Can the phenomenology of a suicidal crisis be usefully understood as a suite of antipredator defensive reactions?

When perceiving a dangerous predation threat, mammalian and other species activate antipredator defensive reactions. These include the seemingly paradoxical—but compatible—activation of overarousal (e.g., agitation, insomnia) and “shutdown” (e.g., mutism, withdrawal) states. Acute suicidal crises, too, are characterized by the co-occurrence of overarousal and shutdown behaviors. In the minutes, hours, and days prior to one’s death […]

Voice Therapy: a Treatment for Depression and Suicide (IN: Assessment, Treatment, and Prevention of Suicidal Behavior, edited by R I Yufit & D Lester)

In this chapter, the author first discusses R. Firestone’s overall theoretical approach of separation theory, including the fantasy bond, or self-parenting process, & the voice process. Second, the steps in voice therapy, a cognitive/affective/behavioral treatment, are described. Finally, a hypothetical session is presented to illustrate this methodology as applied in the treatment of an individual […]

Negative Intrusive Thoughts and Dissociation as Risk Factors for Self-Harm

Relationships between self-harm & vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation & childhood trauma, had lower self-worth, & reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly to the self-harmers on the dissociation & […]

Hopelessness and Suicide Risk Emerge in Psychiatric Nurses Suffering From Burnout and Using Specific Defense Mechanisms

The authors investigated correlations of burnout & defense mechanisms with hopelessness in a sample of 120 Italian nurses working in psychiatric, general medicine/rehabilitation, & critical care/surgery wards. Nurses were administered the Maslach Burnout Inventory, Gleser & Ihilevich’s Defense Mechanisms Inventory, & Beck’s Hopelessness Scale. Results indicated that burnout & some of the defense mechanisms predicted […]

Effect of Gender on Suicide Attempters Versus Nonattempters in an Adolescent Inpatient Unit

The effect of gender on suicide among 4 groups of psychiatrically hospitalized adolescents was studied using a cross-sectional design. 404 patients, ages 12-21 were divided into 76 male suicide attempters, 103 male nonattempters, 143 female suicide attempters, & 82 female nonattempters. Findings were analyzed by multivariate regression with stepwise logistic models. Depression & anxiety were […]

Defense Mechanisms and Suicide Risk in Major Depression


Defenses in the Assessment of Suicidal Propensities (IN: 101 Defenses: how the Mind Shields Itself, by J S Blackman)

The author presents a summary of the common psychological knowledge about what factors heighten the risk of people dying by suicide after they have been evaluated. Then, the use of defense theory & technique is discussed.

Therapeutic Mechanisms of Suicidal Ideation: the Influence of Changes in Automatic Thoughts and Immature Defenses

This study evaluates the influence on suicide ideation of theory-based intrapsychic processes: maladaptive cognition & defensive style. 33 community mental health patients completed questionnaires at 2 time points. Decreases in automatic thoughts were a strong correlate of decreased suicide ideation & decreases in immature defenses were a moderate strength correlate. These relationships remained significant even […]

Defense Styles in Depressed Suicide Attempters

This study examined which defense mechanisms are associated with recent suicide attempts in depression. Defense style was rated at admission in 60 depressed inpatients with a recent suicide attempt & 96 without an attempt. Depression intensity was correlated negatively with mature style, humour, & sublimation & positively with projection. Prospective assessment of defense styles & […]

Death Anxiety in a Psychiatric Population of Suicidal and Nonsuicidal Adolescents (IN: New Directions in Affective Disorders, ed. by B Lerne and S Gershon)


Treatment-via-the-parent: a Case of Bereavement (IN: Essential Papers on Object Loss, ed. by R V Frankiel)

Conceptualizing Parent-Adolescent Conflict: Applications From Systems and Attachment Theories

This article describes how parent-adolescent conflict can be conceptualized from a systems-based attachment model. This conceptualization shifts the focus of conflictual interactions from blaming the parent or the adolescent to viewing the conflict as an attempt to re-establish security needs of the adolescent. Case examples are provided to illustrate how various types of insecure behaviours […]

“I am Nobody”: a Case Study of Suicidal Dynamics in Pedophilia

The authors describe a patient at acute suicide risk. His Rorschach protocol was analyzed using Exner’s Comprehensive System & a number of psychoanalytic scales. The results pointed at a predominance of borderline defences, identification with abusers & victims, symbiotic & violent interpersonal relations, self-fragmentation, & intertwined dynamics of suicide & pedophilia. His suicide dynamics consist […]

Transactions of the Topeka Psychoanalytic Society


Lying and Reasons for Living: is Lying Adaptive?

The authors summarize the findings of a study investigating whether lying, a type of ego-protecting mechanism, may be interpreted as an adaptive strategy that might prevent an individual from considering suicide.

Suicide and the Suicidal Body

It is argued that bodily experiences & attitudes toward the body in suicidal individuals, such as rejection of the body, detachment, numbness, physical anhedonia, & lack of protection, can facilitate acts of self-destruction. This argument is supported by theories of developmental psychology, theories on suicide, & empirical data. It is demonstrated that suicidal individuals experience […]

Depression, Anxiety, and Psychological Defense in Attempted Suicide: a Pilot Study Using PORT

Depressive affect, anxiety, & psychological defenses were studied in the presented research with PORT, a projective test that exploits subliminal perception of object-relation images. Protocols of 20 hospitalized suicide attempters were compared to those of matched controls, previously studied non-suicidal depressed patients, patients with panic attack, & patients with borderline & psychotic disorders. Suicide attempters […]

A New Model for Parasuicidal Behavior

Attitudes Toward the Body in Suicidal, Depressed, and Normal Adolescents

Scales for suicidal tendencies, dissociative tendencies, perception of actual vs ideal body features, & feelings toward the body were administered to suicidal adolescents, depressed nonsuicidal, & nonsuicidal normal adolescents. This article reviews previous studies & presents & discusses findings. A series of correlations showed that the higher the suicidal tendency, the higher the dissociation, the […]

Suicidal Children Grow up: ego Functions Associated With Suicide Attempts

133 children were assessed initially & at a 6-8-year follow-up for levels of reality testing, impulse control & frequency of usage of several ego defense mechanisms. Associations between suicidal ideation & suicide attempts at the initial assessment & at follow-up were analyzed with regard to ego functions. Specific ego functions, such as impulsivity, & ego […]

When Patients Commit Suicide (IN: The Psychology of Suicide: a Clinician’s Guide to Evaluation and Treatment, edited by E S Shneidman, N L Farberow & R E Litman)

This chapter discusses the reaction of psychotherapists to patient suicide. Therapists often react on 2 levels – personally & professionally. Emotional responses to a patient suicide are examined. Guilt, anger & feelings of personal/professional inadequacy were found to be common. Denial was a common defensive mechanism. A strategy that helped many therapists to work through […]

Suicide Risk and Violence Risk in Alcoholics: Predictors of Aggressive Risk

74 male alcoholics were given questionnaires measuring suicide risk, violence risk, defenses, & disordered personality functioning. Results show that suicide & violence risk were significantly positively correlated. 3 sets of predictor/mediator variables were identified: those predicting violence risk alone; those predicting suicide risk alone; & those predicting combined aggressive risk. Connections obtained between these variables […]

Childrens’ Reactions to the Knowledge of Death

This paper describes the impact on children of their growing awareness of death. The ongoing influence of this realization on the development of personality & defenses is explained. It is stated that in some cases, individuals feel a sense of mastery over death by taking fate into their own hands in a suicide attempt. Therefore, […]