Suicide

Chapter 7

Fundamentals of Abnormal Psychology RONALD J. COMER | JONATHAN S. COMER | ninth edition

Suicide

• Suicide is one of the leading causes of death in the world

• Approximately 1 million people die by suicide each year,
including more than 42,000 in the United States
• Classification
• Not officially classified as a mental disorder in DSM-5
• Suicidal behavior disorder has been proposed for the next
revision
What Is Suicide? (part 1)

• Suicide
• Self-inflicted death in which one makes intentional, direct, and conscious
effort to end one’s life
• Intentional death (Shneidman)
• Death seeker: _________________________________________________
• Death initiator: ________________________________________________
• Death ignorer: _________________________________________________
• Death darer: ___________________________________________________
• Subintentional death
• Indirect, covert, partial, or unconscious
• Self-injury or self-mutilation
What Is Suicide? (part 2)

• How is suicide studied?

• Using retrospective analysis as psychological
____________
• Studying people who survive their suicide attempts
Trending: Internet Horrors
• _____-_________ Web sites
• Found across the Internet and have tripled over
past seven years
• Provide constructive advice or information about
suicide to 7.5 percent of teenagers
• Live-streaming of suicides
• Concerted social networking efforts to identify
people at risk and provide aid and information
• On January 22, 2017, 14-year-old Nakia Venant
broadcast her suicide on Facebook while sending
and receiving texts.
What Is Suicide? (part 3)

• Patterns and statistics

• Suicide rates vary
• Country to country
• Gender and marital status
• Race and ethnicity
• Social environment
• Religious _______________ (not exclusively affiliation)
• Under-reporting may exist
Suicide, Race, and Gender

Suicides per 100,000 population

• American Indian
Males 27.4 vs Females 8.7
• Non-Hispanic white American
Males 25.8 vs Females 7.5
• Hispanic American
Males 10.3 vs Females 2.5
• African American
Males 9.7 vs Females 2.1
• Asian American
Males 9.5 vs Females 4.0
What Triggers a Suicide? (part 1)

• Common triggers
• _____________ events
• Mood and thought changes
• ___________ and other drug use
• Mental disorders
• Modeling
What Triggers a Suicide? (part 2)

• Stressful events and situations

• _____________ stressors
• Loss of loved one through death, divorce, or rejection
• Loss of job or significant financial loss
• Natural disasters
What Triggers a suicide (Part 3)

• In 2015, Aaron Hernandez, a star tight end in the National

Football League, was convicted of first-degree murder and
sentenced to life in prison without parole for the 2013 killing
of an acquaintance. Hernandez killed himself by hanging at a
Massachusetts prison in 2017, just days after being acquitted
of two additional killings.
• Around 11 percent of all prison deaths are due to suicide
(BJS, 2016).
What Triggers a Suicide? (part 4)

• Stressful events and situations

• _____________ stressors
• Social isolation
• Serious illness
• Abusive or repressive environment
• Occupational stress

• Researchers have counted more stressful events in the

lives of suicide attempters than in the lives of
nonattempters.
What Triggers a Suicide? (part 5)

• Mood and thought changes

• Many suicide attempts are preceded by changes in mood
and shifts in thinking patterns
• ______________
• Sadness, anxiety, tension, frustration, shame
• ______________
• Dichotomous thinking
What Triggers a Suicide? (part 6)

• Alcohol and other drug use

• ______ percent of suicide attempters drink alcohol just
before the act
• One-fourth of these people are legally intoxicated
• Use of other kinds of drugs may have similar ties to
suicide, particularly in teens and young adults
What Triggers a Suicide? (part 7)

• Mental disorders
• The majority of suicide attempters have a psychological
disorder
• Unipolar depression or bipolar (____ percent)
• Chronic alcoholism (____ percent)
• Schizophrenia (____ percent)
• Risk increases with multiple disorders
What Triggers a Suicide? (part 8)

• Mental disorders
• Other psychological disorder
• Posttraumatic stress disorder (PTSD)
• Panic disorder
• Substance use disorder
• Often in conjunction with schizophrenia or borderline
personality disorder
What Triggers a Suicide? (part 9)

• Modeling: ___________________________
• A suicidal act appears to serve as a model for other such
acts, especially among teens
• Common models
• ___________ members and friends
• _____________
• Highly publicized cases
• Coworkers and colleagues
What Are the Underlying Causes of Suicide?
(part 1)
• Psychodynamic view
• Suicide results from
• Depression and anger at others that is redirected
toward __________ (Stekel)
• An introjecting lost person (Freud; Abraham): Anger
over a lost loved one turns to self-hatred and then
depression
• Later suicidal behaviors related to childhood losses
(Freud)
• Death instincts (Freud)
What Are the Underlying Causes of Suicide?
(part 3)
• Interpersonal view
• Interpersonal-psychological theory (Joiner et al.)
• Perceptions related to desire for suicide
• Perceived burdensomeness
• Thwarted belongingness
• Psychological ability to carry out suicide
• Important to examine variables collectively
What Are the Underlying Causes of Suicide?
(part 4)
• Biological view
• Genetics
• Early twin studies point to genetic links to suicide
• Brain development
• Low ______________ activity and abnormalities in
depression-related brain circuits contribute to suicide
• Both aid in production of aggressive feelings and
impulsive behavior
• Key psychosocial factors
Is Suicide Linked to Age? (part 1)

• The likelihood of committing suicide increases with age,

although people of all ages may try to kill themselves.
• In the United States, suicide rates keep rising through middle
age, then fall during the first decade of old age, then rise
again among people over the age of 74. (Information from
AFSP, 2017; CDC, 2016.)
Is Suicide Linked to Age? (part 2)

• Children
• Suicide is infrequent among children
• Suicide by very young is often preceded by behavioral
struggles
• Many child suicides appear to be based on a clear
understanding of death and a clear wish to die
Is Suicide Linked to Age? (part 3)

• Adolescents
• Suicidal actions become much more common after the
age of _____
• About 8 of every 100,000 U.S. teenagers commit
suicide yearly
• 12 percent have persistent suicidal thoughts
• 4 to 8 percent make suicide attempts
Is Suicide Linked to Age? (part 4)

• Adolescents
• Teenage suicide links
• Developmental stress of adolescence
• Long- and short-term stressors, especially among
LGBTQ teens
• _______, low self-esteem, hopelessness
• Anger, _______________, alcohol or drug problems
• Internet and in-person modeling
Is Suicide Linked to Age? (part 5)

• Adolescents
• Far more teens __________ suicide than __________
• Ratio may be as high as 200:1
• Factors linked to suicide attempts
• Competition for jobs, college position, academic and
athletic honors
• Weakening family ties
• Availability of alcohol/drugs
• Mass media
Is Suicide Linked to Age? (part 6)

• Adolescents
• U.S. teen suicide rates vary by ethnicity
• Young _______________ Americans are more suicide-
prone than African Americans or Hispanic Americans at
this age
• Highest suicide rates are displayed by American Indians
• Incidence rates are closing among all groups
Is Suicide Linked to Age? (part 7)

The Elderly
• U.S. elderly are most likely to commit suicide and most
successful
• Contributory factors
• Illness
• Loss of close friends and relatives
• Loss of control over one's life
• Loss of social status
• Ethnicity
Treatment and Suicide (part 1)

• Treatments after suicide attempts

• Medical care
• Appropriate follow-up with psychotherapy or drug
therapy
• Therapies
• Psychodynamic therapy
• Drug therapy
• Group and family therapies
• _________________ therapy (Beck)
• Mindfulness-based
• Dialectical behavior
Treatment and Suicide (part 2)

• Treatments after suicide attempts

• Therapy goals
• Keep the patient alive
• Reduce psychological pain
• Achievement of nonsuicidal state of mind and a sense
of hope
• Development of better ways of stress management
Treatment and Suicide (part 3)

• Suicide prevention
• Prevention programs and crisis hotlines–provided crisis
prevention
• Staffed by professionals or ______________
• Offered through various modalities
Treatment and Suicide (part 4)

• Suicide prevention goals for initial contact

• Establishing a positive relationship
• Understanding and clarifying the problem
• Assessing suicide potential
• Assessing and mobilizing the caller's resources
• Formulating a plan
• Longer-term prevention
• Referral
• Therapy
• Reduction of access to common suicide means
Treatment and Suicide (part 5)

• Another way to prevent suicide may be to limit the public's

access to common means of suicide
• For example, through gun control, safer medications, better
bridge barriers, and car emissions controls.
Treatment and Suicide (part 5)

• Do suicide prevention programs work?

• Assessment of program effectiveness is difficult
• Variety of program types, variables, and confounds
• ___________ results
• Accurate suicide risk assessment is elusive
• Newer assessment approaches
• Nonverbal behaviors
• Psychophysiological measures
• Brain scans
• Self-Injury Implicit Association Test (Nock)
Psychological and Biological Insights Lag
Behind
• Suicide has received much more examination from the sociocultural
model than from any other
• Sociocultural factors shed light on the general background and
triggers of suicide, but typically leave us unable to predict that a
given person will attempt suicide
• Clinicians do not yet fully understand why some people kill
themselves while others in similar circumstances manage to find
better ways of addressing their problems