Adolescent Suicide Attempts: Some Significant Factors

ABSTRACT: A group of 108 adolescents who attempted suicide over a two-year period is described. Significant factors related to these attempts are presented and discussed. These adolescent suicide attempts are most significantly related to long-term family dysfunction. Some vegetative depressive symptoms are noted in a majority of patients. Implications are drawn for strengthening the mental health practitioner's role in detecting and preventing adolescent suicide.     

Anorexia Nervosa,Buliminarexia, and Bulimia

No abstract available for this article.     

Psychological Impairment as a Predictor of Suicide Ideation in Individuals with Anorexia Nervosa

Anorexia nervosa (AN) is an eating disorder characterized by severe food restriction resulting in low body weight and an intense fear of gaining weight. This disorder has one of the highest suicide rates of any psychiatric illness; however, few studies have investigated prospective predictors of suicide ideation (SI) in this population. Quality‐of‐life impairment may be particularly relevant for understanding suicide risk in AN, given associations with SI in other psychiatric disorders and associations with chronicity and severity in AN. This study explored associations between eating disorder‐related impairment and SI in individuals with AN (n = 113) who completed assessments at treatment discharge and 3, 6, and 12 months after discharge. Greater psychological impairment predicted future occurrence of SI controlling for age, depression, history of SI, and eating disorder variables. Associations were specific to psychological impairment as other domains of impairment did not predict SI over time. Findings highlight the potential importance of targeting interpersonal–psychological consequences of AN to decrease future suicide risk.     

Suicide Attempts in Major Depressed Patients with Personality Disorder

Suicide attempters who met criteria for borderline personality disorder (BPD) comorbid with major depressive disorder (MDD) were compared to both suicide attempters suffering from MDD alone and to attempters with comorbid MDD and other personality disorders (PD). Participants were 239 (158 patients with comorbid PD and 81 patients with MDD without comorbidity) inpatients consecutively admitted after a suicide attempt made in the last 24 hours. Suicide attempters with comorbid MDD and BPD had more frequent previous suicide attempts and were more likely to have a history of aggressive behaviors and alcohol and drug use disorders compared with patients suffering from MDD without Axis II comorbidity.     

Recovering Identity from Anorexia Nervosa: Women's Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years

There is little consensus about the meaning of recovery in anorexia nervosa with most studies focusing on researcher selected variables of weight gain and improvement in eating disorder symptomatology. There is also a paucity of research that focuses on how the experiencing person themselves define recovery and whether this term is useful to them to depict their journey of reclaiming their life and identity from anorexia nervosa. This article explores 21 Australian women's experiences of anorexia nervosa (AN) over 10 years and the ways they negotiated their identities in relation to the question of recovery. The research interviews sought to provide a context for these women to speak on their own terms, terms not confined to the medical discourse. The discursively constructed category of recovery was troublesome for the majority of these women, despite the researcher inadvertently taking up this category in lines of questioning, particularly in the earlier interviews. Most troubling for the women was the assumption that recovery erased their experiences with the expectation that they should return to a pre-illness state. On the other hand, speaking on their own terms—including the use of metaphor and (re)authoring their experiences as an identity journey—was significant in scaffolding the women toward narratives of reclaiming their lives and identities from AN and its effects. The women in this study refused to confine the terms of their speaking to a recovery discourse; instead, they honored the narratives of their experiences and histories as profound in their identity formation. The implications of this research are significant given that the majority of research and many treatments to date confine the terms of speaking to the “anorexia” discourse.     

Classification of Co-occurring Depression and Substance Abuse Symptoms Predicts Suicide Attempts in Adolescents

Although both depression and substance use have been found to contribute to suicide attempts, the synergistic impact of these disorders has not been fully explored. Additionally, the impact of subthreshold presentations of these disorders has not been researched. We utilized the Quadrant Model of Classification (a matrix of severity of two disorders) to assess for suicide attempt risk among adolescents. Logistic regression was used to examine the impact of co-occurring disorder classification on suicide risk attempts. Results indicate that quadrant classification had a dramatic impact on suicide attempt risk, with individuals with high severity co-occurring disorders at greatest risk.     

Friendship,Depression, and Suicide Attempts in Adults: Exploratory Analysis of a Longitudinal Follow‐Up Study

Social support is thought to protect against the risk of suicidal behavior in young people and late life, but less is known about the role of friendship in adults. We explored the effect of friendship on suicide attempt risk during 1‐year follow‐up of 132 adults presenting with major depressive episode (MDE). Items from the Social Adjustment Scale–Self‐Report were used as an index of frequency and quality of recent friendship contacts. Survival methods tested associations of friendship with risk of suicide attempt, recurrent MDE, and related outcomes during follow‐up. Impaired friendship predicted greater risk of suicide attempt in an unadjusted Cox model. This association was stronger for quality (p = .009) than frequency (p = .081) of friendship contacts. In the adjusted model, the effect of friendship on suicide attempts was largely explained by self‐reported depression severity. Friendship has a potentially bidirectional relationship with depression, and its effect on suicidal behavior appears to occur through its relationship with depression. Future research should examine the effect of antidepressant treatment on friendship and be designed to test mediation models of relationships between friendship, depression, and suicidal behavior.     

Gender Roles,Suicide Attempts,and Substance Abuse

In this article, the focus is on a comparison of suicide attempts and substance abuse in the United States. It is argued that suicide attempts and substance abuse may function as psychologically equivalent but gender-specialized forms of self-injurious behaviors. Possible explanations for the gender segregation of suicide attempts and substance abuse are reviewed, and the benefits of crossover theories and treatments are presented.     

Pathological Conflict Avoidance in Anorexia Nervosa: Family Perspectives

Conflict avoidance is a common pattern in families of patients with anorexia nervosa (AN), but little systematic controlled research has been conducted to elucidate the formal mechanics of such interaction. Forty family triads with daughters suffering from AN were compared to 40 matched control (CON) triads, on five measures of conflictual family situations. Results revealed that the AN group had significantly more difficulty in choosing the topic of discussion, adhering to the topic, developing and exploring the chosen topic, and reaching a solution—all within a family setting. Findings empirically support previous clinical and research evidence on the pathological avoidance of conflict in families with a member who has AN. Therapeutic implications are discussed.     

Anorexia Nervosa: The Hospital's Role in Family Treatment

When an anorexia nervosa patient requires hospitalization for her ¹ 1 We will use the pronoun “her” to refer to anorexic patients since the overwhelming majority are female. Our discussion will focus mainly on younger adolescent girls who are still living with their families.
medical condition, the treatment team faces the problem of integrating the individual focus of inpatient care with the systems focus of family therapy. In this paper we propose a family-systems model of hospitalization, the aim of which is to facilitate such integration. The model draws on current theories of anorexia nervosa, as well as general concepts from psychodynamic, developmental, and family systems theories. The major hypothesis of the model is that all members of the anorexic family are developmentally arrested in the area of separation-individuation. On this assumption, we propose that the entire treatment team (including medical professionals and therapists) needs to function as “parents” to the anorexic family in much the same way that two cotherapists become parental figures in family therapy. Specifically, the team needs to provide those parenting responses that facilitate the family's individuation process.     

Assessing Motivations for Suicide Attempts: Development and Psychometric Properties of the Inventory of Motivations for Suicide Attempts

This study describes the psychometric properties of the Inventory of Motivations for Suicide Attempts (IMSA). The IMSA was designed to comprehensively assess motivations for suicide emphasized by major theories of suicidality. The IMSA was administered to two samples of recent suicide attempters, undergraduates (n = 66) and outpatients (n = 53). The IMSA exhibited a reliable two‐factor structure in which one factor represented Intrapersonal motivations related to ending emotional pain, and the second represented Interpersonal motivations related to communication or help‐seeking. Convergent validity and divergent validity of IMSA scales were supported by expected patterns of correlations with another measure of suicide motivations. In addition, the IMSA scales displayed clinical utility, in which greater endorsement of intrapersonal motivations was associated with greater intent to die, whereas greater endorsement of interpersonal motivations was associated with less lethal intent and greater likelihood of rescue. Findings suggest the IMSA can be of use for both research and clinical purposes when a comprehensive assessment of suicide motivations is desired.     

An Island Entire of Itself: Narcissism in Anorexia Nervosa

ABSTRACT

This article explores the idea of anorexia nervosa as a narcissistic disorder, in which the denial of the need for food symbolically represents a denial of the need for relatedness and dependence. Narcissism is a state in which self and object are undifferentiated and all objects are felt to be within the individual’s omnipotent control. Primary narcissism occurs when the capacity for object relations has never developed and secondary narcissism develops as a defense against dependence which is associated with overwhelming anxiety, envy, or fear of disappointment. Both processes can occur in anorexia nervosa, which provides a cognitive and behavioral framework for the expression and maintenance of the narcissistic position. Narcissistic anorexia is a state of omnipotent isolation in which the patient denies one of her most basic needs and rejects a powerful source of connection with the outside world. An important aim of therapy is to help the patient to develop a capacity for object relations and to be able to acknowledge dependence. This is achieved through coming to experience the therapist as separate and real and requires the therapist to resist being taken over by the patient’s projections.