We all have an innate drive to keep ourselves alive. We eat when we are hungry, get out of the way of fast-
Tim, a 35-
Suicide, which refers to intentional self-
Nonfatal suicide attempt, in which a person engages in potentially harmful behavior with some intention of dying, occurs much more frequently than suicide deaths. In the United States, approximately 15% of adults report that they have seriously considered suicide at some point in their lives, 5% have made a plan to kill themselves, and 5% have actually made a suicide attempt. The rates of these behaviors in the United States are slightly above the percentages seen across a wide range of countries, which are 9% (considered suicide), 3% (planned suicide), and 3% (made an attempt), respectively (Nock et al., 2008). As these numbers suggest, only one third of those who think about suicide actually go on to make a suicide attempt. Although many more men than women die by suicide, women experience suicidal thoughts and (nonfatal) suicide attempts at significantly higher rates than do men (Nock et al., 2008). Moreover, the rates of suicidal thoughts and attempts increase dramatically during adolescence and young adulthood. A recent study of a representative sample of approximately 10,000 U.S. adolescents revealed that suicidal thoughts and behaviors are virtually nonexistent before age 10, but then increase dramatically from age 12 to 18 years (see FIGURE 15.7) before leveling off during early adulthood (Nock et al., 2013).
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What are some of the factors that contribute to suicidal behavior?
So the numbers are staggering, but why do people try to kill themselves? The short answer is: We do not yet know, and it’s complicated. When interviewed in the hospital following their suicide attempt, most people who have tried to kill themselves report that they did so in order to escape from an intolerable state of mind or impossible situation (Boergers, Spirito, & Donaldson, 1998). Consistent with this explanation, research has documented that the risk of suicidal behavior is significantly increased if a person experiences factors that can create severely distressing states such as the presence of multiple mental disorders (more than 90% of people who die by suicide have at least one mental disorder); the experience of significant negative life events during childhood and adulthood (e.g., physical and sexual assault); and the presence of severe medical problems (Nock, Borges, & Ono, 2012). The search is ongoing for a more comprehensive understanding of how and why some people respond to negative life events with suicidal thoughts and behaviors, as well as on methods of better predicting and preventing these devastating outcomes.
Louisa, an 18-
Louisa is engaging in a behavior called nonsuicidal self-injury (NSSI), the direct, deliberate destruction of body tissue in the absence of any intent to die. NSSI has been reported since the beginning of recorded history; however, it is a behavior that appears to be on the rise over the past few decades. Recent studies suggest that as many as 15 to 20% of adolescents and 3 to 6% of adults report engaging in NSSI at some point in their lifetime (Klonsky, 2011; Muehlenkamp et al., 2012). The rates appear to be even between males and females, and for people of different races and ethnicities. Like suicidal behavior, NSSI is virtually absent during childhood, increases dramatically during adolescence, and then appears to decrease across adulthood.
What is known so far about why people engage in self-
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In some parts of the world, cutting or scarification of the skin is socially accepted, and in some cases encouraged as a rite of passage (Favazza, 2011). In parts of the world where self-
Unfortunately, like suicidal behavior, our understanding of the genetic and neurobiological influences on NSSI is limited, and there currently are no effective medications for these problems. There also is very limited evidence for behavioral interventions or prevention programs (Mann et al., 2005). So, whereas suicidal behavior and NSSI are some of the most disturbing and dangerous mental disorders, they also, unfortunately, are among the most perplexing. The field has made significant strides in our understanding of these behavior problems in recent years, but there is a long way to go before we are able to predict and prevent them accurately and effectively.