background Suicidality in adolescence is increasingly becoming a societal problem, especially because there remains a small group of patients in which treatment effectiveness is small. Existing formal guidelines often are of limited value in this group that often shows complex comorbidity.
aim To contribute to the diagnostic and aetiological perspective in order to better understand therapy refractory internalising behaviour.
method Integration of several scientific theoretical concepts into a holistic model.
results Evidence shows that suicidality should be considered within a broader scope of therapy refractory internalising behaviour. Important underpinnings comprise a partially overprotective parenting style, disturbed attachment processes and social anxiety. Internalising and externalising behaviour problems are viewed as expressions of avoidance behaviour. Furthermore, we discuss important implications for treatment.
conclusion Applying an aetiological model for therapy refractory internalising behaviour may help to increase efficacy of treatment. Thus, transdiagnostic treatment can be offered, being less dependent on specific dsm-classifications. Focus of treatment is on restoration of basic trust between the youngster and his parents, and on ending avoidance behaviour that is based on social anxiety.