Dear Therapist:

Something has been bothering me for a while and I finally feel like I need to reach out for advice. I have these thoughts that get stuck in my head and no matter what I do I can't seem to get rid of them. For example, I feel like I might do something dangerous and no matter what I do I can't shake that thought or feeling. I never actually do anything, but I am really worried that one day I might. There are a lot of things that I avoid because of this. I used to be an avid bike rider, but I stopped because I got worried that I might drive into traffic. I hope you take me seriously; I am considered a "regular" person, and no one knows about this,  but I don't feel like I have anyone I can turn to and hope you can give me some advice on this. Thank you. 



What you are referring to is known as suicidal ideation without a specific plan. This is very serious, and requires immediate professional attention. If you are having current suicidal thoughts, you should go to an emergency room or call 911. You need to have a full psychiatric evaluation, leading to a specific treatment plan.

Regardless of whether you are currently experiencing these thoughts, you should make an appointment with a psychiatrist. The initial evaluation should help you to obtain a better sense of underlying issues, and should lead to the establishment of a treatment plan.

Suicidal thoughts are generally associated with an underlying psychiatric disorder. Depressive and anxiety disorders, OCD, bipolar disorder, and schizophrenia are some of the psychiatric conditions that can lead to suicidal ideation. There are some medical conditions and other factors, as well, that can be accompanied by feelings of depression and suicidal thoughts. This is one of the reasons that a full psychiatric evaluation is so important.

The layman’s understanding of many psychiatric disorders is often inaccurate or incomplete. People often assume that they don’t have a depressive disorder, for instance, because they don’t feel depressed or “down.” Some people can be “depressed” despite having no conscious, overt feelings of sadness. Even seasoned professionals cannot self-diagnose. This is due to emotional involvement and the inability to be properly objective. For similar reasons, mental health professionals are not supposed to treat family members.

Please do not attempt to diagnose yourself, or to rule out any diagnosis. You should play a central role in the assessment and treatment process. However, you need to rely on the expertise and experience of a treatment professional to help guide you in the appropriate direction. Do not downplay the seriousness of your suicidal thoughts. These are thoughts that you should not be having. Proper treatment can rid you of these thoughts while resolving any underlying causes.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200