Suicidal Behavior
We all have an innate desire to keep ourselves alive. So why do some people purposely do things to harm themselves?
PIOTR POWIETRZYNSKI/GETTY IMAGES
Tim, a 35-year-old accountant, had by all appearances been living a pretty happy, successful life. He was married to his high school sweetheart and had two young children. Over the past several years, though, his workload had increased and he started to experience severe job-related stress. At around the same time, he and his wife began to experience some financial problems, and his alcohol consumption increased, all of which put significant strain on the family and began to affect his work. Tim’s coworkers noted that he had become pretty angry and agitated lately—even yelling at coworkers on a few occasions. One evening Tim and his wife got into a heated argument about the family’s finances and Tim’s excessive alcohol use; Tim went into the bathroom and swallowed a bottle full of prescription medicine in an effort to end his life. He was taken to the hospital and kept there to be treated for suicidal behavior.
Suicide, which refers to intentional self-inflicted death, is the 10th leading cause of death in the United States and the 2nd leading cause of death among people 15 to 24 years old. It takes the lives of more than 5 times as many people as HIV-AIDS each year in the United States, and more than twice as many people as homicide (Hoyert & Xu, 2012). There are large demographic differences in the suicide rate. For instance, approximately 80% of suicides in the United States and around the world occur among men, and in the United States, White people are much more likely to kill themselves than members of other racial and ethnic groups, accounting for 90% of all suicides (Centers for Disease Control and Prevention, 2013). Unfortunately, we currently do not have a good understanding of why these enormous sociodemographic differences exist.
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).
Figure 15.7: Age of Onset of Suicidal Behavior During Adolescence A recent survey of a nationally representative sample of U.S. adolescents shows that although suicidal thoughts and behaviors are quite rare among children (the rate was 0.0 for ages 1–4), they increase dramatically starting at age 12 and continuing to climb throughout adolescence.
Adapted from Nock et al., 2013
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.
Nonsuicidal Self-Injury
Louisa, an 18-year-old college student, secretly cuts her lower waist and upper thighs about once per week, typically when she is in the midst of feeling intense anger and hatred, either toward herself or someone else. She has always had a bit of a “hot streak” as she calls it, but it wasn’t until she turned 14 that she started to use self-injury as a way to calm herself down. Louisa says that she actually feels a little ashamed after each episode of cutting, but she doesn’t know how else to calm down when she gets really upset and so she has no plans of stopping this behavior.
Although in the United States self-injury is considered to be pathological, in some parts of the world scarification of the skin is viewed as a rite of passage into adulthood and a symbol of one’s tribe, as in the case of this young man from the Republic of Benin in West Africa.
JEAN-MICHEL CLAJOT/AURORA PHOTOS
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-injury?
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-cutting is not socially encouraged, why would a person purposely hurt him- or herself if not to die? Recent studies suggest that people who engage in self-injury have very strong emotional and physiological responses to negative events, that they perceive this response as intolerable, and that NSSI serves to diminish the intensity of this response (Nock, 2009). There also is some evidence that in many instances, people engage in self-injury as a means to communicate distress or elicit help from others (Nock, 2010). Although we are beginning to get an understanding of why some people engage in NSSI, there are many aspects of this behavior that we do not yet understand, and the study of NSSI is an increasingly active area of research.
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.
Suicide is among the leading causes of death in the United States and the world. Most people who die by suicide have a mental disorder, and suicide attempts most often are motivated by an attempt to escape intolerable mental states or situations.-
NSSI, like suicidal behavior, increases dramatically during adolescence, but for many is a persistent problem throughout adulthood. Although NSSI is performed without suicidal intent, like suicidal behavior, it is most often motivated by an attempt to escape from painful mental states.