Too much to swallow? Some reflections on adolescent overdose

Overdose, as a subcategory of self-harm, is under-represented in the psychoanalytic literature in terms of attempts to understand what may underpin it. Given the current prevalence of overdose amongst self-harming adolescents, it seems important to try to understand this from a psychoanalytic perspective. Drawing on clinical material from adolescent patients who overdosed, the author attempts to make sense of how overdose was used by these patients as a means of unconsciously communicating their difficulties. It is suggested that overdose might be understood in the following ways: as a physical enactment of the way in which the patient’s mind is overwhelmed by thoughts, feelings and experiences which it cannot digest or process; as a disguised wish beneath overt self-destructiveness to take in a ‘good feed’; as an enactment of past and present force-feeding, both literally and figuratively, by parents or carers; as an enactment of an internalised death wish from an object which has projected something poisonous into the patient.     

The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients’ good mental health.     

Interpersonal Trauma,Posttraumatic Stress Disorder Symptoms,and the Interpersonal Theory of Suicide in Women Seeking Shelter from Intimate Partner Violence

This study examined how trauma exposure and posttraumatic stress disorder symptoms of reexperiencing, avoidance, numbing, dysphoric arousal, and anxious arousal relate to the major components of the interpersonal theory of suicide; namely, thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide. A sample of 137 women seeking shelter from intimate partner violence completed self-report assessments. Symptoms of dysphoric arousal and numbing were uniquely and positively associated with thwarted belongingness. Numbing symptoms were uniquely and positively associated with perceived burdensomeness. Reexperiencing and anxious arousal symptoms were uniquely but negatively associated with the acquired capability for suicide. Interpersonal trauma was also positively associated with acquired capability, but only when examined independently. Posttraumatic stress disorder symptoms of dysphoric arousal and numbing symptoms might complement brief screenings for acute suicide risk and can help inform in-shelter activities as well as postshelter treatment recommendations to decrease suicide risk for shelter-seeking women.     

Assessment of acquired capability for suicide in clinical practice

The Interpersonal Psychological Theory of suicide proposes that the interaction between Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide (ACS) predicts proximal risk of death by suicide. Instruments to assess all three constructs are available. However, research on the validity of one of them, the acquired capability for suicide scale (ACSS), has been limited, especially in terms of its clinical relevance. This study aimed to explore the utility of the different versions of the ACSS in clinical assessment. Three versions of the scale were investigated, the full 20-item version, a 7-item version and a single item version representing self-perceived capability for suicide. In a sample of patients recruited from a clinic specialising in the treatment of suicidality and in a community sample, all versions of the ACSS were found to show reasonable levels of reliability and to correlate as expected with reports of suicidal ideation, self-harm, and attempted suicide. The item assessing self-perceived acquired capacity for suicide showed highest correlations with all levels of suicidal behaviour. However, no version of the ACSS on its own showed a capacity to indicate suicide attempts in the combined sample. It is concluded that the versions of the scale have construct validity, but their clinical utility is limited. An assessment using a single item on self-perceived ACS outperforms the full and shortened versions of ACSS in clinical settings and can be recommended with caution for clinicians interested in assessing this characteristic.     

The Relationship Between Nonsuicidal Self‐Injury and Suicidal Ideation

This correlational study was conducted with 403 undergraduate college students from 2 universities. The authors used path analysis and bootstrap regression to analyze the relationships between variables. Locus of control and family connectedness related to current nonsuicidal self‐injury (NSSI) engagement. However, when entered into the same regression, the variables current NSSI engagement and current NSSI number of methods used mediated all other relationships with suicidal ideation. Implications to current theories and clinical practice are provided.     

A last defence: the negotiation of blame within suicide notes

This paper presents a discursive analysis of 172 suicide notes left by 120 suicide victims. Instead of searching for the underlying psychological reasons for suicide in the content of notes, we argue that such notes should be viewed as acts of communication which serve to manage the blame accorded to both author and recipients of the suicide note. Consequently notes may provide evidence of socially shared beliefs as to when suicide is more or less acceptable. The analysis largely confirms this approach. It is found that matters relating to blame are referred to more frequently than any other issue (87% of notes). The precise arguments which are used to justify the actions of both self and others are then described in detail and some evidence is provided that the nature of these arguments may vary as a function of the social position of the author and also the identity of the recipient. The implications of these findings, and for a general use of a discursive approach to suicide, are then discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

The Epistemology of Communitarian Bioethics:Traditions in the Public Debates

I consider the problem liberalism poses for bioethics.Liberalism is a view that advocates that the state remain neutralto views of the good life. This view is sometimes supported by askeptical moral epistemology that tends to propel liberalismtoward libertarianism. I argue that the possibilities for sharedagreement on moral matters are more promising than is sometimesappreciated by such a view of liberalism. Using two examples ofpublic debates of moral issues, I show that commonly sharedintuitions may ground moral principles even if they may be givendifferent weight by persons of different moral and religioustraditions. Nevertheless, the fact that the intuition andprinciple is widely shared may be sufficient to chart somedirections for public policy or cooperative action even if theydo not lead to complete agreement. As a result, I argue that aliberal communitarianism that presupposes a fairly minimalistepistemology is a legitimate approach to achieving sharedagreement in a pluralistic society.     

Familicide: The killing of spouse and children

A familicide is a multiple-victim homicide incident in which the killer's spouse and one or more children are slain. National archives of Canadian and British homicides, containing 109 familicide incidents, permit some elucidation of the characteristic and epidemiology of this crime. Familicides were almost exclusively perpetrated by men, unlike other spouse-killings and other filicides. Half the familicidal men killed themselves as well, a much higher rate of suicide than among other uxoricidal or filicidal men. De facto unions were overrepresented, compared to their prevalence in the populations-at-large, but to a much lesser extent in familicides than in other uxoricides. Stepchildren were overrepresented as familicide victims, compared to their numbers in the populations-at-large, but to a much lesser extent than in other filicides; unlike killers of their genetic offspring, men who killed their stepchildren were rarely suicidal. An initial binary categorization of familicides as accusatory versus despondent is tentatively proposed. © 1995 Wiley-Liss, Inc.     

Perfectionism and psychological distress: evidence of the mediating effects of rumination

Three studies investigated the role of ruminative tendencies in mediating the effects of multidimensional perfectionism (Hewitt & Flett, 1991) on psychological distress. Study 1 (Sample 1, N = 279; Sample 2, N = 224) and Study 2 (N = 205) found evidence, cross‐sectionally and prospectively, that brooding ruminative response style either fully or partially mediated the effects of socially prescribed and self‐oriented perfectionism on psychological distress, depression and hopelessness levels. In addition, Study 3 (N = 163) confirmed these mediation effects for socially prescribed perfectionism in relation to depression and hopelessness, 2 months later, after initial levels of distress were controlled. Overall, these findings provide evidence that brooding ruminative response style is an important mechanism that can explain, in part, the relationship between perfectionism and distress. Copyright © 2006 John Wiley & Sons, Ltd.     

The effect of the model's presence and of negative evidence on infants' selective imitation

This study demonstrated selective “rational” imitation in infants in two testing conditions: in the presence or absence of the model during the response phase. In the study, 14-month-olds were more likely to imitate a tool-use behavior when a prior failed attempt emphasized the logical reason and relevance of introducing this novel means, making it cognitively transparent for the infants. Infants also learned imitatively from the cognitively opaque (yet socially communicated) modeling situation, but to a lesser degree. Furthermore, the presence of the model as a social partner during testing influenced the performance of infants in that they were more likely to imitate the novel means when the model was present during testing. These results highlight the important interaction of interpretive schemas (e.g., causality, teleological stance) and social communicative cues in action interpretation guiding imitative learning.