Cognitive behavioral therapy of social anxiety

Suicide (suicide) – the conscious, deliberate deprivation of his life. It is usually carried out independently and voluntarily, although other options are possible, for example, suicide with the help of another person during a serious illness or mass suicide of members of a destructive religious sect. The cause of suicide can be somatic and mental illness, acute and chronic stressful situations, self-incrimination, the need to preserve honor, fear of condemnation, imitation of an idol, etc. Suicide is a serious medical and social problem of modern society.

General information

Suicide – voluntary self-destruction. It is carried out in connection with certain moral, social, religious and philosophical attitudes. In addition, suicide may be the result of a somatic illness, occur during an existential crisis, or become a consequence of circumstances that the patient regards as hopeless. Often provoked by mental illness. Mental health professionals see suicide as a way to avoid an intolerable situation, an act of auto-aggression, and / or a call for help.

According to statistics, suicide ranks second among the causes of death for people aged 15-29 years. 30% of patients who have attempted suicide sooner or later repeat it, and 10% do not retreat until they realize their intention. In the presence of severe mental disorders and the threat of repeated suicide attempts, treatment is carried out by psychiatric specialists. Persons without mental illness who have a history of suicide attempt and need specialized assistance may be observed by psychotherapists and clinical psychologists.

Causes of suicide

One of the most common causes of suicide among people who do not suffer from severe mental illness, are problems in their personal lives. Among the events that can push a person to suicide are the death of a loved one, a serious illness of a family member, divorce, separation, problems in a relationship with a partner, unrequited or unhappy love, loneliness, difficulties in relations with parents. Along with problems in his personal life, suicide patients are often prompted by failures when attempting to professionalize and difficulties associated with social relations.

Suicide can be triggered by bankruptcy, dismissal, large monetary losses, the impossibility of professional realization, a change in customary life stereotypes, social isolation, falling out of a familiar social group or public disclosure of information with high personal significance (about sexual orientation, extramarital relations, “unseemly” past). A serious illness or a disfiguring defect of appearance can become a push towards suicide, while older people are more likely to commit suicide because of serious illnesses, and young people because of external defects.

In a separate category of causes of suicide should be made to bring suicide. In accordance with Russian law, this act is a criminal offense. By bringing to suicide includes physical or sexual violence, humiliation, threats, slander and targeted harassment. Sometimes no one commits to suicide, but the person himself decides to attempt suicide because of fear of possible punishment (for example, after committing a crime), feelings of guilt or a desire to preserve a good name.

Adolescents commit suicide because of conflicts with their parents and peers or because of unhappy love. In adolescence, imitative suicide is also possible – suicide following the example of a real idol (for example, an actor or a singer) or a favorite fictional character. There are cases of solitary suicide and mass suicide among followers of destructive religious cults. The initiator of suicide in such cases usually becomes one of the leaders of the sect.

Suicide can be provoked by a variety of mental diseases, including manic-depressive psychosis, depression, schizophrenia, psychopathy and psychotic states of various origins, as well as, to a lesser extent, neuroses, obsessive-compulsive disorders, generalized anxiety disorder and some other disorders. The probability of suicide increases in the presence of chemical dependencies: alcoholism, drug addiction and substance abuse.

Factors Influencing the Risk of Suicide

Social factors. Of certain importance are the state of society and the level of public morality. It is noted that the number of suicides increases dramatically during periods of political and economic instability (a vivid example is the huge number of “caste” suicides of financiers during the Great Depression). Tolerance of society to suicide and the secret promotion of “problem solving” by self-deprivation increase the risk of suicide, and some cultural, religious and ethnic characteristics (for example, acknowledging suicide as a mortal sin or having strong family ties) decrease.

Age. The greatest number of cases of suicide occurs at the age of 15-24 years, 40-60 years, 70 years or more. Men commit suicide four times more often than women. Researchers have noted an increase in the risk of suicide "at opposite ends of the social ladder." Rich, well-educated citizens, unskilled workers, and the unemployed attempt suicide more often than people with middle income and education.

Marital status, features of education. At increased risk of suicide are (as the probability decreases) people who have never been married, divorced, married, but not having children. Tendency to suicide increases with traumatic childhood experience, including episodes of emotional, sexual and physical abuse, early death of parents, early divorce of parents, lack of care, pedagogical neglect, too severe education with a lack of emotional contact with significant adults, etc. .

Features of character and personality. Suicidal tendencies often occur with uncompromising, maximalism, demonstrativeness, heightened suggestibility, expressed guilt, inadequate self-esteem (too high, too low or unstable), the presence of chronically unmet needs, constant or situational (for example, caused by overwork) emotional instability and inability to cope with frustration. The risk of suicide increases during conflicts, with a change in the usual stereotypes of life and the loss of old values. Suicide, as a way of solving problems, is chosen by psychasthenic individuals, people with infantile attitudes and requirements in relationships.

Medical factors. The probability of suicide is increased in the presence of chronic somatic or mental illness, and successful suicide attempts are more often observed in patients with somatic rather than mental pathology. Most often, suicidal attempts are made by patients with cardiovascular and oncological diseases. Other factors that increase the risk of suicide include recent surgeries, chronic pain of any origin, diseases and injuries of the musculoskeletal system, which caused disability, kidney and lung diseases, as well as medication with a mood-lowering effect (reserpine, corticosteroid drugs, some antihypertensive drugs, etc.).

Among patients with mental illness, patients with affective disorders (depression, manic-depressive psychosis) take the first place in the number of suicide attempts. The likelihood of suicide increases with a combination of two or more mental disorders, for example, depression and panic disorder or anxiety disorder and post-traumatic stress disorder. Depressed patients often attempt suicide some time after the start of treatment, when they have enough strength to be active. Patients with manic-depressive psychosis are more likely to commit suicide when the manic or hypomanic phase passes into the depressive phase.

Dependencies Among those who have attempted suicide, many patients suffering from drug addiction, alcoholism and substance abuse. Psychoactive substances adversely affect the instinct of self-preservation. The behavior becomes impulsive, the ability to critically assess what is happening decreases. The patient may commit suicide under the influence of a minute emotional outburst. According to statistics, 20-25% of suicide attempts are made in a state of drug or alcohol intoxication.

Types and signs of upcoming suicide

There are two groups of suicides – demonstrative and true. In a demonstrative suicide, the goal is not to deprive oneself of life, but to influence others, call for help. Attempted suicide in such cases, as a rule, is made impulsively, against the background of pronounced affect. The goal of true suicide is to take one’s life, regardless of the circumstances, public opinion and feelings of loved ones. True suicide is usually a pre-planned, well-prepared event.

Suicide is preceded by a special emotional state, which is a combination of a feeling of isolation (nobody understands me, I’m not interested in anyone), helplessness, hopelessness and one’s own insignificance (shame, a sense of incompetence, reduced self-esteem). This set of experiences pushes the patient to find a solution. Since the situation seems intractable, the only option for the patient is suicide – the final departure from life, the cessation of existence, as a way to eliminate the thoughts and feelings.

True suicide is preceded by a preparatory period. Typically, the duration of this period is several days, less often patients have the intention to commit suicide for several years. At this time, patients ponder the situation, analyze the events that prompted them to commit suicide, and consider the possible consequences of suicide. Patients choose a way out of life, determine the method, time and place, plan the sequence of actions.

Pondering and planning are followed by practical actions to “put in order” of your life. Patients who planned suicide hand out debts, clean an apartment, sort documents, write a will, apologize to enemies, pay visits to friends, give others valuables as a souvenir. Patients become calm and peaceful, detached from the existing reality. Such a change in behavior, especially in the presence of severe unresolved problems that previously provoked rage, feelings of helplessness, and other similar experiences, can be viewed as peculiar markers of the upcoming suicide.

Patients often leave suicide notes in which they explain the causes of suicide, ask for forgiveness or accuse someone of their death. Immediately before suicide, many patients take a shower, perform urination and bowel movements and put on clean clothes. Some create conditions for the timely detection of the body – they give a friend the keys to the apartment, ask to come in at a certain time, do not close the door, etc.

Suicide prevention

Suicide prevention includes a whole range of activities – from proper education and the formation of a negative attitude towards suicide to the timely detection of mental illness and support of mentally healthy people who find themselves in a difficult life situation. Helpline is used as short-term support. This way of working with patients who are predisposed to suicide allows reducing the level of emotional tension until the moment of rendering professional assistance, which includes psychotherapy and pharmacotherapy.

Psychotherapy is used in traumatic situations, in neurosis, obsessive-compulsive disorders, generalized anxiety disorder, depression and other mental disorders. Psychotherapeutic work with patients who have attempted suicide or have suicidal thoughts and intentions is possible in the absence of psychotic manifestations and there are sufficient internal resources to create a constructive alliance with a psychologist or psychotherapist. Cognitive-behavioral therapy, a technique aimed at identifying dysfunctional stereotypes of thinking and behavior, replacing these stereotypes with new, more adaptive and active learning to use new ways of thinking and behavior in various areas of life, is considered to be the most effective when feeling hopeless.

If necessary, antidepressants are prescribed with a sedative effect in patients with suicidal tendencies. The use of antidepressants with a stimulating effect is contraindicated, as these drugs reduce the level of inhibition and may increase anxiety levels. An increase in activity against a background of depressed mood and lingering depressive thoughts may provoke a suicide attempt. At the initial stage of treatment, any antidepressant medication requires particularly careful monitoring of the patient.

Patients who have attempted suicide are examined by a psychiatrist. If a mental disorder is detected and the threat of suicide persists, compulsory hospitalization in a psychiatric ward is shown (environmental therapy). Patients are observed, conditions are created that prevent harm to themselves and others (they are placed in a special room, tranquilizers and neuroleptics are used, if necessary, the patient is fixed to the bed). The tactics of treatment is determined individually, depending on the nature and characteristics of the underlying disease that provoked a suicide attempt.

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