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The Internal Struggle hypothesis of suicide holds that suicidal individuals have both a wish to live and a wish to die.[1] The difference between the wish to die versus the wish to live appears to be a unique risk factor for suicide.[2] In an online survey of 1,016 respondents, nearly all suicide-risk respondents engaged in such a debate.[3] A cycle of negative feedback and decreased self-esteem may push a patient's internal struggle in the direction of suicide.[4]


  1. Kovacs, Maria (21 Feb 2006), The wish to die and the wish to live in attempted suicides, 33, pp. 361–365,
  2. Brown, Gregory K. (1977-1979), The Internal Struggle Between the Wish to Die and the Wish to Live: A Risk Factor for Suicide, Am J Psychiatry, doi:10.1176/appi.ajp.162.10.1977
  3. Harris, Keith M. (April 2010), The Internal Suicide Debate Hypothesis: Exploring the Life versus Death Struggle, 40, Suicide and Life-Threatening Behavior, pp. 181–192, doi:10.1521/suli.2010.40.2.181, ISSN 0363-0234
  4. PG Cotton, RE Drake, C Gates (1985), Critical treatment issues in suicide among schizophrenics,
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