Abnormal hand out ch08

11Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 8, 5e – Chapter 8Slides & Handouts by Karen Clay Rhines, Ph.D.Slides & Handouts by Karen Clay Rhines, Ph.D.

Chapter 8 Chapter 8 HandoutsHandouts

SuicideSuicide

2Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 8, 5e – Chapter 8

SuicideSuicide

Suicide is one of the leading causes Suicide is one of the leading causes of death in the worldof death in the world It is estimated that 700,000 people die It is estimated that 700,000 people die

of it each year, with 31,000 suicides of it each year, with 31,000 suicides per year in the U.S. aloneper year in the U.S. alone

Many more unsuccessfully attempt Many more unsuccessfully attempt suicide than actually succeedsuicide than actually succeed Such attempts are called Such attempts are called

“_________________”“_________________”


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 Many “accidents” may be intentional

deathsdeaths

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 disorders or involve no clear mental disorder at allmental disorder 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…



Shneidman’s characterizations of suicide Shneidman’s characterizations of suicide seekers:seekers: Death ___________ – clearly intend to end their livesDeath ___________ – clearly intend to end their lives

Death ___________ – intend to end their lives Death ___________ – intend to end their lives because they believe that the process of death because they believe that the process of death already is underwayalready is underway

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

Death ____________ – have ambivalent feelings Death ____________ – have ambivalent feelings about death and show this in the act itselfabout death and show this in the act itself



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 “______________________”“______________________” 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 Researchers use two different strategies to try to overcome this strategies to try to overcome this obstacle (with partial success): obstacle (with partial success): ______________________________________________________________

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 ______________ country, with religious ______________ (not simply _______) helping to explain (not simply _______) 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 __________ rate (3x men)Women have a higher __________ rate (3x men)

Men have a higher ___________ rate (3x women)Men have a higher ___________ rate (3x women) Why? _____________________________________Why? _____________________________________

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

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


Patterns and Statistics Patterns and Statistics

Suicide also is related to marital Suicide also is related to marital status and level of social supportstatus and level of social support 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

Divorced people have a higher suicide Divorced people have a higher suicide rate than married or cohabiting rate than married or cohabiting individualsindividuals


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 The suicide rate of white Americans (12

per 100,000) is almost twice as high as per 100,000) is almost twice as high as that of African Americans, Hispanic that of African Americans, Hispanic Americans, and members of other racial Americans, and members of other racial groupsgroups

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


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 control subjectscontrol subjects

Both immediate and long-term Both immediate and long-term stressors can be risk factors for suicidestressors can be risk factors for suicide Immediate stressors can include the loss of Immediate stressors can include the loss of

a loved one, the loss of a job, or natural a 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 nurses, dentists, lawyers, farmers, and unskilled laborers have particularly high unskilled laborers have particularly high suicide ratessuicide rates


Mood and Thought Mood and Thought ChangesChanges

Many suicide attempts are preceded by a Many suicide attempts are preceded by a change in moodchange in mood These changes may not be enough to These changes may not be enough to

warrant a ________________________________warrant a ________________________________ The most common change is a rise in The most common change is a rise in

__________________ 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 “______________,” a feeling of Shneidman calls this “______________,” 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 effective solutioneffective solution They often develop a sense of ________________ – They often develop a sense of ________________ –

a pessimistic belief that their present a pessimistic belief that their present circumstances, problems, or mood will not circumstances, problems, or mood will not changechange

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



People who attempt suicide also may People who attempt suicide also 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 Autopsies reveal that about 25% of

these people are legally intoxicatedthese people 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 ____________, _____________, Those with ____________, _____________, and/or ______________ are at greatest and/or ______________ are at greatest riskrisk


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 ______________________________________________________________________________

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 workers are particularly common triggerstriggers


Modeling: The Contagion Modeling: The Contagion of Suicideof Suicide

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

Some clinicians argue that more Some clinicians argue that more ____________ reporting could reduce ____________ reporting could reduce this effectthis 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 psychodynamic, sociocultural, and biological perspectivesbiological perspectives These hypotheses have received limited These hypotheses have received limited

research support and fail to address the full research support and fail to address the full range of suicidal actsrange of suicidal 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”) have a basic death instinct (“Thanatos”) that operates in opposition to the life that operates in opposition to the life instinctinstinct 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 ____________________________________________________________________________

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 _______________ are committed by people over _______________ are committed by people over

whom society has little or no controlwhom society has little or no control _______________ 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

_______________ 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 ____________________________________________ can also ____________________________________________ can also

lead to this type of suicidelead to this type of suicide



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

the position that biological factors the position that biological factors contribute to suicidal behaviorcontribute to suicidal 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 non-suicidal who commit suicide than among non-suicidal peoplepeople

As always with this type of research, As always with this type of research, however, nonbiological factors and however, nonbiological factors and interpretations must also be consideredinterpretations must also be considered



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 _____________ of among suicidal subjects with _____________ of depressiondepression

Serotonin activity may contribute to ______________ Serotonin activity may contribute to ______________ behavior 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 and the elderly) have been the focus of much study because of the unique of 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 behavioral generally are preceded by behavioral patterns such as running away, temper patterns such as running away, temper tantrums, social withdrawal, dark tantrums, social withdrawal, dark fantasies, and marked personality changesfantasies, and marked personality changes

Many child suicides appear to be based on Many child suicides appear to be based on a a ____________________________________________________________________________________________________________________________________________________


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, _______________, poor problem-Anger, _______________, poor problem-

solving skills, and stress also play a rolesolving skills, and stress also play a role

Some theorists believe that the period Some theorists believe that the period of adolescence itself produces a of adolescence itself produces a stressful climate in which suicidal stressful climate in which suicidal actions are more likelyactions are more 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:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________


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 ____________________________________________________ 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 _______ 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

systematic follow-up care after a suicide systematic follow-up care after a suicide attemptattempt


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 Guide them to develop better coping strategiesstrategies

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 There are hundreds of ____________________ in the U.S. and in ____________________ in the U.S. and in EnglandEngland

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

______________ –people trained in counseling ______________ –people trained in counseling but without formal degreesbut without formal degrees



Both suicide prevention programs and Both suicide prevention programs and suicide hot lines provide crisis interventionsuicide hot 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 seem to reduce the Prevention programs seem to reduce the

number of suicides among those high-risk number of suicides among those high-risk people who callpeople who call

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

Education

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