The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality

Abstract

Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development.Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture.Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area.Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.

From a Symptom-Based to a Person-Centered Approach in Treating Depressive Disorders in Adolescence: A Clinical Case Formulation Using the Psychodynamic Diagnostic Manual (PDM-2)’s Framework

“…Albert’s concerns about self-definition and difficulties with self-esteem regulation constantly require infusions of external validation regarding their importance and value [ 67 ]. When an individual fails to recognize their intellectual brightness, cultural superiority, and physical beauty, they feel profoundly depressed, ashamed, and sometimes may fantasize about suicide to obtain some temporary, vicarious gratification by escaping from painful emotions [ 68 ].…”

Are PID-5 personality traits and self-harm attitudes related? A study on a young adult sample pre-post COVID-19 pandemic

“…Whereas suicidal behaviour consists of self-directed injurious behaviour with the intent to die. Individuals with NSSI do not intend to take their own lives, unlike people with suicidal behaviour ( Moselli et al, 2021b ; Andover and Gibb, 2010 ; Favazza, 1998 ; Patton et al, 1997 ). Thinking about suicide or committing self-harming acts does not necessarily mean committing a suicide attempt ( Iob et al, 2020 ; Glenn and Nock 2014 ; Klonsky et al 2013 ; Nock et al, 2008 ).…”

The Road from Pathological Narcissism to Suicidality in Adolescence: An Empirical Study

“…This condition of internal splitting is thought to be responsible for the dissociative state and emotional detachment that may explain the features of narcissistic suicidal attempts: the apparent immediacy and absence of previous signals, its careful, “cold “and “rational” planning of its often lethal outcome [ 25 ]. It thus seems that the typical narcissistic modes of self-esteem regulation can account for the differences observed in the more recurrent but less lethal suicide attempts exhibited by borderline patients [ 16 , 58 ]. Borderline patients report suicidal motivations that are more oriented to help-seeking and control over relationships as well as by a general background of emotional instability, less structured defenses, mainly cantered on impulsive acting out [ 54 , 59 ].…”

“…Furthermore, the considerations concerning the role of pathological narcissism in shaping the suicidal ideational process could be analyzed in more detail. In particular, the link between the dimensions of the DIN and the motivational profiles for suicide identified by our research group can be empirically investigated in a future study [ 58 ].…”