The Internal Struggle hypothesis of suicide holds that suicidal individuals have both a wish to live and a wish to die. The difference between the wish to die versus the wish to live appears to be a unique risk factor for suicide. In an online survey of 1,016 respondents, nearly all suicide-risk respondents engaged in such a debate. A cycle of negative feedback and decreased self-esteem may push a patient's internal struggle in the direction of suicide.
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