Medically serious suicide attempts (MSSA) or high‑lethality suicide attempts (HLSA) are defined as those involving severe organic compromise, regardless of their psychiatric severity.

Within the wide spectrum of suicidal behavior, MSSA are the closest to completed suicide, and the two groups overlap substantially, sharing common characteristics. In addition, MSSA carry a higher risk of subsequent death by suicide compared with low‑lethality suicide attempts.

An important aspect to consider is that evaluating survivors of a severe suicidal act allows direct information to be obtained from the survivor, unlike completed suicides, in which assessment is carried out indirectly through third parties (psychological autopsy). Being able to assess individuals who have come so close to suicide is of great value for understanding the psychological mechanisms behind severe suicidal behavior and for identifying warning signs to prevent suicide.

A considerable percentage of these cases show underlying psychiatric disorders, mainly affective disorders (Depression), followed by Personality Disorders and other Substance‑related Disorders. Other non‑psychiatric and socio‑environmental risk factors must also be assessed: the presence of severe or chronic medical conditions, functional limitations and their impact (such as in people with physical disabilities or older adults), and social support.

Symptoms

Most patients present depressive symptoms that do not always coincide with a recent stressful event. They often have a history of previous suicide attempts. Prior to the MSSA, they typically experience thoughts of wanting to die or a more structured suicidal ideation.

Who is affected?

People with an unstable or untreated psychiatric disorder—particularly unipolar affective disorders (Depression)—may be more predisposed to suicidal behavior.

Diagnosis

In the event of an MSSA, it is essential to assess and treat any underlying psychiatric disorder.

Typical treatment

Once the patient has recovered from the life‑threatening situation, a comprehensive approach is required, addressing both clinical and socio‑environmental aspects. Clinically, it is crucial to evaluate and treat any psychiatric condition. After medical discharge, referral to the mental health network is important, as well as activation of the Suicide Risk Code, which ensures follow‑up after hospital discharge.

Most common assessments

Medical‑psychiatric history and psychological evaluation.

Prevention

Combat myths that perpetuate the social stigma surrounding suicide and assess suicidal ideation in individuals with clinical and sociodemographic risk factors.

In addition, these thoughts trigger repeated actions or rituals that serve to “cope with” the aforementioned obsessions, called compulsions. Some examples of compulsions include: washing hands, religious behaviors (such as praying a written prayer exactly 15 times to prevent something bad from happening), and counting or checking things (e.g., making sure the door is locked, the gas is off, etc.).

Very often, they feel that “something bad” will happen if they do not carry out the compulsions, so they feel “forced” to perform them. This generates a lot of anxiety and distress, as they feel responsible for a possible misfortune.

They may become detached from daily life activities or avoid them completely due to fear of the obsessions or compulsive behaviors.

They may also experience difficulties with everyday tasks (cooking, cleaning, bathing, etc.) and suffer higher levels of anxiety.

Following some recommendations can help you “live with” or overcome Obsessive-Compulsive Disorder.

However, if recommendations are not enough and the disorder becomes more severe, you should see a psychologist or psychiatrist to complement these tips with other types of treatment (cognitive-behavioral therapy, pharmacological treatment).

Recommendations to help cope with or overcome your obsessions and compulsions:

• You must believe that you can overcome it and be determined to tackle your problem.
• You should learn to lose fear of your obsessive thoughts and allow your mind to think “silly” things without getting scared, as they pose no real danger.
• Regarding your rituals, you should change the way you perform them and be clear that the ultimate goal is to eliminate them.
• When you think that something bad will happen to you or a loved one if you don’t perform a ritual, realize that it is a completely irrational and false worry.
• You will experience anxiety for a while, but it will then decrease as if you had performed the ritual.
• Be aware that nothing bad happens when you feel the urge to perform the ritual and do not do it.
• Part of your brain recognizes that all this is “absurd” and that nothing bad can happen if you do not perform your rituals.
• Rituals calm you at the moment, but increase the problem in the medium and long term. Use distraction (call someone, go for a walk, relaxation techniques…) to reduce anxiety.
• Accept your irrational thoughts and leave them there without fighting them, seeing them as what they are —unpleasant thoughts— but understanding they pose no danger and will weaken until disappearing.
• Tell yourself: “It’s okay if I have obsessions; no matter how silly my thoughts are, nothing bad will happen.”
• Write down and record your “absurd” thoughts so you can listen to them repeatedly and realize they are completely false and harmless.
• Focus on your normal life; as you do so, unpleasant thoughts will gradually disappear.
• Do not feel guilty for having the obsession; accept it.

To help reduce or even eliminate compulsions or rituals:

• Postpone or delay the ritual; in the meantime, distract yourself with interesting things and pleasant activities (such as talking to someone, listening to your favorite music, playing with your pet, exercising…).
• Perform the ritual more slowly; you can help yourself by doing several slow diaphragmatic breaths.
• Change some aspect of the ritual: for example, if you used a particular soap, change the brand; if you repeatedly touched an object, touch another; if you performed the ritual in one room, do it in another; if you did it standing, do it sitting.
• Add a consequence of the ritual: each time you perform a ritual, you must complete an additional task unrelated to your compulsions. It should be something time- and effort-consuming to help you avoid performing the ritual. For example: if you perform the ritual, afterward you must drive for an hour, clean the house, take a 30-minute walk, or do 10 push-ups, etc.
• Exercise regularly, as it reduces anxiety and will help you have fewer obsessions and compulsions.