Are Suicide Attempters Wired Differently?

Abstract

Limited research exists on internal risk processes in suicide attempters and factors that distinguish them from nonsuicidal depressive individuals. In this qualitative study, we investigated Plans, motives, and underlying self-regulatory processes of the two groups and conducted a comparative analysis. We analyzed narrative interviews of 17 suicide attempters and intake interviews of 17 nonsuicidal depressive patients using Plan Analysis. Then, we developed a prototypical Plan structure for both groups. Suicidal behavior serves various Plans found only in suicide attempters. Plans of this group are especially related to social perfectionism and withdrawal to protect their self-esteem. Depressive patients use several interpersonal control and coping strategies, which might help prevent suicidal behavior. The prototypical Plan structure of suicide attempters may be a valuable tool for clinicians to detect critical Plans and motives in their interaction with patients, which are related to suicide risk. (World Health Organization, 2008). Suicide is among the ten leading causes of death, and it is estimated that in 2020, suicide will represent 2.4% of the global burden of disease (World Health Organization, 2008). In the past two decades, a considerable number of models trying to understand suicidal behavior have been developed. The main focus has been identifying risk factors of suicidal behavior and associated high-risk groups. For example, mood disorders are a frequently discussed risk factor for suicidal behavior. Bertolote and Fleischmann (2002) found that in the general population, 35.8% of individuals who committed suicide had a mood disorder. The highest risk of committing suicide is during a major depressive episode; 3.2% of individuals who experience a major depression die of suicide (Blair-West et al., 1999). After a closer examination, it seems that depression predicts suicidal ideation, but not suicide plans or attempts (Nock et al., 2010). Powell et al. (2000) found in a study with psychiatric inpatients that on the basis of identified risk factors (e.g., chronic mental illness, family history of suicide), only two of the patients who committed suicide had a predicted risk of suicide above 5%. These findings imply that suicidal behavior is more than a psychiatric diagnosis, such as depression, and should be approached as an independent behavior that must be examined separately (Linehan, 2008). Hence, the understanding of proximal processes that lead to suicidal behavior is crucial and can be clinically useful. Until now, research surrounding the internal risk processes of suicidal behavior has been limited. Furthermore, we know little about the mechanisms that may distinguish suicide attempters from depressive individuals who do not attempt suicide. Therefore, the present qualitative study focuses on typical Plans (as explained below), motives, and the underlying selfregulatory processes of suicide attempters compared with nonsuicidal depressive individuals. Self-Regulatory Processes and Sui...

Resting-State Functional Connectivity of the Habenula in Mood Disorder Patients With and Without Suicide-Related Behaviors

“…Although the exact mechanism that links suicide and chronic stress is not fully understood, stress-related alterations in cell structure have been documented in suicide attempters {41}. Chronic dysregulation of the habenula circuit may lead to long-term alterations of dopamine, serotonin, and norepinephrine release that impact behavioral functioning, particularly the learning of maladaptive coping strategies related to suicide-related behaviors {42}. Interestingly, the parahippocampal gyrus has been linked to suicidality: in an fMRI experiment using a delay discount task, suicidal patients showed longer reward delays were associated with diminished parahippocampal response {43}.…”

Maintaining Delusional Beliefs to Satisfy and Protect Psychological Needs

“…A number of empirical studies have investigated Plan structures and their clinical application in mental disorders such as borderline personality disorder, depression, and bipolar disorder (Berthoud, Kramer, de Roten, Despland, & Caspar, 2013;Brüdern et al, 2015;Kramer, Berger, & Caspar, 2009;Kramer et al, 2011Kramer et al, , 2014. For instance, in a study with 85 patients with borderline personality disorder, Kramer et al (2014) reported an additional reduction of general problems (e.g., social problems) and an increase in the therapeutic alliance in a condition with a manualbased short variant of the general psychiatric management treatment amended with motive-oriented therapy relationship building based on Plan analysis, compared with general psychiatric management alone.…”