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Theory of the Three Steps of Suicide From Klonsky and May

A theory that proposes what are the factors that facilitate the appearance of suicide attempts.

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Each year around one million people commit suicide. Suicides have been increasing progressively, and in Spain in 2017, 3,679 people took their lives. The most current theory that tries to explain this phenomenon is the theory of the three steps of the suicide of the investigators Klonsky and May.

Through the theory of Klonsky and May we will know how to go from thinking about committing suicide to trying or finally committing suicide.

Suicide

Suicide is the act by which a person deliberately causes death. In Spain, suicide is the first cause of unnatural death, and this has been the case for the past 10 years. In 2007, suicide exceeded for the first time those killed in traffic accidents, which for decades was the first cause of deaths from external causes (those not derived from diseases). In addition, the suicide rate increased by 3.1% in Spain from 2017 to 2018.

Suicide has been and still is a problem that has been silenced for so many years, and nowadays, Health is developing a plan to prevent suicide.

On the other hand, 90% of people who commit suicide suffer from some type of mental disorder, the most frequent being bipolar disorder, depression and a substance abuse disorder, followed by personality disorders. The majority of patients present with depressive symptoms, which do not always coincide with the presence of a stressful event, but usually there are always attempts of suicide in the past, as well as ideas of wanting to die or a more structured suicidal ideation.

The theory of the three steps of suicide

The most current theory that tries to explain suicide is the theory of the three steps of suicide (3ST) of Klonsky and May, which postulates that suicidal ideation originates from the combination of “pain and despair”, “lack of connection or connection to other people “,” absence of a significant work or life project “together with the” suicide capacity “itself.
The theory proposes that the combination of these factors explains the passage from suicidal ideation to action (attempts and suicides).

From intention to action

In the theory of the three steps of suicide, Klonsky and May establish a concrete scheme: “From Ideation to Action”, and believe that it should guide the theory, research and prevention of suicide. According to this scheme, first a suicidal ideation develops, and later one goes from ideation to action (attempts and suicide). These two processes (idea and action) require different explanations.

In addition, it is worth mentioning that in Spain it has been estimated that suicide attempts are between 10 and 20 times more frequent than suicide.

The three steps

The three steps established by the theory of the three steps of the suicide of Klonsky and May are:

  • Suicidal ideation results from the combination of pain and despair.
  • If the connection with others and life is less than that pain, the ideation becomes stronger.
  • To reach the action (to try to commit suicide) you have to acquire the ability to attempt suicide.

Klonsky and May propose three concrete categories of variables that contribute to the capacity of suicide:

  • Dispositional: fundamentally genetic (for example, sensitivity to pain)
  • Acquired: habituation to experiences associated with pain, self-harm, fear and death.
  • Practices: factors that make the suicide attempt easier, such as easy access to information and methods to carry it out.

The three questions

The three steps already explained, are translated into three fundamental questions in the theory (for practical purposes, the statement of one question leads to the following):

1. Are you in pain and without hope?

If the subject’s answer is no, then there is no idea of ​​suicide. On the other hand, if the answer is YES, then there is an idea of ​​suicide. The positive answer to this question leads to formulating question 2.

2. Is your pain bigger than your connection?

If the answer to this question is negative, suicidal ideation is moderate; if it is affirmative, on the other hand, the suicidal idea is strong, important. Once again, the affirmation of this question leads to the last question, question 3.

3. Are you able to attempt suicide?

If the person is not able to try, (negative response), then we find a person who only has suicidal ideas. On the other hand, if the answer is affirmative, and the person is able to try it, then he has a real intention of committing suicide.
You may be interested: “Types of depression: its symptoms, causes and characteristics”

How to reduce the risk of suiciding?

The most important tool will evidently be prevention. That is why suicide prevention campaigns are and will be necessary, as well as specific protocols for action against suicidal ideas and attempts. It will be essential that these be applied in all mental health centers (primary care centers, hospitals, clinics, etc.), whether public or private.

On the other hand, and following the theory of the three steps of the suicide of Klonsky and May, either as friends, relatives and especially health professionals (and therefore of mental health), we should focus on:

  • Increase the hope of the person who thinks or wants to commit suicide.
  • Reduce your pain.
  • Increase your connection with life, with others, with your interests, with him / herself, etc.
  • Decrease your suicide capacity (reducing your access to media and information to carry it out) to prevent it from acting.
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