An empirical study of the psychodynamics of suicide.

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.

Childhood abuse and suicidality in obstetrics patients in a hospital-based urban prenatal clinic.

This study reports findings from a chart review examining the relationship between self-report of a history of childhood abuse and the emergence of suicidal ideation in pregnancy in a group of patients referred for psychiatric evaluation. The relationship between history of childhood abuse and actual suicide attempts prior to the current pregnancy was also investigated. Results revealed that women reporting a history of childhood sexual abuse, physical abuse, or both were significantly more likely than those not reporting a history of abuse to evidence suicidal ideation during the pregnancy. Additionally, those reporting a history of sexual abuse or both physical and sexual abuse were more likely than those not reporting such a history to have made a suicide attempt in the past at some point prior to the current pregnancy. Interpretations and potential implications of these findings for clinical work with psychiatrically at-risk pregnant women are discussed.

An empirical study of the psychodynamics of suicide: a preliminary report.

Preliminary results from a study of psychodynamic constructs are presented based on data from inpatients following a suicide attempt. The study examines the association between four psychodynamic constructs, severity of suicidal intent, and severity of depressive symptomatology in a sample of hospitalized suicide attempters. Higher levels of suicidal intent were associated with less differentiated self and object representations and less emotional investment in relationships. More severe depressive symptoms in suicide attempters were correlated with more self-targeted anger, less eternally directed anger, higher levels of shame and guilt, more affectively negative views of relationships, greater use of maladaptive and self-sacrificing defenses, and more impaired reality testing. These findings offer some preliminary empirical support for the validity of psychodynamic theories of suicidal behavior.