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Abnormal Psychology Chapter 7: Suicide

Terms in this set (39)

Suicide
a leading cause of death in the world
Only humans knowingly take their own lives - curse of consciousness
Close to 1 million global
per year in the U.S. alone (> 100 per day - equivalent to a passenger jet crashing every day with all on board dying!)
(> twice as many homicides); 10th leading cause of death
parasuicides
Many more (600,000 in the U.S. alone) unsuccessfully attempt suicide than actually succeed
low; difficult;
It is difficult to obtain accurate figures on suicide rates, and many investigators believe that estimates are often _____
Suicide can be _________ to establish & coroners may be loathe to label them suicides due to the stigma involved
-Many "accidents" may be intentional deaths
-Since suicide is frowned upon in our society, relatives and friends often refuse to acknowledge that loved ones have taken their own lives
suicidal behavior disorder; majority
People qualify for a diagnosis of __________ ___________ _________ if they have tried to kill themselves within the last two years, even if they changed their mind after initiating the attempt or if the attempt was interrupted
It is not surprising that the ____________ of suicide attempters also display another psychological disorder, such as major depressive disorder, schizophrenia, or alcohol use disorder
seekers; initiators; ignorers; darers
Shneidman defines suicide as an intentioned death - a self-inflicted death in which one makes an intentional, direct & conscious effort to end one's life

Shneidman's 4 categories of suicide seekers:
1. Death _________ - clearly intend to end their lives
2.Death _________- intend to end their lives because they believe the process of death is already underway; mainly elderly or terminally ill
3. Death _________- do not believe that their self-inflicted death will mean the end of their existence; actually an upgrade to their status; many children & cults
4. Death __________- have ambivalent feelings about death and show this in the act itself; Russian roulette; attention-seeking or "teaching a lesson" to others
subintentional death
When individuals play indirect, hidden, partial or unconscious roles in their own deaths, Shneidman classification
--Their true intent is unclear, as in mismanagement of medications in seriously ill patients
11
Role of family - ____ % of victims have a close relative who has also killed self; Margaux Hemingway was 5th family member in 4 generations to kill self; genetics &/or environment
non-suicidal self injury
People who have intentionally injured themselves on five or more occasions in the last year - without intent to kill themselves qualify for a diagnosis of ____________ _______ _________
Retrospective analysis
a kind of psychological autopsy; i.e., histories & suicide notes (< 1/3); half have never been in treatment
8 -20
Studying people who survive their suicide attempts; ________ attempts for every suicide; but this could be a very different population
highs
U.S. & Canada, at 12.7/100K, fall between ______ of South Korea, Russia, Hungary, Germany, Austria, Finland, Denmark, China & Japan at 20/100K & England at 9/100K
22
Most recent data (2009) for the U.S. military was up to 20.3/100K, much higher than the civilian rate for the first time since Viet Nam; over 1,000 troops since 2005 & 2,000 since '01; an average of _____ veterans commit suicide daily
3x; 4x; violent; 2/3
The suicide rates of men and women also differ:
Women have a higher attempt rate (____ men)
Men have a higher completion rate (____ women)

Men tend to use more ___________ methods (shooting, stabbing or hanging) than women (drug overdose); guns are used in nearly _____ of male suicides in the U.S. compared to 40% of female suicides
half; higher
Suicide is also related to social support and marital status

1 study found that ______ of the subjects who had committed suicide were found to have no close friends & weren't close with family
Divorced people have a _______ suicide rate than married/cohabiting individuals
twice
Suicide rate of white Americans (12 per 100,000) is at least ______ as high as that of African Americans, Hispanic Americans and Asian Americans
1.5
very high suicide rate of Native Americans, which overall is _____ times the national average; may be explained by extreme poverty, alcohol use, modeling & availability of guns
highest
Elderly (>65) white American men have _________ rate
Long term stresser; 1/3; 3 hours
Common triggers

Social isolation - individuals w/o social support are particularly vulnerable

Serious illness - especially those which cause great pain or severe disability; may think death is unavoidable/imminent or more than they can handle; ______ of suicides had been in poor physical health; must consider quality & comfort of life

Abusive environments from which there is little/no hope of escape - POWs, domestic abuse or prison inmates (107/100K inmates commit suicide); can't take it anymore/hopeless about their future (highest incidence within first __________ of incarceration - next slide)

Occupational stress
Psychiatrists & psychologists, physicians, nurses, dentists, lawyers, police officers, farmers & unskilled laborers have particularly high suicide rates -
mood; psychache
Many suicide attempts are preceded by changes in ______
-These changes may not be enough to warrant a diagnosis of a mental disorder
The most common change is a rise in sadness
---Increases in feelings of anxiety, tension, frustration, anger or shame are also common
Shneidman calls this "___________," a feeling of psychological pain that seems intolerable to the person
thinking; hopelessness; dichotomous; only
Attempts may also be preceded by shifts in patterns of _____________

-Individuals may become preoccupied, lose perspective and see suicide as the only effective solution to their difficulties
-Often develop a sense of _______________- a pessimistic belief that their present circumstances, problems or mood will not change
-----Some clinicians believe that is the single most likely indicator of suicidal intent
People who attempt suicide fall victim to ____________thinking, viewing problems & solutions in rigid either/or terms
The "four-letter word" in suicide is "________," as in "suicide was the ___'___thing I could do" (see quote by a survivor on p. 214)
70; 25; lethal
Studies indicate that as many as ______ % of the people who attempt suicide drink alcohol just before the act
Autopsies reveal that about ______ % of these people are legally intoxicated
May reduce their inhibitions to act, disinhibit underlying aggression or simply impair judgment
Part of the ________ triad of (1) emotional upset , (2) access to firearms & (3) alcohol/drug use
majority; 70; 20; 10; increases; 75; improve
Nevertheless, the ________of all suicide attempters do display such a disorder
Those with severe depression (up to ________ %), substance use disorders (________ %) and/or schizophrenia (________ %) are at greatest risk (percentages of suicide victims)
Comorbidity _____________ the chances even more
Borderline personality disorders often attempt (_______ %) & 6 - 10% are eventually successful
Risk of suicide increases as depressed clients' mood begins to____________; may now have the energy to act on the depression
10
Media have probably played a role in _____ % of all suicides by those < 25; some clinicians argue that more responsible reporting could reduce this effect
limited; fail
Leading theories come from the psychodynamic, sociocultural and biological perspectives
These hypotheses have received ________ research support and ______ to address the full range of suicidal acts
oneself; loss; more;
The Psychodynamic View
-Theorists believe that suicide results from depression and from anger at others that is redirected toward _________
-While most people learn to direct their death instinct (Freud's Thanatos) towards others, suicidal people direct it toward themselves
-Have found a relationship between childhood _______ (real or symbolic) & suicidal behaviors; early loss of a parent was much _______ common among suicide attempters (common losses were death of a father & separation/divorce of parents; keep in mind neural plasticity)
war; higher; lower
The Psychodynamic View

Supportive & critical data
National suicide rates drop in times of ____; i.e., war may re-direct any self-directed aggression outward
Nations with ______ homicide rates have ________ suicide rates
Data does not consistently show elevated hostility in suicides; more often other emotions such as sadness
Durkheim's Sociocultural View
probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions and community as in nurturing resiliency
The more thoroughly a person belongs, the lower the risk of suicide
Based on this premise, he developed several categories of suicide, including egoistic, altruistic and anomic suicide\

cannot by itself explain why some people who experience particular societal pressures commit suicide while the majority do not
Egoistic
Durkheim's Sociocultural View

________ suicides are committed by people over whom society has little or no control; i.e., isolated, alienated & nonreligious loners
Altruistic
Durkheim's Sociocultural View

___________ suicides are committed by people who are so well- integrated into their society that they intentionally sacrifice their lives for its well-being; e.g., soldiers, kamikazes & Buddhists
Anomic
Durkheim's Sociocultural View

_________ suicides are those committed by people whose social environment fails to provide stable structures that support & give meaning to life (anomie = without law)
--Economic depression & population change through increased immigration are associated with rises in suicide rates
--A major change in an individual's immediate surroundings can also lead to this type of suicide; upwardly mobile societies have higher rates as opposed to a society like India with a more rigid caste system
The Biological View; low
higher rates of suicide among the parents and close relatives of those who commit suicide than among non-suicidal people
---As always with this type of research, however, non-biological factors and environment must also be considered; e.g., maybe the loss caused a depression or it modeled the behavior; the diathesis-stress model

Serotonin levels have been found to be _____ in people who commit suicide
-Known link between low serotonin & depression
--Evidence, though, of low serotonin activity among suicidal subjects with no history of depression
-One possibility is that low serotonin activity may contribute to aggressive & impulsive behaviors ; e.g., lower levels found in more aggressive men, arsonists & murderers
children; rising; 500; 6; 5
Suicide is infrequent among ___________
Rates have been __________ over the past several decades (8x the rate in 1950); up to 1/100,000 children per year
About _______ children younger than 14 years of age commit suicide each year
More than ___% of all deaths among children between the ages of 10 and 14 are caused by suicide
Boys outnumber girls by as much as ___ :1
Thousands of children are hospitalized each year for self-destructive acts (stabbing, cutting, burning, overdosing or jumping)

Warning signs - suicide attempts by the very young generally are preceded by such behavioral patterns as running away, temper tantrums, social withdrawal, dark fantasies and marked personality changes; often linked to recent/anticipated loss of a loved one, family stress (e.g., unemployment), abuse & depression
Despite common misperceptions, many child suicides appear to be based on a clear understanding of death and on a clear wish to die; between 6 & 33% of schoolchildren have thought of it
Must take all threats/talk of suicide seriously
1500; 6; half
Adolescents
Suicidal actions become much more common after the age of 14
About _________ teens commit suicide in the U.S. each year; 7.3/100K
Up to 10% make a suicide attempt and 1 in ___ thinks about suicide each year
About _______ of teen suicides have been tied to clinical depression, low self-esteem and feelings of hopelessness
Anger, impulsiveness, poor problem-solving skills, substance use and stress also play a role
Some theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likely; e.g., the search for identity, including sexual orientation
200; half; 93
Far more teens attempt suicide than succeed
Ratio may be as high as ______:1 or more
Unsure of intent; may be a cry for help or a plea for attention
Up to _______ of suicide attempters make another attempt & 14% eventually die
Very suggestible - ______ % of attempters knew another attempter
Several explanations, most pointing to societal factors, have been proposed for the high rate of attempts among teenagers
Teen suicide rates vary by ethnicity in the U.S.
Young white Americans are more suicide-prone than African Americans at this age, although rates are growing closer
The highest teen suicide rate is displayed by Native Americans
elderly; 4; 60
In Western society, the ________ are more likely to commit suicide than people in any other age group (16.3/100K); 12% of population but 19% of suicides; may be changing

There are many contributory factors:
Illness
Loss of close friends and relatives
Loss of control over one's life - 44% were afraid of placement in nursing home
Loss of social status; watch the stereotyping (see next slide)
more determined than younger persons in their decision to die & give less warning, so their success rate is much higher

Ratio of attempts to successes is ____:1
As many as ______ % may be clinically depressed - should be getting treatment!
The suicide rate among the elderly is lower in some minority groups in the U.S., especially Native Americans- total reversal from younger members
African Americans - 1/3 as high as whites
alive; psychological; state of mind; handling stress;
Therapy goals:
Keep the patient _____
Reduce the ___________ pain
Help them achieve a nonsuicidal ______ ___ _______
Guide them to develop better ways of __________ _______
Treatment appears to be somewhat successful; 30 % of those not receiving treatment try again vs. 16% of those getting treatment; no singlee approach is better
Various therapies and techniques have been employed
*Cognitive & cognitive-behavioral therapies may be particularly helpful*
Hundreds; paraprofessionals; crisis intervention
__________ of suicide prevention centers in the U.S. & in England (since 1955)
Also hundreds of suicide hot lines (24/7 telephone services)
Hot lines are predominantly staffed by _______________ - people trained in counseling but without formal degrees
Help the individual see their situation more accurately, make better decisions, act more constructively & see some hope - hopelessness is the most powerful predictor of suicide; referral to mental health provider
Both suicide prevention programs and suicide hot lines provide ________ ____________
Suicide Prevention
The general approach includes:
1.Establishing a positive relationship
2.Understanding and clarifying the problem
3. Assessing suicide potential (lethality)
4.Assessing and mobilizing the caller's resources
5.Formulating a plan to often include a no-suicide contract
**May involve finding location of caller & dispatching assistance (action by the state to prevent a "crime")
public education
Several theorists have argued for more effective _______ ______________ about suicide as the ultimate form of suicide prevention- need to identify these people & help them get the help they need; don't be afraid to talk to people who may be contemplating suicide; you will not talk them into it!
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