In 2020, in Australia, 99 deaths by suicide were recorded in children and adolescents (aged 5–17 years) with 74% in those aged 15–17 years. While land transport accidents are the most common cause of death among 1 – 14-year-olds, suicide was the leading cause in those 15 – 24 years. It is an outcome feared by parents and practitioners, but little discussed. Brazilian paediatrician Orli Carvalho da Silva Filho speaks of a continuum of taboos (taboo of death < taboo of suicide < taboo of child suicide) which keeps us silenced and afraid.
One way of avoiding looking too closely is to decide the young person was ‘depressed’ and therefore ‘sick’ which accounts for their actions. A better model is proposed by Benton et al (2020) who note that a ‘growing body of evidence shows that there exists a strong relationship between emotional dysregulation and suicidality for youth; it cuts across psychiatric diagnostic groups, increases risk for self-harm, and can be measured as a stable symptom profile across diagnostic groups.’ Dysregulation is inherently interactional with distressed behaviour precipitating symmetrical distress in the child or adolescent’s social world which escalates to crisis. In some cases, this may draw in professionals who also become dysregulated and ineffective. Interventions which explore the pattern, identify all key people, and intervene to introduce the opposite, complementary response are more likely to be helpful than those which focus intently on the individual showing the symptom. Being frightened and avoiding the part everyone plays will not solve the problem but daring to look may do.
Benton, T., Muhrer, E., Jones, J., Lewis, J. Dysregulation and Suicide in Children and Adolescents Child Adolesc Psychiatric Clin N Am 30 (2021) 389–399
Note: Methods of mapping the pattern of emotional dysregulation developed at Bower Place is fully described on bower(knowledge), the Bower Place Knowledge Portal, which can be accessed on our website.