Abnormal Psych Chapter 7 Flashcards
Suicide
The purposeful taking of one’s own life
Sub-intentional death
Indirect, covert, partial, or unconscious
Is suicide classified as a mental disorder in DSM-5 TR?
No
What has been proposed for possible inclusion in next revision of DSM?
Suicidal Behavior Disorder and NSSI (non-suicidal self-injury)
Methods of studying suicide
Retrospective analysis:
*Piecing together available evidence
Study survivors of suicide attempts
What is one of the leading causes of death in the world?
Suicide
Approximately how many people die by suicide each year?
1 million
Approximately how many people in the US die by suicide each year?
More than 48000
Around how many people in the world make nonfatal attempts or gestures to kill themselves?
25 million
Around how many people in the world make nonfatal attempts or gestures to kill themselves?
1.4 million
Women vs men attempting suicide
Women are 3 times more likely than men
Women vs men taking their own lives
Men are 4 to 5 times more likely
What ethnic group makes up 72% of all suicides?
European American men
Native Americans suicide rate
Double national average
Black and hispanic suicides
Fewer suicides, but youth do make attempts, and rates rising
Pro-suicide websites
Found across the Internet
and have tripled over past
seven years
Provide constructive advice
or information about how to
kill self to 7.5 percent of
teenagers
Live-streaming suicides
Concerted social networking
efforts to identify people at
risk and provide aid and
information
What are the 4 motivations according to Shneidman?
Death seekers
Death initiators
Death ignorers
Death darers
Death Seekers
Clearly and explicitly seek to end their life.
Example: person who actively decides, plans and executes the plan with no likelihood of rescue
Death Initiators
Believe they’re hastening inevitable death.
Example: someone with a terminal illness who wants to avoid suffering through it
Death Ignorers
Intend to end their life, as distinct from ending their existence.
Example: members of the comet cult who believed they were going to a better place by mass suicide
Death Darers
Ambivalent about dying, take risks that defy death, increasing their likelihood of dying.
Example: person who repeatedly goes over Niagara Falls in a barrel
Biological factors in suicide
Genetics:
*Disordered genes increase risk for suicide
Neurotransmitters:
*Deficiencies in serotonin lead to impulsive, violent and
suicidal behavior
Impulsivity:
*May have biological basis.
*Low threshold for frustration – need “quick fix”
*Inadequate coping skills
Relationship between guns and suicide
Several studies have found that suicide rates decrease when cities or states enact antigun legislation that limits people’s access to guns
Psychodynamic view of suicide
Suicide results from:
*Depression and anger at others that is redirected toward self
*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 or parental rejection (Freud)
*Death instincts/Thanatos (Freud)
Research does not establish that suicidal people are dominated by intense anger.
Durkheim’s Sociocultural view of suicide
Suicide probability is determined by attachment to social groups such as family, religious institutions, and community.
Suicide categories:
*Egoistic: Isolated, alienated; nonreligious people
*Altruistic: Socially well-integrated people
*Anomic: Inhabitants of personally unstable social environment and structure
What sets the stage for suicide?
Biological vulnerability
Environmental stress
Emotional pain
Impaired cognition
Inadequate coping
Inadequate support
Suicide “Contagion”
Group member commits suicide, other members at increased risk
Media reports of suicides
May be modeling, increased acceptability, or the impact of the traumatic event on already vulnerable people
Suicide definition
An intentional death - a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one’s life
Subintentional deaths
A death in which the victim plays an indirect, hidden, partial, or unconscious role
What behaviors could contribute to subintentional deaths?
Drug, alcohol, or tobacco use, recurrent physical fighting, medication mismanagement, and self-injury or self-mutilation
Nonsuicidal self-injury
Direct and deliberate destruction of one’s own body tissue that is not accompanied by an intent to die
What
What percent of all adolescents try to injure themselves at least once?
13%
Why do many people partake in self-injury?
The pain seems to offer some relief from tension or other kinds of emotional suffering, the behavior serves as a temporary distraction from problems, the scars that result may document the person’s distress, and it may help a person deal with chronic feelings of emptiness, boredom, negativity, isolation, and identity confusion
Retrospective analysis
A psychological autopsy in which clinicians piece together information about a person’s suicide from the person’s past
Relationship between religion and suicide
Very religious people seem less likely to die by suicide
What types of things can be used in retrospective analysis?
Relatives, friends, therapists, or physicians may remember past statements, conversations, and behaviors that shed light on a suicide
Suicide notes left behind
Medical records (more reliable)
Approximately how many nonfatal suicide attempts are there for every fatal suicide?
28
Women vs men suicide attempts
2 times as many women as men
Women vs men actual suicides
Men die from their attempts at more than 3 times the rate of women
Why are men more likely than women to die from their suicide attempt?
They tend to use more violent methods, like shooting, stabbing and hanging, than women, who use methods like drug overdose
Guns are used in 56% of male suicides in the US, vs 32% of female
Suicide and social environment/relationship status
At least half of individuals who carry out suicide have few or no close personal friends
Never-married and divorced persons have a higher suicide rate than those in more harmonious relationships
Common triggering factors of suicide
Stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and modeling
One stressor consistently linked to suicide
Combat stress
Combat veterans vs nonveterans suicide
Combat veterans are more than twice as likely to die by suicide
Immediate stress
Death, divorce, rejection, loss of job, significant financial loss, natural disasters
Long-term stress
Social isolation, serious illness or injury, abusive environment, occupational stress
Common mood changes associated with suicide
Increase in sadness, anxiety, tension, frustration, anger, or shame
Hopelessness
Pessimistic belief that present circumstances, problems, or mood will never change
What do some clinicians believe is the single most likely indicator of suicidal intent?
A feeling of hopelessness
Dichotomous thinking
Viewing problems and solutions in rigid either/or terms
Believe that suicide is the ONLY option
What do autopsies reveal about suicide and intoxication?
1/4 of people who attempt suicide are legally intoxicated at the time of the act
Correlation between intoxication and suicide method
The more intoxicated a person is, the more lethal their chosen suicide method
Likelihood of completing suicide among those who engage in extended drug use
7x greater
What percent of all suicide attempters had been experiencing sever depressive or bipolar disorders?
70%
What percent of all suicide attempters had been experiencing chronic alcoholism?
20%
What percent of all suicide attempters had been experiencing schizophrenia?
10%
What do suicides by people with schizophrenia reflect?
Feelings of demoralization, a sense of being entrapped by their disorder, and fears of further mental deterioration
Social contagion effect
Increases in risk of suicide among the relatives and friends of people who recently killed themselves
Celebrities and the social contagion effect
Suicides by entertainers, political figures, and other well-known people are regularly followed by unusual increases in the number of suicides across the nation
What do psychodynamic theorists believe suicide results from?
Depression and anger at others that is redirected toward oneself
What have psychodynamic researchers found a relationship between?
Childhood losses - real or symbolic - and later suicidal behaviors
Common forms include death of the father and divorce or separation of the parents
Thanatos
Freud’s proposal of a basic “death instinct” that opposes the “life instinct”
While most people learn to redirect their death instinct by aiming it toward others, suicidal people direct it squarely toward themselves
How is Thanatos supported in research?
National suicide rates drop in times of war, when people direct their self-destructive energy against “the enemy”
In many parts of the world, societies with high rates of homicide have low rates of suicide, and vice versa
How is the probability of suicide determined by Durkheim?
Determined by how attached a person is to such social groups as the family, religious institutions, and community
The more thoroughly a person belongs, the lower the risk of suicide
What are the categories of suicide according to Durkheim?
Egoistic, altruistic, and anomic
Egoistic suicide
Carried out by people over whom society has little or no control
People not concerned with the norms or rules of society and not integrated into the social fabric
Altruistic suicides
Undertaken by people who are so well integrated into the social structure that they intentionally sacrifice their lives for its well-being
Anomic suicides
Pursued by people whose social environment fails to provide stable structures, such as family and religion, to support and give meaning to life
Unlike egoistic suicide, which is the act of a person who rejects the structures of a society, anomic suicide is the act of a person who has been let down by a disorganized, inadequate, often decaying society
Anomie
Lack of the usual social or ethical standards in an individual or group
What happens when societies go through periods of anomie?
Suicide rates increase
Interpersonal theory of suicide
A theory that asserts that people with perceived burdensomeness, thwarted belongingness, and a psychological capability to carry out suicide are the most likely to attempt suicide
Perceived burdonsomeness
Believe that their existence places a heavy and permanent burden on their family, friends, and even society
Thwarted belongingness
Feel isolated and alienated from others - not an integral part of a family or social network
Genetic factors of suicide
Biological researchers have found higher rates of suicide among the parents and close relatives of suicidal people, and higher rates of suicide among identical twins of suicide victims
Serotonin in suicide victims
Lower activity, corresponding to dysfunction throughout the depression-related brain circuit, even among people with no history of depression
How could serotonin and brain-circuit abnormalities increase the likelihood of suicidal behavior?
They contribute to aggressive and impulsive behaviors
Suicide and age
The likelihood of dying by suicide steadily increases with age up through middle age, then decreases during the early stages of old age, then increases again beginning at age 75
What are suicide attempts by the very young commonly preceded by?
Behavioral patterns like running away from home, accident-proneness, aggressive acting out, temper tantrums, self-criticism, social withdrawal and loneliness, extreme sensitivity to criticism by others, low tolerance of frustration, sleep problems, dark fantasies, daydreams, or hallucinations, marked personality change, and overwhelming interest in death and suicide
What is the second leading cause of death among adolescents?
Suicide
What have about half of teenage suicides been tied to?
Clinical depression, low self-esteem, and feelings of hopelessness
Suicide and bullying
Suicide attempts are at least twice as common among teenage victims of bullying
What is the ratio of teenagers who attempt versus complete suicide?
From 100 to 1 to 200 to 1
Which ethnic group has the highest rate of teenage suicide?
American Indians
How many people between the ages of 65 and 74 in the US kill themselves?
More than 16 of every 100,000
How many people over the age of 74 in the US kill themselves?
19 of every 100,000
What are the goals of therapy for those who have attempted suicide?
To keep the individuals alive, reduce their psychological pain, help them achieve a nonsuicidal state of mind, restrict their access to lethal suicide means, provide them with hope, and guide them to develop better ways of handling stress
What type of therapy is particularly helpful for those who have attempted suicide?
Cognitive-behavioral: focuses largely on identifying and changing the painful thoughts, sense of hopelessness, dichotomous thinking, poor coping skills, weak problem-solving abilities of suicidal people
Dialectical behavior therapy
Therapists guide clients to accept many of the painful thoughts and feelings that keep streaming through their minds rather than try to eliminate them
Suicide prevention program
A program that tries to identify people who are at risk of killing themselves and to offer them crisis intervention
Paraprofessional
A person trained in counseling but without a formal degree
Crisis intervention
A treatment approach that tries to help people in a psychological crisis to view their situation more accurately, make better decisions, act more constructively, and overcome the crisis
Tasks of a counselor at a suicide prevention center
Establish a positive relationship
Understand and clarify the problem
Assess suicide potential
Assess and mobilize the caller’s resources
Formulate a plan
What is a key difficulty for suicide prevention programs?
They depend on accurate assessments of suicide risk, and accurate assessments are elusive
Self-Injury Implicit Association Test
Rather than asking people if they plan to attempt suicide, this cognitive test simply instructs them to pair various suicide-related words with words that are personally relevant and with words that are not personally relevant
