Comer, Abnormal Psychology, 6e Chapter 10 1 Chapter 10 Suicide Slides Handouts by Karen Clay Rhines, Ph.D. Seton Hall University

Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e – Chapter 10Chapter 10

11

Chapter 10Chapter 10

SuicideSuicide

Slides & Handouts by Karen Clay Slides & Handouts by Karen Clay Rhines, Ph.D.Rhines, Ph.D.

Seton Hall UniversitySeton Hall University

2Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e –


SuicideSuicide Suicide is a leading cause of death in the Suicide is a leading cause of death in the

worldworld There are about 700,000 people who die of it There are about 700,000 people who die of it

each year, with 31,000 suicides per year in each year, with 31,000 suicides per year in the U.S. alonethe U.S. alone

Many more unsuccessfully attempt suicide Many more unsuccessfully attempt suicide than actually succeedthan actually succeed Such attempts are called “parasuicides”Such attempts are called “parasuicides” There are about 600,000 attempts per year in There are about 600,000 attempts per year in

the U.S.the U.S.



SuicideSuicide It is difficult to obtain accurate figures It is difficult to obtain accurate figures

on suicide rateson suicide rates Many “accidents” may be intentional deathsMany “accidents” may be intentional deaths

Suicide is not classified as a mental Suicide is not classified as a mental disorder in the DSM-IV-TRdisorder in the DSM-IV-TR While suicide is often linked to depression, While suicide is often linked to depression,

about half of all suicides result from other about half of all suicides result from other mental disorders or involve no clear mental mental disorders or involve no clear mental disorder at alldisorder at all



What Is Suicide?What Is Suicide?

Shneidman defines suicide as an Shneidman defines suicide as an intentioned death – a self-inflicted intentioned death – a self-inflicted death in which one makes an death in which one makes an intentional, direct, and conscious intentional, direct, and conscious effort to end one’s lifeeffort to end one’s life

He characterizes four kinds of He characterizes four kinds of suicide seekers…suicide seekers…



What Is Suicide?What Is Suicide? Shneidman’s characterizations of suicide Shneidman’s characterizations of suicide

seekers:seekers: Death seekers – clearly intend to end their livesDeath seekers – clearly intend to end their lives Death initiators – intend to end their lives because Death initiators – intend to end their lives because

they believe that the process of death is already they believe that the process of death is already underwayunderway

Death ignorers – do not believe that their self-Death ignorers – do not believe that their self-inflicted death will mean the end of their existenceinflicted death will mean the end of their existence

Death darers – have ambivalent feelings about Death darers – have ambivalent feelings about death and show this in the act itselfdeath and show this in the act itself



What Is Suicide?What Is Suicide?

When individuals play indirect, When individuals play indirect, hidden, partial, or unconscious roles hidden, partial, or unconscious roles in their own deaths, Shneidman in their own deaths, Shneidman classifies them in a category called classifies them in a category called “subintentional death”“subintentional death” True intent is unclearTrue intent is unclear



How Is Suicide Studied?How Is Suicide Studied? Suicide researchers face a major Suicide researchers face a major

obstacle: their subjects are no longer obstacle: their subjects are no longer alivealive

Researchers use two different strategies Researchers use two different strategies to try to overcome this obstacle (with to try to overcome this obstacle (with partial success): partial success): Retrospective analysisRetrospective analysis Studying people who survive their suicide Studying people who survive their suicide

attemptsattempts



Patterns and Statistics Patterns and Statistics

Researchers have gathered statistics Researchers have gathered statistics regarding the social contexts in regarding the social contexts in which suicides take placewhich suicides take place Suicide rates vary from country to Suicide rates vary from country to

country, with religious devoutness (not country, with religious devoutness (not simply affiliation) helping to explain simply affiliation) helping to explain some of the differencesome of the difference



Patterns and StatisticsPatterns and Statistics The suicide rates of men and women also The suicide rates of men and women also

differ:differ: Women have a higher attempt rate (3x men)Women have a higher attempt rate (3x men) Men have a higher completion rate (3x Men have a higher completion rate (3x

women)women) Why? Different methods have differing lethalityWhy? Different methods have differing lethality

Men tend to use more violent methods (shooting, Men tend to use more violent methods (shooting, stabbing, or hanging) than women (drug overdose)stabbing, or hanging) than women (drug overdose)

Guns are used in nearly two-thirds of male suicides Guns are used in nearly two-thirds of male suicides in the U.S., compared to 40% of female suicidesin the U.S., compared to 40% of female suicides



Patterns and Statistics Patterns and Statistics

Suicide is also related to marital Suicide is also related to marital status and level of social supportstatus and level of social support Divorced people have a higher suicide Divorced people have a higher suicide

rate than married or cohabiting rate than married or cohabiting individualsindividuals

One study found that half of the One study found that half of the subjects who had committed suicide subjects who had committed suicide were found to have no close friendswere found to have no close friends



Patterns and StatisticsPatterns and Statistics In the U.S., suicide also seems to vary In the U.S., suicide also seems to vary

according to raceaccording to race The suicide rate of white Americans (12 per The suicide rate of white Americans (12 per

100,000) is almost twice as high as that of 100,000) is almost twice as high as that of African Americans and members of other African Americans and members of other racial groupsracial groups

A major exception to this pattern is the very A major exception to this pattern is the very high suicide rate of Native Americans, which high suicide rate of Native Americans, which overall is 1.5 times the national averageoverall is 1.5 times the national average



What Triggers a Suicide?What Triggers a Suicide?

Suicidal acts may be connected to Suicidal acts may be connected to recent events or current conditions recent events or current conditions in a person’s lifein a person’s life

Common triggers include stressful Common triggers include stressful events, mood and thought changes, events, mood and thought changes, alcohol and other drug use, mental alcohol and other drug use, mental disorders, and modelingdisorders, and modeling



Stressful Events and Stressful Events and SuicideSuicide

Researchers have counted more Researchers have counted more stressful events in the lives of suicide stressful events in the lives of suicide attempters than in the lives of matched attempters than in the lives of matched controlscontrols

Both immediate and long-term stresses Both immediate and long-term stresses can be risk factors for suicidecan be risk factors for suicide Immediate stresses can include the loss of a Immediate stresses can include the loss of a

loved one, the loss of a job, or natural loved one, the loss of a job, or natural disasterdisaster



Stressful Events and Stressful Events and SuicideSuicide

Long-term stressors can include:Long-term stressors can include: Serious illnessSerious illness Abusive environmentAbusive environment Occupational stressOccupational stress

Psychiatrists and psychologists, physicians, Psychiatrists and psychologists, physicians, nurses, dentists, lawyers, farmers, and unskilled nurses, dentists, lawyers, farmers, and unskilled laborers have particularly high suicide rateslaborers have particularly high suicide rates

Work outside the home may be linked to Work outside the home may be linked to lowerlower suicide rates among women, contrary to suicide rates among women, contrary to previously held beliefspreviously held beliefs



Mood and Thought Mood and Thought ChangesChanges

Many suicide attempts are preceded by Many suicide attempts are preceded by changes in moodchanges in mood These changes may not be enough to These changes may not be enough to

warrant a diagnosis of a mental disorderwarrant a diagnosis of a mental disorder The most common change is a rise in The most common change is a rise in

sadnesssadness Increases in feelings of anxiety, tension, Increases in feelings of anxiety, tension,

frustration, anger, or shame are also commonfrustration, anger, or shame are also common Shneidman calls this “psychache,” a feeling of Shneidman calls this “psychache,” a feeling of

psychological pain that seems intolerable to the psychological pain that seems intolerable to the personperson




Suicide attempts may also be preceded Suicide attempts may also be preceded by shifts in patterns of thinkingby shifts in patterns of thinking Individuals may become preoccupied, lose Individuals may become preoccupied, lose

perspective, and see suicide as their only perspective, and see suicide as their only optionoption They often develop a sense of hopelessness – a They often develop a sense of hopelessness – a

pessimistic belief that their present pessimistic belief that their present circumstances, problems, or mood will not changecircumstances, problems, or mood will not change

Some clinicians believe that a feeling of Some clinicians believe that a feeling of hopelessness is the single most likely indicator hopelessness is the single most likely indicator of suicidal intentof suicidal intent




People who attempt suicide may People who attempt suicide may experience dichotomous thinking, experience dichotomous thinking, viewing problems and solutions in viewing problems and solutions in rigid either/or termsrigid either/or terms The “four-letter word” in suicide is The “four-letter word” in suicide is

“only,” as in “suicide was the “only,” as in “suicide was the onlyonly thing thing I could do”I could do”



Alcohol and Other Drug Alcohol and Other Drug UseUse

Studies indicate that as many as 70% Studies indicate that as many as 70% of the people who attempt suicide of the people who attempt suicide drink alcohol just before the actdrink alcohol just before the act Autopsies reveal that about 25% of these Autopsies reveal that about 25% of these

people are legally intoxicatedpeople are legally intoxicated Research shows the use of other Research shows the use of other

kinds of drugs may have similar ties kinds of drugs may have similar ties to suicideto suicide



Mental DisordersMental Disorders

Attempting suicide does not Attempting suicide does not necessarily indicate the presence of necessarily indicate the presence of a psychological disordera psychological disorder Nevertheless, the majority of all suicide Nevertheless, the majority of all suicide

attempters do display such a disorderattempters do display such a disorder Those with mood disorders, substance Those with mood disorders, substance

use disorders, and/or schizophrenia are use disorders, and/or schizophrenia are at greatest riskat greatest risk



Modeling: The Contagion Modeling: The Contagion of Suicideof Suicide

It is not unusual for people, It is not unusual for people, particularly teens, to commit suicide particularly teens, to commit suicide after observing or reading about after observing or reading about someone who has done sosomeone who has done so One suicide appears to serve as a model One suicide appears to serve as a model

for anotherfor another Suicides by celebrities, other highly Suicides by celebrities, other highly

publicized suicides, and suicides by co-publicized suicides, and suicides by co-workers are particularly common triggersworkers are particularly common triggers



Modeling: The Contagion Modeling: The Contagion of Suicideof Suicide

Suicides with bizarre or unusual aspects Suicides with bizarre or unusual aspects often receive intense coverage by the often receive intense coverage by the news media, possibly leading to similar news media, possibly leading to similar suicidessuicides

Even media programs clearly intended to Even media programs clearly intended to educate and help viewers may have the educate and help viewers may have the paradoxical effect of spurring imitatorsparadoxical effect of spurring imitators Some clinicians argue that more responsible Some clinicians argue that more responsible

reporting and postvention programs could reporting and postvention programs could reduce this effectreduce this effect



What Are the Underlying What Are the Underlying Causes of Suicide?Causes of Suicide?

Most people faced with difficult Most people faced with difficult situations never attempt suicidesituations never attempt suicide In an effort to explain suicide-proneness, In an effort to explain suicide-proneness,

theorists have proposed more fundamental theorists have proposed more fundamental explanations for self-destructive behaviorexplanations for self-destructive behavior

Leading theories come from the Leading theories come from the psychodynamic, sociocultural, and biological psychodynamic, sociocultural, and biological perspectivesperspectives

These hypotheses have received limited research These hypotheses have received limited research support and fail to address the full range of support and fail to address the full range of suicidal actssuicidal acts



Underlying Causes of Underlying Causes of Suicide: Suicide:

The Psychodynamic ViewThe Psychodynamic View Theorists believe that suicide results from Theorists believe that suicide results from

depression and from anger at others that is depression and from anger at others that is redirected toward oneselfredirected toward oneself

Additionally, Freud proposed that humans Additionally, Freud proposed that humans have a basic death instinct (“Thanatos”) that have a basic death instinct (“Thanatos”) that operates in opposition to the life instinctoperates in opposition to the life instinct While most people learn to direct their death While most people learn to direct their death

instinct toward others, suicidal people direct it instinct toward others, suicidal people direct it at themselvesat themselves




The Sociocultural ViewThe Sociocultural View Durkheim argues that the probability of Durkheim argues that the probability of

suicide is determined by how attached a suicide is determined by how attached a person is to such social groups as the person is to such social groups as the family, religious institutions, and family, religious institutions, and communitycommunity The more thoroughly a person belongs, the The more thoroughly a person belongs, the

lower the risk of suicidelower the risk of suicide Based on this premise, he developed Based on this premise, he developed

several categories of suicide, including several categories of suicide, including egoistic, altruistic, and anomic suicide… egoistic, altruistic, and anomic suicide…




The Sociocultural ViewThe Sociocultural View Egoistic suicidesEgoistic suicides are committed by people over are committed by people over

whom society has little or no controlwhom society has little or no control Altruistic suicidesAltruistic suicides are committed by people who are committed by people who

are so well integrated into their society that are so well integrated into their society that they intentionally sacrifice their lives for its they intentionally sacrifice their lives for its well-beingwell-being

Anomic suicidesAnomic suicides are those committed by people are those committed by people whose social environment fails to provide stable whose social environment fails to provide stable structures that support and give meaning to lifestructures that support and give meaning to life A change in an individual’s immediate surroundings A change in an individual’s immediate surroundings

can also lead to this type of suicidecan also lead to this type of suicide




The Biological ViewThe Biological View Family pedigree and twin studies support the Family pedigree and twin studies support the

position that biological factors contribute to position that biological factors contribute to suicidal behaviorsuicidal behavior For example, there are higher rates of suicide For example, there are higher rates of suicide

among the parents and close relatives of those among the parents and close relatives of those who commit suicide than among nonsuicidal who commit suicide than among nonsuicidal peoplepeople

As always with this type of research, As always with this type of research, however, nonbiological factors, such as however, nonbiological factors, such as shared environment, must also be consideredshared environment, must also be considered



Underlying Causes of Underlying Causes of Suicide:Suicide:

The Biological ViewThe Biological View Recent laboratory research has offered more Recent laboratory research has offered more

direct support for a biological model of direct support for a biological model of suicidesuicide Serotonin levels have been found to be low in Serotonin levels have been found to be low in

people who commit suicidepeople who commit suicide There is a known link between low serotonin and There is a known link between low serotonin and

depressiondepression There is evidence, though, of low serotonin activity There is evidence, though, of low serotonin activity

among suicidal subjects with among suicidal subjects with no historyno history of depression of depression Serotonin activity may contribute to aggressive behavior Serotonin activity may contribute to aggressive behavior



Is Suicide Linked to Age?Is Suicide Linked to Age?

The likelihood of committing suicide The likelihood of committing suicide increases with age, but people of all increases with age, but people of all ages may try to kill themselvesages may try to kill themselves

Although the general findings about Although the general findings about suicide hold true across age groups, suicide hold true across age groups, three groups (children, adolescents, three groups (children, adolescents, and the elderly) have been the focus of and the elderly) have been the focus of much study because of the unique much study because of the unique issues that face themissues that face them



ChildrenChildren

Suicide is infrequent among childrenSuicide is infrequent among children Rates have been rising for the last Rates have been rising for the last

decadedecade About 500 children younger than 14 About 500 children younger than 14

years of age commit suicide each yearyears of age commit suicide each year

Boys outnumber girls by as much as 5:1Boys outnumber girls by as much as 5:1



ChildrenChildren

Suicide attempts by the very young Suicide attempts by the very young generally are preceded by such generally are preceded by such behavioral patterns as running away, behavioral patterns as running away, temper tantrums, social withdrawal, temper tantrums, social withdrawal, dark fantasies, and marked personality dark fantasies, and marked personality changeschanges

Many child suicides appear to be based Many child suicides appear to be based on a clear understanding of death and on a clear understanding of death and on a clear wish to dieon a clear wish to die



AdolescentsAdolescents

Suicidal actions become much more Suicidal actions become much more common after the age of 14 than at any common after the age of 14 than at any earlier ageearlier age About 2000 teens commit suicide in the About 2000 teens commit suicide in the

U.S. each yearU.S. each year As many as 500,000 may make attemptsAs many as 500,000 may make attempts

Young white Americans are more suicide-Young white Americans are more suicide-prone than African Americans at this ageprone than African Americans at this age Suicide rates are growing closerSuicide rates are growing closer




About half of teen suicides have been About half of teen suicides have been linked to depression, low self-esteem, linked to depression, low self-esteem, and feelings of hopelessnessand feelings of hopelessness Anger, impulsiveness, poor problem-solving Anger, impulsiveness, poor problem-solving

skills, and stress also play a roleskills, and stress also play a role Some theorists believe that the period of Some theorists believe that the period of

adolescence itself produces a stressful adolescence itself produces a stressful climate in which suicidal actions are climate in which suicidal actions are more likelymore likely




Far more teens attempt suicide than Far more teens attempt suicide than succeedsucceed Ratio may be as high as 200:1Ratio may be as high as 200:1

Several explanations, most pointing Several explanations, most pointing to societal factors, have been to societal factors, have been proposed for the high rate of proposed for the high rate of attempts among teenagersattempts among teenagers



The ElderlyThe Elderly

In Western society the elderly are In Western society the elderly are more likely to commit suicide than more likely to commit suicide than people in any other age grouppeople in any other age group There are many contributory factors:There are many contributory factors:

IllnessIllness Loss of social supportLoss of social support Loss of control over one’s lifeLoss of control over one’s life Loss of social statusLoss of social status



The ElderlyThe Elderly Elderly persons are typically more Elderly persons are typically more

determined than younger persons in their determined than younger persons in their decision to die, so their success rate is decision to die, so their success rate is much highermuch higher Ratio of attempts to successes is 4:1Ratio of attempts to successes is 4:1

The suicide rate among the elderly is The suicide rate among the elderly is lowerlower in some minority groups in the U.S.: in some minority groups in the U.S.: Native AmericansNative Americans African AmericansAfrican Americans



Treatment and SuicideTreatment and Suicide

Treatment of suicidal persons falls Treatment of suicidal persons falls into two categories: into two categories: Treatment after suicide has been Treatment after suicide has been

attempted attempted Suicide preventionSuicide prevention



What Treatments Are What Treatments Are Used After Suicide Used After Suicide

Attempts?Attempts? After a suicide attempt, most victims After a suicide attempt, most victims

need medical careneed medical care Psychotherapy or drug therapy may Psychotherapy or drug therapy may

begin once a person is medically begin once a person is medically stablestable Many suicidal people fail to receive Many suicidal people fail to receive

psychotherapy after a suicide attemptpsychotherapy after a suicide attempt



What Treatments Are What Treatments Are Used After Suicide Used After Suicide

Attempts?Attempts? Therapy goals:Therapy goals:

Keep the patient alive Keep the patient alive Help them achieve a nonsuicidal state of mindHelp them achieve a nonsuicidal state of mind Guide them to develop better coping strategiesGuide them to develop better coping strategies

Various therapies and techniques have Various therapies and techniques have been employedbeen employed

Treatment appears to be somewhat Treatment appears to be somewhat successfulsuccessful



What Is Suicide What Is Suicide Prevention?Prevention?

There are hundreds of suicide prevention There are hundreds of suicide prevention centers in the U.S. centers in the U.S.

There also are hundreds of suicide hot There also are hundreds of suicide hot lines lines (24-hour-a-day telephone services) (24-hour-a-day telephone services) Hot lines are predominantly staffed by Hot lines are predominantly staffed by

paraprofessionals –people trained in paraprofessionals –people trained in counseling but without formal degreescounseling but without formal degrees




Both suicide prevention programs and suicide Both suicide prevention programs and suicide hot lines provide crisis interventionhot lines provide crisis intervention

The general approach includes:The general approach includes: Establishing a positive relationshipEstablishing a positive relationship Understanding and clarifying the problemUnderstanding and clarifying the problem Assessing suicide potentialAssessing suicide potential Assessing and mobilizing the caller’s resourcesAssessing and mobilizing the caller’s resources Formulating a planFormulating a plan




Although crisis intervention appears to be Although crisis intervention appears to be sufficient treatment for some suicidal sufficient treatment for some suicidal people, longer-term therapy is needed for people, longer-term therapy is needed for mostmost

Another way to prevent suicide may be to Another way to prevent suicide may be to limit the public’s access to common limit the public’s access to common means of suicidemeans of suicide Examples: gun control, safer Examples: gun control, safer

medications, and car emissions controlsmedications, and car emissions controls



Do Suicide Prevention Do Suicide Prevention Programs Work?Programs Work?

It is difficult to measure the It is difficult to measure the effectiveness of suicide prevention effectiveness of suicide prevention programsprograms Prevention programs do seem to reduce Prevention programs do seem to reduce

the number of suicides among those high-the number of suicides among those high-risk people who do callrisk people who do call

Several theorists have argued for more Several theorists have argued for more effective public education about effective public education about suicide, as education is the ultimate suicide, as education is the ultimate form of suicide preventionform of suicide prevention

Documents

Comer, Abnormal Psychology, 6e Chapter 10 1 Chapter 10 Suicide Slides Handouts by Karen Clay Rhines, Ph.D. Seton Hall University