CHAPTER 9 – SUICIDE
DSM-5 doesn’t include suicide as a specific mental disorder
o Some clinicians have developed criteria for the proposed disorder
The presence of suicidal thoughts, intent, or both within a 2 week period
Evidence of some intent to die
Affective, cognitive and behavioural symptoms
Facts About Suicide:
Psychological autopsy – systematically examining information after a person’s death in an
effort to understand and explain a person’s behaviour before death
Frequency:
Page 289-290
Methods of Suicide:
Page 290
Occupational Risk Factors:
Page 291-292
Effects of Suicide on Friends and Family:
Page 293-294
Suicide and Specific Populations:
Suicide Among Children:
Suicide rate for young people is at its highest since 2000 and appears to be climbing
dramatically
Page 295
The role of bullying
Copycat suicides
Decreased prescribing of antidepressant medication
Suicide Among Those Who Serve in the Military:
Culture may inhibit veterans or those on active duty from seeking help even when dealing
with strong emotions such as hostility, anger, hopelessness, or feeling like a burden
Suicide Among College Students:
Page 300
Suicide Among Older Adults:
Suicide rates for elderly men are the highest for any age group
A Multipath Perspective of Suicide:
Biological
o Low serotonin
o Genetic and epigenetic effects
o Alcohol effects
o Sleep difficulties
o Physical illness/disability
Psychological
o Childhood abuse
o Mental illness
o Hopelessness
o Psychache
o Impulsivity
o Prior attempts
Social
o Isolation
o Relationship conflict
o Loss of partner
o Bullying
Sociocultural
o Financial decline
o Male gender
o Suicide contagion
o Access to firearms
o Cultural alienation
Preventing Suicide:
Prevention is critical
Someone in crisis can self-refer for help or referral can originate from concerned loved ones
Gatekeeper training
o Designated people within a system learn about risk factors associated with suicide
and methods for screening people at high risk
Look at table 9.2 on page 310
Clues to Suicidal Intent:
Page 310
Look at figure 9.4 on page 311
o Assess risk factors
o Determine lethality
Suicide Hotlines:
Crisis intervention techniques
o Maintaining contact and establishing a relationship
o Obtaining necessary information
o Evaluating suicidal potential
o Clarifying the nature of the caller’s distress
o Assessing strengths and resources
o Recommending and initiating an action plan
Suicide Crisis Intervention:
Can be highly successful for
o Those who independently seek professional help for suicidal ideation
o Clients who bring suicidal thoughts or intentions to the attention of their therapist
o People encouraged to seek professional help by concerned loved one
Crisis workers focus on the person’s emotional pain and operate under the assumption that
anyone considering suicide is ambivalent about the act; they exert great effort to preserve
the drive to live
“No-harm” agreement or a “no-suicide contract”
Psychotherapy for Suicidal Individuals:
Treatment often involves both medication and psychotherapy
CBT
o Focuses on vulnerabilities associated with suicide
o One cognitive behavioural programme addresses 2 factors related to suicidal risk –
“thwarted belongingness” and “perceived burden”
DBT
o Focuses on helping clients accept their current lives and the emotional anguish they
feel
o Clients learn to regulate and tolerate their emotions rather than allowing emotions to
overwhelm them
Cognitive behavioural therapy for suicide prevention combines features of both CBT and
DBT
o Chain analysis
o Safety planning
o Psychoeducation
o Building hope and addressing reasons for living
o Learning and using adaptive strategies from CBT and DBT to deal with specific
problems
Recovery After a Suicide Attempt:
Aftermath of a suicide attempt
o Continuation of the emotional pain that led to the suicidal act
o Complicated emotions including relief, anger, embarrassment, shame, guilt
Important to focus on activities that increase optimism and social connection and to realise
that there is hope for a positive future
Steps that may assist a survivor move toward recovery and develop resilience include:
o Talking with others about the suicide attempt
o Re-establishing connections
o Making a plan to stay safe
o Finding a therapist
o Moving toward a hopeful future
Moral, Ethical, and Legal Issues Surrounding Suicide:
Page 318
Contemporary Trends and Future Directions:
Pages 319
