SYNOPSISPersonality and behavioural features in pediatric migraine were investigated in a comparison study of 20 boys and girls with migraine, matched for age and sex with a "pain" control group of 20 children with musculoskeletal pain, and with a "no-pain" control group of 20 children. When the amount of pain experienced by children was controlled, the only discriminating variable was that of somatic complaints which included vomiting, nausea, and perceptual disturbances, all migraine-related phenomena. The inclusion of the "pain" control group in this investigation yielded results which indicated that the behavioural and personality features thought to be characteristic of childhood migraine are common to a chronic pain disorder and in fact, the manifestation of many of these features correlate directly with the amount of pain experienced. It is suggested that the personality and behavioural characteristics evident in many children with migraine may result from the recurrent chronic pain episodes rather than in some way being causative of the pain. (Headache 27:16-20, 1987) Migraine headaches in children are a common phenomenon 1 and a number of investigators have described personality and behavioural characteristics which they believe contribute to the occurrence of the headaches. This view was first espoused by Harold Wolff (described by Anderson) 2 in his description of the childhood personalities of his adult migraine patients, as reported retrospectively by the patients and their families. More than half of the migraineurs were described as delicate, shy, withdrawn, sober, polite, well-mannered, conscientious, responsible, unusually thoughtful, and extremely obedient to parental wishes. These sterling, if somewhat submissive qualities were said to co-exist with unusual obstinacy, stubborness and inflexibilty. As children, these individuals were remembered as being very neat and clean and as adolescents, more than usually concerned with moral and ethical issues.Wolff's observations, although of heuristic value, are fraught with major methodological problems. This population included only people who continued to have headaches in adulthood and who sought help from a specialist. The reliance on retrospective family and self-descriptions may well have been biased. The use of an unstructured clinical interview to gather information may have elicited recollections that were in keeping with the interviewer's own opinions. Finally, the lack of any control group prevented meaningful comparisons with individuals who did not have headaches.Wolff's observations, with some variations, have been supported by numerous subsequent investigations with children with migraine, rather than with adult migraineurs recalling their childhood. 3-9 However, most have been marred by major methodological flaws that have compromised their validity.For example, Koch and Melchoir 4 found that 39 of their 136 pediatric migraine patients exhibited some degree of mental symptoms related to stress. Similarly, Krupp and Friedman 5 noted s...

The irony of man's condition is that the deepest need is to be free of the anxiety of death and annihilation; but it is life itself which awakens it, and so we must shrink from being fully alive.

No abstract

Suicide and self-destructive behavior are strongly influenced by a negative thought process, referred to here as the "voice." The voice process represents a well-integrated pattern of thoughts, attitudes, and beliefs, antithetical to self and hostile toward others, that is at the core of a patient's self-limitations and self-defeating actions. The voice varies along a continuum of intensity ranging from mild self-criticism to angry self-attacks and even suicidal thoughts. Self-destructive behavior similarly exists on a continuum ranging from self-denial to accident proneness, drug abuse, alcoholism, and other self-defeating behaviors, culminating in actual bodily harm. The two processes, cognitive and behavioral, parallel each other, and suicide represents the acting out of the extreme end of the continuum. The authors provide a chart depicting the levels of increasing suicidal intent along the continuum. The chart identifies specific negative thoughts and injunctions typically reported by persons who attempt suicide, neurotic patients, and "normal" subjects. Understanding where an individual can be placed on the continuum of self-destructive thoughts and actions can assist clinicians in their diagnoses and help pinpoint those students who are more at risk for suicide.

The "voice" refers to an internal system of hostile thoughts and attitudes, antithetical to the self and cynical toward others. It reaches its most dangerous and life-threatening expression in suicidal acting-out behavior.Preliminary studies indicate that this partly conscious thought process is at the root of much depressive behavior and lowered self-esteem and that there is powerful negative affect accompanying the inner voice. The voice is described as a core defense that originated in family interactions. The dynamics and probable sources of the voice are analyzed, and the relationship between this destructive thought process and actual suicidal behavior are explored.David Shaffer, head of a three-year study of teenage suicide, recently lamented the lack of knowledge about the predictors of suicide:Warning signs? My experience in the pilot phase of this study is that these signs have not been present. There's no empirical evidence to tell anybody what are the precursors of death. (Breskin, 1984, p. 35, italics added) The author of this article suggests, however, that there are certain recognizable "precursors of death" identifiable in suicidal ideology. Our point of view regarding the underlying thought process This article has been expanded into a chapter to be published in 1987 by Human Sciences Press in a book entitled