One of the most important things I have learned from working with survivors of domestic abuse is that suicidal thoughts are often not separate from the abuse itself.

As a psychotherapist working with survivors of domestic abuse, and a trustee of Woman’s Trust, I have spent years listening to women describe the long-term impact abuse has had on their mental health. This year marks the 30th anniversary of Woman’s Trust, and over three decades of specialist practice, survivors have taught us invaluable lessons about the relationship between abuse, trauma and mental health. Perhaps the most important is that suicidality cannot always be understood outside the context of abuse.

As therapists, we can sometimes view suicidality primarily through the lens of mental illness, internal distress or individual vulnerability. Yet survivors repeatedly describe something different. Suicidal thoughts can emerge within a context of coercive control, fear and profound entrapment, where autonomy has been systematically eroded and every perceived route to safety appears blocked.

I was reminded of this through the experiences of a survivor I will call Anna. Over more than two decades, she experienced coercive control, physical violence, sexual abuse, stalking and abuse involving her children. When she spoke about suicidality, she did not describe it as something separate from the abuse. She described it as something that grew within it.

Her words have stayed with me:

‘When you're in a domestic abuse relationship, you always consider taking your life to get away.’

Anna’s experience raises important questions about how we, as therapists, understand and respond to suicide risk in the context of domestic abuse.

Her suicidal thoughts were not sudden or disconnected from her circumstances. They developed over time within an environment of fear, control and entrapment. At times, they were directly reinforced by the abuse itself.

‘Statements such as, “Why don't you just kill yourself?” left them feeling caged.’

When someone is repeatedly told they are worthless, isolated from support, deprived of autonomy and subjected to violence, suicidal thoughts can become understandable responses to seemingly impossible circumstances.

As Anna explained:

‘Because somebody told me those words about what I was, it seeps into your blood.’

For many survivors, suicidality becomes intertwined with the abuse. Coercive control is fundamentally about domination. It systematically erodes freedom, identity and agency until many women describe feeling there is no escape. Suicide may come to feel less like a wish to die and more like an attempt to escape circumstances that feel impossible to survive.

This understanding changes how we formulate risk. Rather than viewing suicidal ideation only as evidence of internal distress, we must also understand it as a response to gendered abuse, chronic trauma, unequal power and entrapment. Asking only “’What is wrong with this person?’ risks missing the equally important question: ‘What has happened to them?’

Why therapists can miss what is happening

Traditional risk assessments often focus on symptoms, intent and individual vulnerability. These are important, but they can overlook the wider context in which suicidality develops.

Domestic abuse creates conditions of chronic fear, powerlessness and entrapment. Understanding those dynamics is essential to understanding the meaning of suicidal thoughts.

I have also seen how survivors may present with remarkable composure when describing experiences that are profoundly traumatic. Anna’s matter-of-fact description of considering suicide was striking not because of visible distress, but because of how normalised those thoughts had become within the reality she was living in. Low affect does not necessarily indicate low risk. Sometimes it reflects years of adapting to danger. Emotional numbing, hopelessness and hypervigilance can be survival responses to chronic threat.

We must also recognise that many survivors arrive in therapy carrying not only the trauma of abuse, but the trauma of trying to seek help.

Anna reflected:

‘At times, it would have been easier to stay and be raped and abused than to go through the re-traumatisation of trying to get help from criminal justice and safeguarding systems.’

This is difficult to hear, but essential to understand. Experiences of seeking help may themselves be traumatic and can shape a survivor’s relationship with support, trust and hope.

The power of being believed

By the time Anna reached therapy, she was carrying not only the effects of abuse, but the impact of not being believed.

She described repeated experiences of systems that felt fragmented, dismissive or being unable to fully understand what she had experienced.

Then something changed.

‘The first time a therapist said, “I believe you,” I broke down crying.’

That moment became a turning point.

‘It felt like a weight lifted. I felt safe. From that point, I could process what had happened.’

At Woman’s Trust, Anna also attended support groups, where hearing other women’s experiences helped her make sense of her own.

‘I thought, this abuse is all out of the same rulebook.’

Being believed is not a small intervention in this context. It directly challenges the gaslighting and distortion many survivors have lived with for years. It restores trust in their own perceptions and creates the conditions necessary for therapeutic work to begin.

What this means for therapists

Anna’s story reflects a wider reality that remains insufficiently recognised. Domestic abuse is a significant factor in suicidality among women, yet it is often overlooked in clinical formulations and wider conversations about suicide risk.

For therapists working with survivors of domestic abuse, alongside our commitment to collaborative risk assessment (see Good Practice in Action 042 for more information) we must:

  • explore suicidal thoughts within the context of coercive control, entrapment and loss of autonomy
  • consider power, abuse and inequality alongside symptoms when assessing risk
  • recognise that help-seeking histories may themselves be traumatic
  • understand that survivors may minimise or normalise dangerous experiences
  • remember that low affect does not necessarily indicate low risk
  • recognise that being believed can itself be therapeutic
  • consider whether specialist domestic abuse support is needed alongside therapy.

The trauma does not necessarily end when the abuse ends. For many women, abuse continues after separation through stalking, harassment, child contact arrangements, family court proceedings or economic abuse. Even when the relationship has ended, the effects of prolonged trauma often remain.

Anna is now years beyond the relationship, yet continues to live with intrusive thoughts, hypervigilance and the lasting effects of trauma.

‘The stress affects your brain and it doesn't just reverse.’

As therapists, we need to understand these ongoing adaptations not simply as pathology, but as understandable responses to chronic danger.

Final reflection

Anna’s message to therapists is simple:

‘Listen to those going through it. Learn from it.’

Survivors are often our greatest teachers. Their experiences challenge assumptions, deepen our understanding and remind us that suicidality does not emerge in a vacuum.

When working with survivors of domestic abuse, we must look beyond symptoms and ask what conditions have made those thoughts feel necessary. Only then can we begin to understand the full picture of risk, survival and recovery.

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