Comer, Abnormal Psychology, 5th edition.ppt

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1、Chapter 10SuicideSlides&Handouts by Karen Clay Rhines,Ph.D.Seton Hall University1Slide 2SuicideSuicide is a major health problem in the worldIt ranks among the top 10 leading causes of deathThere are about 31,000 suicides per year in the U.S.Many more unsuccessfully attempt suicide than actually suc

2、ceedSuch attempts are called“parasuicides”There are about 600,000 attempts per year in the U.S.Slide 3SuicideIt is difficult to obtain accurate figures on suicide ratesMany“accidents”may be intentional deathsSuicide is not classified as a mental disorder in the DSM-IVWhile suicide is often linked to

3、 depression,about half of all suicides result from other mental disorders or involve no clear mental disorderSlide 4What Is Suicide?Shneidman defines suicides as an intentioned death a self-inflicted death in which one makes an intentional,direct,and conscious effort to end ones lifeHe characterizes

4、 four kinds of suicide seekersSlide 5What Is Suicide?Shneidmans characterizations of suicide seekers:Death seekers clearly intend to end their livesDeath initiators intend to end their lives because they believe that the process of death is already underwayDeath ignorers do not believe that their se

5、lf-inflicted death will mean the end of their existenceDeath darers have ambivalent feelings about death and show this in the act itselfSlide 6What Is Suicide?When individuals play indirect,hidden,partial,or unconscious roles in their own deaths,Shneidman classifies them in a category called“subinte

6、ntional death”True intent is unclearSlide 7How Is Suicide Studied?Suicide researchers face a major obstacle:their subjects are no longer aliveResearchers use two different strategies to try to overcome this obstacle:Retrospective analysisStudying people who survive their suicide attemptsSlide 8Patte

7、rns and Statistics Researchers have gathered statistics regarding the social contexts in which suicides take placeSuicide rates vary from country to country,with religious devoutness(not simply affiliation)helping to explain some of the differenceFor example,countries that are largely Catholic,Jewis

8、h,or Muslim generally tend to have low suicide ratesSlide 9Patterns and StatisticsThe suicide rates of men and women also differ:Women have a higher attempt rate(3x men)Men have a higher completion rate(3x women)Why?Different methods have differing lethalityMen tend to use more violent methods(shoot

9、ing,stabbing,or hanging)than women(drug overdose)Guns are used in nearly two-thirds of male suicides in the U.S.,compared to 40%of female suicidesSlide 10Patterns and Statistics Suicide is also related to marital status and level of social supportMarried people,especially those with children,tend to

10、 have a fairly low suicide rateDivorced people have the highest rate of allSlide 11Patterns and StatisticsIn the U.S.,suicide also seems to vary according to raceThe suicide rate of white Americans(12 per 100,000)is almost twice as high as that of African Americans and members of other racial groups

11、A major exception to this pattern is the very high suicide rate of Native Americans,which overall is 1.5 times the national averageIn some tribes the rate is as high as 4 to 10 times the national averageSlide 12What Triggers a Suicide?Suicidal acts may be connected to recent events or current condit

12、ions in a persons lifeCommon triggers include stressful events,mood and thought changes,alcohol and other drug use,mental disorders,and modelingSlide 13Stressful Events and SuicideResearchers have counted more stressful events in the lives of suicide attempters than in the lives of matched controlsB

13、oth immediate and long-term stresses can be risk factors for suicideImmediate stresses can include the loss of a loved one,the loss of a job,or natural disasterSlide 14Stressful Events and SuicideLong-term stressors can include:Serious illnessSuicides related to serious illness have become more comm

14、on in recent yearsAbusive environmentPrisoners of war,inmates of concentration camps,abused spouses,abused children,and prison inmates have tried to end their livesOccupational stressPsychiatrists and psychologists,physicians,nurses,dentists,lawyers,farmers,and unskilled laborers have particularly h

15、igh suicide ratesWork outside the home may be linked to lower suicide rates among women,contrary to previously-held beliefsSlide 15Mood and Thought ChangesMany suicide attempts are preceded by changes in moodThese changes may not be enough to warrant a diagnosis of a mental disorderThe most common c

16、hange is a rise in sadnessIncreases in feelings of anxiety,tension,frustration,anger,or shame are also commonShneidman calls this“psychache”:a feeling of psychological pain that seems intolerable to the personSlide 16Mood and Thought ChangesSuicide attempts may also be preceded by shifts in patterns

17、 of thinkingIndividuals may become preoccupied,lose perspective,and see suicide as their only optionThey often develop a sense of hopelessness a pessimistic belief that their present circumstances,problems,or mood will not changeSome clinicians believe that a feeling of hopelessness is the single mo

18、st likely indicator of suicidal intentSlide 17Mood and Thought ChangesPeople who attempt suicide may experience dichotomous thinking,viewing problems and solutions in rigid either/or termsThe“four-letter word”in suicide is“only,”as in“suicide was the only thing I could do”Slide 18Alcohol and Other D

19、rug UseStudies indicate that as many as 60%of the people who attempt suicide drink alcohol just before the actAutopsies reveal that about 25%of these people are legally intoxicatedResearch shows the use of other kinds of drugs may have a similar link to suicideSlide 19Mental DisordersAttempting suic

20、ide does not necessarily indicate the presence of a psychological disorderThe presence of a psychological disorder does,however,greatly increase the probability of a suicide attemptThose with mood disorders,substance use disorders,and/or schizophrenia are at greatest riskSlide 20Slide 21Modeling:The

21、 Contagion of SuicideIt is not unusual for people,particularly teens,to commit suicide after observing or reading about someone who has done soOne suicide appears to serve as a model for anotherSuicides by celebrities,other highly publicized suicides,and suicides by co-workers are particularly commo

22、n triggersSlide 22Modeling:The Contagion of SuicideSuicides with bizarre or unusual aspects often receive intense coverage by the news media,possibly leading to similar suicidesEven media programs clearly intended to educate and help viewers may have the paradoxical effect of spurring imitatorsSome

23、clinicians argue that more responsible reporting could reduce this effectSlide 23What Are the Underlying Causes of Suicide?Most people faced with difficult situations never attempt suicideIn an effort to explain suicide-proneness,theorists have proposed more fundamental explanations for self-destruc

24、tive behaviorLeading theories come from the psychodynamic,sociocultural,and biological perspectivesNone of these explanations has received strong research supportSlide 24Underlying Causes of Suicide:The Psychodynamic ViewTheorists believe that suicide results from depression and from anger at others

25、 that is redirected toward oneselfIn support of this view,researchers have often found a relationship between childhood losses and later suicidalityAdditionally,Freud proposed that humans have a basic death instinct(“thanatos”)that operates in opposition to the life instinctWhile most people learn t

26、o direct their death instinct toward others,suicidal people directly it at themselvesSlide 25Underlying Causes of Suicide:The Sociocultural ViewDurkheim argues that the probability of suicide is determined by how attached a person is to such social groups as the family,religious institutions,and com

27、munityThe more thoroughly a person belongs,the lower the risk of suicideBased on this premise,he developed several categories of suicide,including egoistic,altruistic,and anomic suicide Slide 26Underlying Causes of Suicide:The Sociocultural ViewEgoistic suicides are committed by people over whom soc

28、iety has little or no controlAltruistic suicides are committed by people who are so well integrated into their society that they intentionally sacrifice their lives for its well-beingAnomic suicides are those committed by people whose social environment fails to provide stable structures to support

29、and give meaning to lifeA change in an individuals immediate surroundings can also lead to this type of suicideSlide 27Underlying Causes of Suicide:The Biological ViewFamily pedigree and twin studies support the position that biological factors contribute to suicidal behaviorFor example,there are hi

30、gher rates of suicide among the parents and close relatives of those who commit suicide than among nonsuicidal peopleAs always with this type of research,however,nonbiological factors such as shared environment must also be consideredSlide 28Underlying Causes of Suicide:The Biological ViewRecent lab

31、oratory research has offered more direct support for a biological model of suicideSerotonin levels have been found to be low in people who commit suicideThere is a known link between low serotonin and depressionThere is evidence,though,of low serotonin activity among suicidal subjects with no histor

32、y of depressionSerotonin activity may contribute to aggressive behavior Slide 29Is Suicide Linked to Age?The likelihood of committing suicide increases with age,but people of all ages may try to kill themselvesAlthough the general findings about suicide hold true across age groups,three groups(child

33、ren,adolescents,and the elderly)have been the focus of much study because of the unique issues that face themSlide 30ChildrenSuicide is infrequent among childrenRates have been rising for the last decadeAbout 500 children younger than 14 years of age commit suicide each yearBoys outnumber girls by a

34、s much as 5:1Slide 31ChildrenSuicide attempts by the very young generally are preceded by“acting out”behaviors:running away,temper tantrums,social withdrawalMany child suicides appear to be based on a clear understanding of death and on a clear wish to dieSlide 32AdolescentsSuicidal actions become m

35、uch more common after the age of 14 than at any earlier ageAbout 2000 teens commit suicide in the U.S.each yearAs many as 500,000 may make attemptsYoung white Americans are more suicide-prone than African Americans at this ageRates are becoming closerSlide 33AdolescentsAbout half of teen suicides ha

36、ve been linked to depression,low self-esteem,and feelings of hopelessnessAnger,impulsiveness,poor problem-solving skills,and stress also play a roleSome theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likelySlide 34AdolescentsFa

37、r more teens attempt suicide than succeedRatio may be as high as 200:1Across the world,suicide rates for adolescents are high and increasingPublicity given to teen suicides may contribute to the rise in the suicide rate among the youngSlide 35The ElderlyIn Western society the elderly are more likely

38、 to commit suicide than people in any other age groupThere are many contributory factors:IllnessLoss of social supportLoss of control over ones lifeLoss of social statusSlide 36The ElderlyElderly persons are typically more determined than younger persons in their decision to die,so their success rat

39、e is much higherRatio of attempts to successes is 4:1The suicide rate among the elderly is lower in some minority groups in the U.S.:Native AmericansAfrican AmericansSlide 37Treatment and SuicideTreatment of suicidal persons falls into two categories:Treatment after suicide has been attempted Suicid

40、e preventionSlide 38What Treatments Are Used After Suicide Attempts?After a suicide attempt,most victims need medical carePsychotherapy or drug therapy may begin once a person is medically stableMany suicidal people fail to receive psychotherapy after a suicide attemptSlide 39What Treatments Are Use

41、d After Suicide Attempts?Therapy goals:Keep the patient alive Help them achieve a nonsuicidal state of mindGuide them to develop better coping strategiesVarious therapies and techniques have been employedTreatment appears to be somewhat successfulSlide 40What Is Suicide Prevention?There are hundreds

42、 of suicide prevention centers in the U.S.There also are hundreds of suicide hot lines(24-hour-a-day telephone services)Hot lines are predominantly staffed by paraprofessionals people trained in counseling but without formal degreesSlide 41What Is Suicide Prevention?Both suicide prevention programs

43、and suicide hot lines provide crisis interventionThe general approach includes:Establishing a positive relationshipUnderstanding and clarifying the problemAssessing suicide potentialAssessing and mobilizing the callers resourcesFormulating a planSlide 42What Is Suicide Prevention?Although crisis int

44、ervention appears to be sufficient treatment for some suicidal people,longer-term therapy is needed for mostAnother way to prevent suicide may be to limit the publics access to common means of suicideExamples:gun control,safer medications,and car emissions controlsSlide 43Do Suicide Prevention Progr

45、ams Work?It is difficult to measure the effectiveness of suicide prevention programsPrevention programs do seem to reduce the number of suicides among those high-risk people who do callSeveral theorists have argued for more effective public education about suicide,as education is the ultimate form of suicide prevention