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What are risk factors for suicide in people with bipolar disorder?

There is no perfect formula that will predict who will make a suicide attempt among people with bipolar disorder. However, there are some common characteristics in those who die by suicide. The first and one of the most important of such risk factors is a mother, father, sister, or brother who has committed suicide. This is the single greatest multiplier of suicide risk. Those who commit or attempt to commit suicide are typically in a state of distorted thinking in which the suicide victim convinces themselves that they are in so much pain that it isn't worth staying alive and that those around them will be better off without them.

The second multiplier is substance abuse. A majority of suicide victims have drugs or alcohol in their system at the time.

Another important multiplier is firearm possession. Suicide by firearm is extremely common, especially in young people. Most self-inflicted gunshot suicide attempts are not survived, or if they are, it is with severe brain damage. In fact, we know that if we were given a large grant to reduce the number of suicide deaths in a community, the most effective thing would be to provide trigger locks and gun safes.

Another multiplier is social isolation. This illness often manifests itself in adolescence, the very time when one is developing social skills and patterns of friendships. People who have been quite ill with early onset bipolar illness, often become so dejected about themselves and/or do not develop social skills needed for lasting adult friendships, so that they find themselves isolated. Even family members sometimes burn out after facing repeated crises with their not-yet-stabilized daughter, son, or spouse with bipolar disorder. Therefore, building a community in which those affected by the illness can find support, understanding, and associates whom they can engage in meaningful activities is an important goal in treating people with this illness. One of the things I learned about this illness over the past two decades is that half of the people with bipolar disorder also have an anxiety disorder (generalized anxiety, panic disorder, phobias, obsessive compulsive disorder). This anxiety also appears to be a risk factor for suicide. Take note that some medications commonly used for anxiety can cause mixed states.

Finally, inadequate mood stabilization and the presence of mixed states is a multiplier. This is why we need to stay away from medicines that are known to induce mixed states.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.