A growing subset of adolescents and college students report persistent suicidal thoughts without showing clear intent or planning, according to clinicians involved in two ongoing National Institute of Mental Health–funded randomized controlled trials (RCTs).
Researchers observing these trials report that some young people appear to form a “suicidal identity” that provides a sense of control, visibility, and belonging rather than reflecting a genuine wish to die.
These insights come from clinicians participating in trials of the Collaborative Assessment and Management of Suicidality (CAMS), a structured, suicide-focused clinical framework. One trial examines suicidal college students at several U.S. universities; another focuses on suicidal adolescents in Seattle and Columbus.
Researchers review clinical sessions, provide adherence feedback to clinicians, and conduct weekly case consultations, giving them extensive exposure to youth presenting with chronic suicidal ideation.
Clinicians report that some young people engage deeply with suicide-related content online, discuss suicidal thoughts frequently in therapy, and identify closely with peers who express similar feelings.
Many of these youths, however, lack a history of attempts, have vague plans, and express ambivalence about dying. Their attachment to suicidal thinking appears to function as a stabilizing identity—one that can elicit attention, prompt adult intervention, and create bonds within peer groups.
Experts caution against dismissing these behaviors as attention-seeking. Negative reactions from adults may intensify the young person’s reliance on this identity. Instead, CAMS-trained clinicians work to validate the emotional experience underlying the suicidal identity, while not reinforcing the identity itself. This process involves developing a personalized stabilization plan and identifying the key psychological “drivers” that sustain suicidal thoughts, including trauma, interpersonal conflict, or feelings of worthlessness.
Treatment typically integrates individualized therapeutic strategies—such as cognitive therapy, trauma-focused interventions, family work, or school-based support—to address these drivers. Clinicians often observe substantial reductions in acute suicide risk within six to eight sessions.
A critical component of treatment for youth who hold a suicidal identity is the intentional creation of an alternative “aspirational identity.” Drawing on strategies from Acceptance and Commitment Therapy, clinicians encourage patients to clarify personal values, explore meaning, and envision a future self with purpose and agency.
One teen recently shared that a pivotal moment occurred during a conversation with a psychiatric technician who described his own past suicidal struggles. The staff member challenged the teen to consider “flipping the script” from feeling like a failure to imagining himself as someone who could help others. That reframing became a turning point, guiding the teen toward peer-support involvement, religious community activities, and aspirations to pursue psychology.
Clinicians emphasize that replacing a suicidal identity is neither immediate nor forced. The goal is to offer a compelling alternative narrative—one that feels authentic, empowering, and possible. For parents, educators, and healthcare providers, the recommendation is clear: listen closely, validate fully, and help young people imagine identities grounded in hope and meaning.
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