Cited by 775Suicide and Self-Harm StudiesPsychological Treatments and DisordersMental Health and Psychiatry

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Commentary: Suicide as Psychache

SHNEIDMAN, EDWIN S.·1993·The Journal of Nervous and Mental Disease

DOI 10.1097/00005053-199303000-00001

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“Shneidman (1993), a psychologist who founded the nation’s first comprehensive suicide prevention center and revolutionized the study of suicide, characterized suicide as an escape from intolerable mental suffering.”
Background
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“Distancing” is related to a sense of disconnection from others (Bolger, 1999) and involves a need to not only affiliate with others but also avoid humiliation and embarrassment (Shneidman, 1993).”
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After a doomed patient kills himself: a psychiatrist's reflections
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“참을 수 없는 심적 고통(psychache)은 자살 행동을 이 끌 수 있는데[34], Joiner [35]는 이러한 심적 고통 중 특 히 좌절된 소속감과 짐이 되는 느낌이 자살을 열망하게 한 다고 했다.”
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“According to Shneidman (1993b), Suicide is best understood not so much as a movement toward death as it is a movement away from something and that something is always the same: intolerable emotion, unendurable, or unacceptable anguish.”
Background
Chronic negative mood and emotional strengths: Some evidence for using emotions as a specific buffer to the problem of suicide
Chang, E. C., Sánchez‐Álvarez, N., Rey, L., Extremera, N., & Chang, O. D. (2020) · Personality and Individual Differences · doi:10.1016/j.paid.2020.110384 · Cited by 2
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Is suicide prevention possible?
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Krieger, A. (2024) · European Journal of Philosophy · doi:10.1111/ejop.12967 · Cited by 2
A measure to gauge psychological pain: Assessing convergent construct validity and internal consistency of the Psychache Scale in the Cambodian context
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“At this point, left-behind adolescents may reduce their cognitive processing to view suicide as the only method to end their psychological pain (Shneidman, 1993; Ducasse et al., 2018).”
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Roennfeldt, H., Wyder, M., Castles, C., Hill, N., Byrne, L., & Hamilton, B. E. (2024) · Advances in Mental Health · doi:10.1080/18387357.2024.2428308 · Cited by 1
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Holden, R. R., D’Agata, M. T., & Peter, E. L. (2024) · Psychological Reports · doi:10.1177/00332941241308498 · Cited by 1
“In articulating his model of suicide, Shneidman (1993), a pioneer of suicide research, termed the mental pain associated with suicide as “ psychache ” (p. 145), theoretically asserting that, based on his clinical experience, psychache causes suicide, and that all other factors only associate with…”
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From breaking point to potential transformation: temporal sequencing of mental health crisis
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“Psychological theories of suicide; for example, Schneidman (Shneidman, 1993) and Joiner (Joiner, 2005) identify suicidal thoughts and behavior as emotional pain resulting from a complex interaction of individual and social factors.”
Identifying Suicidal Ideation Through Automatic Extraction of Emotional Traces in Suicide Notes
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“SI defined as, “thoughts about or a preoccupation with killing oneself” (American Psychological Association, 2018), is a response to unbearable psychological pain and/or the perception of intolerable or unendurable mental anguish (Sheindman, 1993; Verrocchio et al., 2016).”
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“Such findings align with the Escape Theory of Suicide, which posits that suicidal behavior serves as a means to escape overwhelming psychological distress in the absence of generating adaptive solutions (Millner et al., 2020; Shneidman, 1993).”
Childhood Trauma and Emotional Dysregulation as Risk Factors for Suicidal Ideation in Adults With ADHD: A Case-Control Study
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“Additionally, difficulties in emotion regulation may impair an individual’s ability to manage emerging problems, intensifying psychological and emotional distress (Klonsky & May, 2015; Rogante et al., 2024; Shneidman, 1993).”
Psychological Pain in Suicidal and Non-Suicidal Populations: Findings from the Translated German Mee-Bunney Psychological Pain Assessment Scale
Aschenbrenner, L. M., Brogna, S., Teismann, T., Frei, A., Sedlinská, M.-A., Glaesmer, H., Forkmann, T., Walther, S., Ehnvall, A., & Gysin-Maillart, A. (2025) · Archives of Suicide Research · doi:10.1080/13811118.2025.2573059 · Cited by 1
“Shneidman (1987, 1993) proposed that suicide is an attempt to escape intolerable psychological pain.”
Uncovering the mechanism linking education expectation and suicide ideation among students in tertiary education: The mediating role of academic burnout, psychache, and hopelessness
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“The obstruction of a psychological need and personal goal results in psychache, which is a robust predictor of suicidal ideation [61].”
The Perspectives of People With Lived Experience of Suicide On Signs Designed to Encourage Help-Seeking
Dempster, G., Pirkis, J., Nicholas, A., Law, P., Ftanou, M., Brooks, A., & Clapperton, A. (2026) · Crisis · doi:10.1027/0227-5910/a001041 · Cited by 1
The chain mediating role of emotion dysregulation and non-suicidal self-injury in the relationship between cyber-victimization and suicidal ideation among college students
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“One widely accepted perspective on suicide posits that psychological pain plays a crucial role in the emergence of suicidal ideation (Baumeister, 1990; Klonsky & May, 2015; Shneidman, 1993).”
Health-Related Quality of Life and Suicidal Behaviors in Primary Care Patients: Conditional Indirect Effects via Interpersonal Needs and Depressive Symptoms
Rowe, C. A. (2014) · Digital Commons - East Tennessee State University (East Tennessee State University) · Cited by 1
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Michel, K. (2014) · Crisis · doi:10.1027/0227-5910/a000272 · Cited by 1
Suicide prevention: a long-lasting Italian tradition. Toward understanding the suicidal mind
Pompili, M. (2010) · IRIS Research product catalog (Sapienza University of Rome) · Cited by 1
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Giner, L., Root, C. W., & Courtet, P. (2016) · Springer eBooks · doi:10.1007/978-3-319-26282-6_34 · Cited by 1
A Psychodynamic Perspective on Suicidal Desire in the Elderly
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PSYCHACHE AND SELF-HARMING BEHAVIOUR AMONG MEN WHO ARE HOMELESS: A TEST OF SHNEIDMAN'S MODEL
Patterson, A. A. (2010) · Cited by 1
Suicide et environnement social
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Mortality Awareness: New Directions
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“intense emotional state termed “psychache,” which can trigger suicidal ideation if it becomes unbearable (Shneidman 1993).”
Background
التعرض للتنمر السیبرانی وعلاقته بالأفکار الانتحاریة لدى عینة من طلبة الجامعة
محمود, ه. س. (2022) · مجلة الإرشاد النفسی · doi:10.21608/cpc.2022.233904 · Cited by 1
Unmet Needs in the Management of Suicide Risk: Psychological Pain as the Main Ingredient of Suicide Risk
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Suicide and suicidal behaviors: insight into clinical challenges and preventive measures
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“● The unbearable psychological pain that Shneidman [85] considered the most distinctive feature of suicide grows and becomes more substantial when the individual has difficulties in emotion regulation.”

Authors: SHNEIDMAN, E. S.
Affiliations: University of California, Los Angeles (US)
Corresponding author: SHNEIDMAN, EDWIN S.
Venue: The Journal of Nervous and Mental Disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1993-03
Volume: 181
Issue: 3
Pages: 145-147
ISSN: 0022-3018 (ISSN-L)
DOI: 10.1097/00005053-199303000-00001
OpenAlex: W2224716391
Cited by: 775
References: 0
Citations by year: 2026: 39 · 2025: 84 · 2024: 58 · 2023: 43 · 2022: 50 · 2021: 49 · 2020: 59 · 2019: 42 · 2018: 32 · 2017: 38 · 2016: 34 · 2015: 25 · 2014: 31 · 2013: 22 · 2012: 20
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Nervous and Mental Disease (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords: suicide, emotional pain, psychological suffering
MeSH terms: Depressive Disorder, Frustration, Happiness, Humans, Models, Psychological, Pain, Personality, Q-Sort, Stress, Psychological, Suicide

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