Progression of suicidal ideation to suicidal behavior from a perspective of selected suicidologial models.

In clinical practice suicidal ideation (SI) is one of the most commonly encountered symptoms
in patients with mental disorders. Such encounter calls for diligent evaluation of suicidal
risk. Although the risk factors are widely known, accurate estimation of suicidal risk remains
one of the most difficult and most important tasks that clinicians face – especially considering
recently collected data showing increase in suicide prevalence in Poland. More thorough
estimation of suicidal risk in patients with SI requires taking under consideration not only
suicidal risk factors but also factors that are more specific for progression of SI to suicidal
behaviors (SB). The review presented in this paper consists of a range of suicidological theories
that allow to select a number of groups of factors and mechanisms that are most specific
for progression of SI to SB. These groups include: (1) transgression of fear of causing harm
and pain to oneself, as well as disintegration of other protective barriers such as (2) decline
of social integration with others, feeling of being alienated or abandoned, decline of sense
of belongingness, lack of social support, (3) resignation from family and social obligations,
(4) dismissing cultural or religious norms, (5) rejection of life goals, values and aspirations that
were appreciated earlier, (6) narrowing down in perceived alternatives for suicide, i.e., “tunnel
vision”, feelings of helplessness and powerlessness, (7) devising in details and accepting
simple suicidal plan, especially when such plan is being consolidated through rehearsals and
as if “automatized”, (8) impulsiveness, (9) accumulation of aggression.