Ask An Expert / Suicide and Self-Harm

My son is obsessed with fears that he will kill himself. He gets upset when I try to stop talking about it. What can I tell him?

When it's anxiety talking, you want to help him fight it

Rachel Busman, PsyD
Rachel Busman, PsyD

Senior Director, Anxiety Disorders Center, Director, Selective Mutism Service

Child Mind Institute

My son is obsessed with fears that he will kill himself. He is not depressed and mostly understands that this is anxiety, and not an action he wants to take. He has these dark thoughts a couple of days a week, and on those days it will be consistent and wear him down. He has started texting me from school to pick him up and bring him home. He is seeing a psychologist, who has taught him coping mechanisms (breathing, mindfulness, distraction) and has started addressing/challenging the fear directly, which has had some good success. They then move onto positive stuff pretty much straight away, like what he likes to do for fun.He is okay just after he sees the psychologist, but with me he gets very upset. I have been told to show empathy but to not dwell on the fear. Which I follow to the book. However he really pushes me to talk more about his fear, and no amount of "moving on" after that helps. He doesn't like it when other people, like his teacher, bring it up, as it makes him think about his fear and makes it more dramatic. So he understands that it's not healthy to dwell on the fear but he can't follow that through with me. To be honest I find it exhausting for him and me. What can I say to him?

Thank you for writing. It sounds like this is a really challenging situation, and probably also an alarming one for you. Thankfully it sounds like you, along with your son’s psychologist, have determined that he doesn’t actually want to harm himself, and this is just a fear. It sounds like he may have obsessive compulsive disorder, which may be something you and his treatment provider have already talked about.

It’s great that your son has learned a variety of coping strategies. After he’s learned these things, the real meat of his treatment should be directly facing and challenging his fears. When doing this it is essential for the psychologist to provoke some distress in your son and then allow him ample time to get used to that distress, until it stops being upsetting. So if his psychologist is changing the subject to positive things too quickly, it can actually serve as a distraction from the treatment, which isn’t good.

I understand your challenge of wanting to balance empathy with not dwelling on his fears. However, if he keeps bringing it up with you then he might be looking for reassurance from you, which my calm his fear temporarily but actually reinforces the anxiety. When a child isn’t ready to move on, I suggest that parents say something like, “I’ve answered that question already and we’ve been talking about this for a few minutes. I know this is your anxiety talking and not you, so I’m going to move on to another topic.” Your son’s psychologist might have some more tips.

You also say he gets upset when other people bring up his fears. This is actually a symptom that needs to be addressed. When we have intrusive, distressing thoughts, our first instinct is to avoid things that trigger them. You can remind him that even if someone brings up something upsetting, it doesn’t make it any more likely to happen. You can also remind him that it is good practice to help him deal with distressing thoughts. The way for him to get through his anxiety will be to learn that he can hear these disturbing things and realize “I actually can co-exist with these thoughts and they’re not going to take over.” Your son’s current therapist might also have some practical tips for helping him handle when other people bring up distressing topics, so it’s a good idea to ask about that, too.