading cause of death in people affected by anorexia nervosa and suicidal behavior is increased in people diagnosed with bulimia nervosa. Having a loved one who is battling suicidal thoughts or is at an increased risk for an attempt can be scary and overwhelming.

Often, I hear from families that they do not think their child is suicidal or they feel afraid to explore this topic because it “might give them ideas.” While all these thoughts are valid, I want to bust through some of the myths around suicidal ideation and discuss how you can put safeguards in place to decrease your child’s vulnerability. 

Will talking to your child about suicide put them at greater risk for an attempt? No, it is quite the opposite! Talk about it and talk about it often, from a curious and nonjudgmental stance.  Opening up the conversation around suicide creates an opportunity for your child to discuss their thoughts and feelings with a safe person rather than facing them alone. In doing this, it allows you to come alongside your child and create a safety plan that gives them and you tangible skills and steps to take when challenging suicidal ideation.

How to create a safety plan:

A safety plan can include warning signs of distress, triggers, helpful skills, reasons to live, support people and emergency contact information. Taking this step allows you to thoughtfully think through what needs your child may have and creates a space for them to verbalize these needs.  

I like to help patients recognize when they feel the most vulnerable to these thoughts and urges. Common questions I ask are, “Is there a time when you notice the thoughts are the loudest? Is there a particular place, environment or person that triggers these thoughts? What skills or actions have been most helpful in challenging these urges?” Help your child identify skills that decrease the urge and turn the mind from these thoughts. Be open to trying new skills with them as this allows you to play an active role in combating and exploring effective skills and approaches. You can find a multitude of helpful skills in the DBT distress tolerance module and emotion regulation module.  

I often take the stance of assuming they have these thoughts daily or even every hour. I may say, “How many times an hour do you experience suicidal ideation?” Overestimating frequency allows them to break through the shame they may feel about how often they have these thoughts. It is much easier to say, “I actually only have suicidal ideation a few times a week,” than to say “I actually have suicidal ideation every hour, not just a few times a week.”  

What if they are not willing to fight their suicidal ideation?

If your child reports that no skills have been helpful and they have no desire to fight their suicidal ideation, you are not alone. This is common when the eating disorder is strong. If this is the case, supervision should be increased, which may look like no bedroom doors, room checks and supervised bathroom visits. 

How can you help your child find ways to fight the suicidal ideation when they report being unmotivated? An approach that can be helpful is discussing the future, their goals, events they may be looking forward to, and people they care about. Help them think beyond the moment. I once had a patient who had strong suicidal ideation and was unwilling to challenge it. When I “played the tape forward” and described the idea of her younger sister learning about her taking her life, she was able to fight the urge. Sometimes, fighting suicidal ideation for another person is the only skill they have access to, and that is okay.  

Creating a safe environment: 

Having an eating disorder is distressing and pursuing recovery can increase that distress.  Knowing this, it is very important to create a safe environment for your child. Some steps to take could be locking up sharps, medications, and firearms. If you do have firearms in the  home, it may be worth getting them out of the house and storing them at a gun club or with a friend or family member. 

Patients that have active suicidal ideation and are considering suicide often have similar signs. You may notice:

  1. They no longer engage in social activities or things they once enjoyed. They begin to isolate themselves. 
  2. They talk about death or wanting to die and speak about not being around in the future.
  3. They talk about being a burden to those around them and feel guilty because of their eating disorder. 
  4. They start to give their personal belongings away and may say goodbye to family and friends. 
  5. They start planning how to kill themselves by searching online. 
  6. They increase their substance use and engage in risky behavior, such as self-harm. 

If your child reports that they have a plan to kill themselves and have identified what they will use and know when they will do it, please call 911 or go to your local emergency room. Getting professional support is very important when intent, means and a plan have been identified.  

Lastly, I want to reinforce that talking about suicide does not increase the risk or likelihood it will happen; it disempowers suicidal ideation over your child because they have you to help them fight it!  Check in often with your child even if they present as happy and stable in this area.



  1. Kevin Dunn

    Danielle…the emphasis on remaining curious is so appreciated. ABC (Always Be Curious) is such an important method when we need to be effective as caregivers. Thank you!

  2. Lisa B

    Danielle, thank you for helping parents receive this information in a clear, kind and considerate way! Suicide historically carries so much stigma and hesitation to talk about it! If you don’t voice it, it’s not real, right?? Wrong, and being able to have a guided way to open the conversation and continue a dialogue is so important.

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