Courageous Conversations in Evidence Based Treatment

• How to recognize when your child may be having thoughts of suicide or self-harm, and what to do next

“If you make me eat that, I will kill myself.”

These are words that no parent wants to hear. Unfortunately, parents attempting to help their child recover from an eating disorder may encounter this phrase at some point in the recovery process.  Even if your child does not say these words directly, there is a chance that he or she is thinking it: in August 2020, the CDC reported that one in four adolescents had thought about suicide in the past 30 days.  There is a large overlap between eating disorders and suicidal thinking and behavior:  individuals with eating disorders have elevated rates of suicidal thinking and behavior  (Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011) compared to the general public while teens with suicidal behaviors and thinking are more likely to have disordered eating than teens who do not self injure (Brausch & Gutierrez, 2009). Given these statistics, it is important to help parents know when to worry and how to help.

This article first appeared as a guest post on the website for F.E.A.S.T. – a global community of parents and those who support parents in families affected by eating disorders. You can read it in its original format here.

When to worry:

Know your role: If your child is saying that they want to die, you should always take it seriously. Your job will be to convey to your child that you understand that they are suffering and will get them the help they need.  Although most people who experience suicidality are wanting to escape from emotional pain rather than actually wanting to be dead, parents should have a low bar for concern. If you are hearing these words from your child, talk to a professional for guidance.

Know the signs: Some kids don’t actually TELL you that they are thinking about suicide. Instead they might show you through their behaviors. These behaviors include isolating from friends or family, having significant mood swings, engaging in risky or self destructive behaviors, poor school performance, preoccupation with death, giving things away. If you are seeing these signs in your child, review with a professional.

Know the risk factors: Be aware if your child is at particular risk for suicide. Some of the  risk factors that are found to increase the likelihood that an individual will make a suicide attempt are:  prior suicide attempt, access to means, being impulsive, being depressed, poor coping skills, substance use, a sense of isolation and lack of support. Some populations are particularly at risk for suicide.  For example, research from  The Trevor Project suggests that Lesbian, Gay or Bisexual youth seriously contemplate suicide and attempted suicide at much higher rates than heterosexual youth.

How to help:

If you believe that your child might be experiencing suicidality, the following suggestions might help:

• Don’t keep it a secret: Open the dialogue. Talking about whether your child is experiencing thoughts of suicide wont “put it in his/her head” if it wasn’t already there. Instead, be direct.  Ask your child, “Are you thinking about hurting yourself?” Or slightly softer: “Sometimes when people feel down and hopeless they think about suicide.  Is that something you have thought about?  I would like to help.”
• Put away the danger/keep them safe.  If there are guns in the house, lock them up (this should be done as a general safety issue whether or not your child is suicidal).  Put away sharp objects or medications.
• Help your child stay engaged and connected: go out for a walk together (exercise helps depression but might be tricky if you are trying to re-feed your child).  Or maybe a drive–some kids do better talking when you are not staring into each other’s eyes! They do better talking in the car.
• Make sure your child and family are getting the right help: make sure that you are working with someone who KNOWS HOW TO TREAT the problem your child has. If he/she is feeling suicidal, is this something that your therapist has training in how to help? Not everyone is trained in how to address chronic suicidality (most training programs teach therapists how to keep someone safe in the short term, not how to address these issues ongoing).  There are certain therapies that are specifically designed to help people with thoughts of suicide. DBT is one of them. Find a DBT therapist (DBT-Linehan Board of Certification) who is willing to consult with or work in addition to your eating disorder therapist.

Having a child who is wanting to hurt themselves can be terrifying for a parent. Don’t go this alone.