Thoughts of suicide can be active or passive, but what is the difference? Experts explain.

·7-min read
A woman looks thoughtfully out a window
What is the difference between passive and active thoughts of suicide? Experts say it's all about the intent and plan that accompanies the words. (Getty Creative)

This article is for educational purposes only and shouldn't be used to treat or diagnose any mental condition. If you or someone else is experiencing suicidal thoughts, call 911 or head to the nearest emergency room.

There's no point.

I'd be better off dead.

As someone with ongoing passive suicidal ideation, I am keenly aware of the types of thoughts that go through a suicidal person’s head. For many, when the conversation approaches suicide, people tend to step back ... when it should really be the opposite.

According to a study published in the National Library of Medicine, there’s evidence that social support is associated with a decreased likelihood of suicide attempts. Specifically, individuals with higher social support may be more than 30% less likely to have a lifetime suicide attempt than those who receive little support.

Over the past few years, conversations around suicide have become more common, but it’s still a topic people don’t like talking about. September is Suicide Prevention Awareness Month and there's no better time to educate on the spectrum of suicidality (a clinical term describing both thoughts of suicide and actual suicide attempts), especially on the difference between active and passive suicidal ideation.

What is passive suicidal ideation?

Suicidal ideation (suicidal thoughts) exists on a spectrum: passive and active. Experts say the main difference between passive and active suicidal ideation is the intent and plan that accompanies the words.

“We refer to suicidal ideation as ‘passive’ when an individual expresses thoughts about death or a wish to die or to no longer be alive, but have no plan to end their life,” Dr. Kristin Gill, a board-certified psychiatrist from New York, tells Yahoo Life. “Individuals who have passive suicidal ideation will often describe feeling like they no longer have the motivation to live.”

According to Gill, some phrases commonly associated with passive suicidal ideation may include: I just wish I didn't wake up in the morning, I don't want to live like this anymore and Everyone would be better off without me around.

What is active suicidal ideation?

Kristen Gingrich, a licensed therapist who has worked with clients experiencing suicidal ideation for over eight years, says active suicidal ideation is different. “Active suicidal ideation is when a person has thoughts of wanting to harm themselves that have an actual plan, means and intent behind them,” she explains. “This means a person may make a statement like the ones above, but they also come up with a plan, such as I don’t want to live like this anymore and I want to end my life.”

Gingrich says it’s also important for those close to an individual experiencing suicidal thoughts to look for any behavioral changes, as sometimes active suicidal ideation may not be seen in what is said but instead in what a person does.

“If a person makes a statement like Everyone would be better off without me, but are doing things with changes in their behaviors or mood like increased isolation, giving away items they love, increasing substance use or risky behaviors or even increasing passive suicidal statements, that could be a red flag towards something more serious,” Gingrich says.

What does suicidality feel like?

While the definitions above are helpful in understanding the suicidality spectrum, they don’t always depict what it actually feels like to experience these types of thoughts. Gingrich says her clients describe suicidal ideation as feeling like a shadow is always following them around: Sometimes the sun hits just right and the shadow disappears for a while, but eventually it comes back.

She adds that some describe their suicidality as not wanting to die, but just wanting their pain to stop and feeling like it's a never-ending tunnel they just want to get out of.

Before seeking treatment, Kelsey Motley, a former patient at Pathlight Mood and Anxiety Center, says the thought of “not being” hovered in her mind constantly. “I struggled with thoughts of my not being good enough, and thought life would be easier if I were not around anymore,” she says. “I reached out to a loved one and told them about my thoughts of ending my life. They took away the means which they thought I would use to end my life. Sadly, I still found a way to move forward in hurting myself.”

Motley experienced multiple self-inflicted injuries and admitted herself to a partial hospitalization program (a program where a patient remains to live at home, but visits a treatment center several times a week) where she recovered. Today, she lives with the effects of a traumatic brain injury that stemmed from her actions, but is working on obtaining a master’s degree in clinical mental health counseling so she can help others.

For people like Saniya Soni, who shares her own experiences as part of her work with the Jed Foundation and advocates for better mental health care for underrepresented youth, suicidal thoughts started in elementary school.

“I started experiencing suicidal ideation in fifth grade at the age of 11,” Soni recalls. “I grew up in an abusive home and witnessed domestic violence from a young age. I started wondering what my family would be like if I didn’t exist and thought it would be a lot better.”

Soni’s suicidal ideation got stronger and during her freshman year of high school, she made a plan to kill herself, attempting suicide during her sophomore year. At the time of the attempt, she was placed on a 72-hour hold in a children’s psychiatric ward, after a 17-hour stay in the emergency room.

Today, Soni is enrolled in the clinical psychology doctorate program at the University of Massachusetts Boston and conducts research on BIPOC mental health and suicide prevention strategies.

How to help someone struggling with suicidal ideation

If someone comes to you and says they are experiencing passive or active suicidal thoughts, it’s important to take action. “Asking direct questions like, ‘Are you thinking about hurting yourself right now?’ are key in these moments,” says Gingrich. “A lot of times people are scared that asking direct questions like this may cause someone to become more suicidal, which is untrue. Asking questions like this actually helps show support and that you care.”

In addition to checking in with and showing support for someone when they are struggling with suicidal thoughts, helping them access resources like local crisis services, national crisis lines or local mental health agencies can be helpful.

“Hotlines are a valuable resource for people to work through difficult emotions, serve as a place where an individual can feel listened to and provide resources for mental health services in the community,” says Gill. “Most important, if you or a loved one is experiencing an emergency and need immediate assistance, it is imperative that you call 911 or go to your nearest emergency room.”

Vivian H., who prefers to keep her last name anonymous due to the sensitivity of the topic of suicide, contacted her psychiatrist about her suicidal thoughts. She says she received help, and is working with her provider to come up with effective coping strategies and a new treatment plan.

“I ended up telling my psychiatrist [about my suicidal thoughts], who then changed my treatment plan,” she says. “I was still finding the right medications and it turned out the ones I was taking at the time were making me feel worse.”

She credits the support of mental health professionals with being able to recover, and says she is now living a happier and healthier life in New York.

What to do if a loved one refuses help

“Sadly, if a person is refusing help, we cannot force them to get help, as much as we wish we could,” says Gingrich. “All we can do is continue to provide support and resources when we can, and set boundaries for ourselves if needed.”

“However,” she emphasizes, “if a person’s suicidality increases to the point where they are a risk to their own safety, you may need to alert local authorities to assist that person while also understanding that that may cause harm to your relationship. In the end it’s to help the individual.”

If you or someone you know is experiencing suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 988 or 1-800-273-8255, or text HOME to the Crisis Text Line at 741741.

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