suicide prof. doina cozman, md, phd. definitions any case of death directly or indirectly resulting...
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SUICIDESUICIDE
Prof. Doina Cozman, MD, PhDProf. Doina Cozman, MD, PhD
DefinitionsDefinitions Any case of death directly or indirectly Any case of death directly or indirectly
resulting from a positive or negative act, resulting from a positive or negative act, performed by the victim, knowing the result of performed by the victim, knowing the result of his/her his/her act act (Durkheim, 1980).(Durkheim, 1980). This definition underlines 3 key elements:This definition underlines 3 key elements:
The act is fatalThe act is fatal The act is performed by the victim on The act is performed by the victim on
herself/himselfherself/himself The victim is aware of the The victim is aware of the lethalitylethality of of
the actthe act Douglas ads 2 more elements:Douglas ads 2 more elements:
The subject’s intent to dieThe subject’s intent to die The motivation to dieThe motivation to die
DefinitionsDefinitions
Suicide is the intentional act, Suicide is the intentional act, performed by the human being, in performed by the human being, in order to cease to exist (Shneidman, order to cease to exist (Shneidman, 1973).1973).
Suicide is the act through which an Suicide is the act through which an individual seeks to physically self-individual seeks to physically self-destruct, with destruct, with aa more or less more or less genuinegenuine intention to intention to endend her/his life, her/his life, being more or less being more or less awareaware of her/his of her/his reasons (WHO).reasons (WHO).
ConceptConcept
SuicideSuicide CompletedCompleted
Results in the death of the individualResults in the death of the individual Called simply: Called simply: suicidesuicide
Not completed – suicide attemptNot completed – suicide attempt Failure Failure to complete the fatal gestureto complete the fatal gesture Called: Called: suicide attemptsuicide attempt (Durkheim) (Durkheim)
ConceptConcept
Is suicide a fatal act that Is suicide a fatal act that undoubtedly belongs to a mental undoubtedly belongs to a mental illness or can it be an act of a illness or can it be an act of a normal person?normal person?
Rational vs. pathological suicideRational vs. pathological suicide
ConceptConcept
SuicideSuicide PathologicalPathological
In a mentally ill personIn a mentally ill person Non-pathologicalNon-pathological
RationalRational In persons without mental illnessIn persons without mental illness Seems Seems ““perfectly perfectly explainableexplainable””
Suicidal behaviorSuicidal behavior
Differences between suicide and Differences between suicide and attempted suicide (attempted suicide (StengelStengel):): Gender distributionGender distribution
Suicide: M/F = 3/1Suicide: M/F = 3/1 Attempted suicide: M/F = 4/1Attempted suicide: M/F = 4/1
AgeAge Suicide maximal incidence > 65Suicide maximal incidence > 65 Attempted suicide maximal incidence 18 – Attempted suicide maximal incidence 18 –
3030 Currently – important increase of suicide Currently – important increase of suicide
rates in 18 – 24 !!!rates in 18 – 24 !!!
Suicidal behaviorSuicidal behavior
Differences between suicide and Differences between suicide and attempted suicide (attempted suicide (StengelStengel):): Social statusSocial status
Suicide more frequent in higher social status Suicide more frequent in higher social status personspersons
Attempted suicide more frequent in lower Attempted suicide more frequent in lower social status personssocial status persons
Overall incidence over the last 100 Overall incidence over the last 100 yearsyears
Suicide – constantSuicide – constant Attempted suicide – over 3 fold increaseAttempted suicide – over 3 fold increase
Suicidal behaviorSuicidal behavior
Mental health indicatorMental health indicator Global problem after 9/11Global problem after 9/11 Suicide rate:Suicide rate:
Suicide No in a year/100000 Suicide No in a year/100000 inhabitantsinhabitants
Suicidal behaviorSuicidal behavior
WHOWHO Sri Lanka – 114 /100000Sri Lanka – 114 /100000 Lithuania, Estonia, Latvia – 48 /100000Lithuania, Estonia, Latvia – 48 /100000 Hungary – 40 /100000Hungary – 40 /100000 Russian Federation – 35-38 /100000Russian Federation – 35-38 /100000 Romania 12-14 /100000Romania 12-14 /100000
Sălaj – 30 /100000Sălaj – 30 /100000 Braşov, Sibiu – 25-30 /100000Braşov, Sibiu – 25-30 /100000 Cluj – 10-25 /100000Cluj – 10-25 /100000 Mehedinţi – 5 /100000Mehedinţi – 5 /100000
Suicidal behaviorSuicidal behavior
Deliberate self-harmDeliberate self-harm Any non-fatal act in which the Any non-fatal act in which the
subject causes a lesion on subject causes a lesion on herself/himself or self-administers herself/himself or self-administers a substance a substance (overdose),(overdose), situations situations that might that might more or lessmore or less endanger endanger her/his existence. her/his existence.
Currently – Currently – deliberate self harm deliberate self harm is is the term used instead of the former the term used instead of the former notion of parasuicide notion of parasuicide
Pathological suicidePathological suicide
PsychosisPsychosis Bipolar affective disorderBipolar affective disorder SchizophreniaSchizophrenia Major depressive disorder (MDD)Major depressive disorder (MDD)
Male – 10-15%Male – 10-15% Female – 3-5%Female – 3-5%
Personality disorders (PD)Personality disorders (PD) Borderline PDBorderline PD Antisocial PDAntisocial PD
Substance dependence (alcohol / other)Substance dependence (alcohol / other) NeurosisNeurosis
Especially if comorbid with depressionEspecially if comorbid with depression Modern life characteristics: anomie, depersonalization, Modern life characteristics: anomie, depersonalization,
burnoutburnout, noise, neglecting spiritual life, , noise, neglecting spiritual life, loss of loss of spiritual and moral valuesspiritual and moral values, lead to agitation and panic , lead to agitation and panic reactions which, by increasing the affective tension, reactions which, by increasing the affective tension, cannot be controlled any longer, and suicide appears as cannot be controlled any longer, and suicide appears as the only way out of the stressful situation.the only way out of the stressful situation.
Phases of suicidePhases of suicide
First phase:First phase: Incubation phaseIncubation phase The subject thinks about dying The subject thinks about dying
and the necessity of deathand the necessity of death It can be It can be triggeredtriggered by a number by a number
of causes:of causes: social social adjustmentadjustment difficulties difficulties degree of social group cohesiondegree of social group cohesion EtcEtc
Phases of suicidePhases of suicide
Second phaseSecond phase Transition from abstract, Transition from abstract, ambivalentambivalent
images to images to actual actual preparations by preparations by searching the searching the meansmeans and method of self- and method of self-destruction.destruction.
This phase is characterized by a marked This phase is characterized by a marked increase of the intra-psychic tension that increase of the intra-psychic tension that reaches paroxysm and explodes in a reaches paroxysm and explodes in a psychogenic reaction. In this moment the psychogenic reaction. In this moment the individual individual reachesreaches the decision to act. the decision to act.
This is the moment of the This is the moment of the ““self-destructive self-destructive acting-outacting-out””
Phases of suicidePhases of suicide
Third phaseThird phase The phase when the individual The phase when the individual
puts into practiceputs into practice the pre- the pre-planned self-destructive planned self-destructive behaviors, followed or not by the behaviors, followed or not by the desired outcome – DEATH.desired outcome – DEATH.
The most important things in this The most important things in this phase are:phase are: The methods usedThe methods used The effects of the methodsThe effects of the methods
Methods used in suicidal Methods used in suicidal behaviorbehavior TraumaticTraumatic
““WhiteWhite”” weapons (knives, blades) weapons (knives, blades) FirearmsFirearms JumpingJumping Crushing (train, car)Crushing (train, car) BurningBurning CorrosivesCorrosives
AsphyxiationAsphyxiation HangingHanging StrangulationStrangulation SuffocationSuffocation DrowningDrowning Carbon vaporsCarbon vapors GasGas ElectrocutionElectrocution
ToxicToxic Poisons (Poisons (arsenicarsenic salts, strychnine, cyanides, belladonna) salts, strychnine, cyanides, belladonna)
Methods used in suicidal Methods used in suicidal behaviorbehavior Cultural differencesCultural differences
FranceFrance 33% - hanging 33% - hanging 25% - drowning 25% - drowning 20% - firearms20% - firearms
Sweden, Norway, Denmark – drowning Sweden, Norway, Denmark – drowning is rareis rare
China – China – most frequent self-poisoningsmost frequent self-poisonings with opium and with opium and arsenicarsenic salts salts
Japan Japan Hara kiriHara kiri FirearmsFirearms
Suicide preventionSuicide prevention
PrimaryPrimary SecondarySecondary TertiaryTertiary
Policies, organizations, Policies, organizations, programsprograms
www.iasp.info
- The International Association for - The International Association for Suicide Prevention – also Suicide Prevention – also available on Twitter and available on Twitter and FacebookFacebook
www.antisuicid.com
Shneidmann: 10 Shneidmann: 10 commonalities of suicidecommonalities of suicide
The common The common purpose purpose of suicide is of suicide is to to seek a solutionseek a solution
The common The common goal goal of suicide is of suicide is cessation of consciousnesscessation of consciousness
The common The common stimulus stimulus of suicide is of suicide is psychological painpsychological pain
The common The common stressor stressor in suicide is in suicide is frustrated psychological needsfrustrated psychological needs
The common The common emotion emotion in suicide is in suicide is hopelessness-helplessnesshopelessness-helplessness
Shneidmann: 10 Shneidmann: 10 commonalities of suicidecommonalities of suicide
The common The common cognitive state cognitive state of suicide of suicide is is ambivalenceambivalence
The common The common perceptual state perceptual state in suicide in suicide is is constrictionconstriction
The common The common action action in suicide is in suicide is escapeescape The common The common interpersonal act interpersonal act in in
suicide is suicide is communication of intentioncommunication of intention The common The common pattern pattern in suicide is in suicide is
consistent with life-long styles of consistent with life-long styles of copingcoping