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The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling... more
The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.
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ObjectivesThere is limited data regarding the prevalence of suicidal risk among physicians during COVID-19, and the risk factors relating to it. Dominant risk factors for suicide among physicians are depression and burnout. Maladaptive... more
ObjectivesThere is limited data regarding the prevalence of suicidal risk among physicians during COVID-19, and the risk factors relating to it. Dominant risk factors for suicide among physicians are depression and burnout. Maladaptive perfectionism may also serve as a profound risk factor for suicidality among physicians and may aggravate symptoms of distress under the challenges of COVID-19. This study aims to evaluate current suicidal risk, suicidal ideation, depression, and burnout before and during COVID-19 among physicians in Israel, and to identify the best sets of correlates between perfectionism and burnout, depression and suicidal ideation, during these time periods.MethodsA sample of 246 Israeli physicians (160 before COVID-19 and 86 during COVID-19) completed online surveys assessing lifetime suicidal risk, suicidal ideation during the last year and current suicidal ideation, depression, burnout symptoms and maladaptive perfectionism.ResultsMore than one-fifth of the sam...
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This article examines whether and to what extent school climate and previous experience of attempted suicide or suicide of someone close, affect the strategies adopted by Israeli school staff members in coping with a student's... more
This article examines whether and to what extent school climate and previous experience of attempted suicide or suicide of someone close, affect the strategies adopted by Israeli school staff members in coping with a student's suicide. Participants included 84 homeroom teachers, principals, counselors, and psychologists who work at schools where a student had died by suicide during the five preceding years. Our findings show that optimal school climate predicts elevated levels of overall coping strategies and higher problem‐focused strategies. Additionally, staff members who previously experienced suicide or attempted suicide of a close person exhibit lower levels of coping strategies, in general, and of emotion‐focused strategies in particular. Thus, they can be considered a risk group for less adaptive adjustment following a student's suicide. Finally, previous incidents of suicide or attempted suicide of a close person do not moderate the link between optimal school clima...
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Background: The suicide of a pupil impacts survivors greatly, but most studies on the subject do not consider school staff, and do not differentiate between the various professional domains. Our aim was to investigate the existence of... more
Background: The suicide of a pupil impacts survivors greatly, but most studies on the subject do not consider school staff, and do not differentiate between the various professional domains. Our aim was to investigate the existence of differences in symptoms of complicated grief as well as post-trauma symptoms after a pupil’s suicide, among school staff in four domains: counsellors, psychologists, principals and home-room teachers. Method: Eighty-four staff members from schools that lost pupils to suicide within the past five years were assessed for symptoms of complicated grief and trauma. All reported their symptoms using self-report scales. Results: Principals and home-room teachers had significantly higher complicated grief and post-trauma symptoms. The main limitations of this study are that the data were collected via self-report questionnaires, which can introduce bias. Additionally, the sample is relatively small and comprises mainly women. Conclusions: School professionals ...
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Background:The research of theory of mind (ToM) and emotion perception (EP) in adolescents with major depressive disorder (MDD) is scarce, and no study to date has investigated the association between EP and long-term outcomes of... more
Background:The research of theory of mind (ToM) and emotion perception (EP) in adolescents with major depressive disorder (MDD) is scarce, and no study to date has investigated the association between EP and long-term outcomes of adolescents with MDD. The aim of the current study was to evaluate ToM and EP in adolescents with MDD, as compared to healthy controls (HCs). In addition, we aimed to assess the association between impairment in ToM and EP, depressive symptom severity, and long-term outcome in the MDD group.Methods:We compared the performance of 14 adolescents with MDD and 25 HC in the Facial Expression Recognition Task (FERT) and the Interpersonal Perception Task. We followed up with the MDD group 2 years later to assess the level of their depressive symptoms using the Children’s Depression Rating Scale–Revised (CDRS-R).Results:No differences were found between adolescents with MDD and HC in the ToM and FERT tasks. Also, within the MDD group, there was no association betwe...
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Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. The association between aggression, impulsivity and suicidal behaviour is well established, well documented and is... more
Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. The association between aggression, impulsivity and suicidal behaviour is well established, well documented and is based on decades of research and clinical practice. Nonetheless, the research is confusing, contradictory, and not easy to organize in a coherent manner. Moreover, there is detaching between the emphasis on impulsivity in suicide as a risk factor and the state of the existing research. This is probably due to the difficulty in defining and separating out the different facets of impulsivity and the fact that there is much overlap between them. Other difficulties stem from the various methods used and the different types of behaviours that are measured under the concept of impulsivity. Impulsivity involves a failure of higher-order control, including decision-making. Thus, decision-making is an emerging field of study of self-harm behaviour and suicid...
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The study of survivors of a serious suicide attempt (SSA)––an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment––can help researchers understand the suicidal mind. Serious... more
The study of survivors of a serious suicide attempt (SSA)––an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment––can help researchers understand the suicidal mind. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interpersonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part o...
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Suicide attempts are the most common reason for seeking psychiatric care in the mid-teens. In the West, females predominantly attempt suicide while males usually commit suicide. In India, deaths in women occurred between 15 and 29 years... more
Suicide attempts are the most common reason for seeking psychiatric care in the mid-teens. In the West, females predominantly attempt suicide while males usually commit suicide. In India, deaths in women occurred between 15 and 29 years and youth suicide is especially common. There are many risk factors to suicide behaviour in the young. Access to means is one of the most preventable of such factors. Psychiatric illness is one of the major risk factors in the young. Those include depression, conduct disorder, dissociative disorders and borderline personality disorder, anorexia and bulimia nervosa, and schizophrenia. When there is more than one disorder, then risks are multiplied. Three personality constellations are also evident in youngsters at risk for suicide attempts. Those include narcissism, perfectionism and the inability to tolerate failure; impulsive and aggressive characteristics combined with oversensitivity to life stress and hopelessness are often related to underlying depression and mental illness. Other risk factors are psychological. Suicidal adolescents should undergo a comprehensive clinical evaluation. It is important to emphasize seriousness of the problem to the child and the family and to ensure evaluation, since lack of compliance with treatment is characteristic of suicidal adolescents who are brought to emergency room. The chapter reviews some of the assessment measures that exist. Suicide prevention in youth includes primary, secondary and tertiary prevention strategies. Primary and secondary prevention programmes are often used at schools. The goal of tertiary prevention is to reduce the rate of relapse in adolescents with known suicidal ideation and attempts. Finally, the chapter reviews some of the interventions used in suicide behaviour.
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Many therapists who treat adolescents encounter patients who frequently hurt themselves. Although this generates concern and anger in those around them, these teenagers often appear to be quite indifferent to the consequences of their... more
Many therapists who treat adolescents encounter patients who frequently hurt themselves. Although this generates concern and anger in those around them, these teenagers often appear to be quite indifferent to the consequences of their maladaptive behaviors. This article introduces Noshpitz’s theory of self-destructive behavior and its relationship to trauma. Noshpitz emphasizes the need to define the influence of what he terms the “negative ego ideal” on self-destructive behavior in adolescents. He claims that the negative ego ideal and trauma work together to strengthen self-destructive behavior. He identifies numerous similarities between the torturous thoughts that occur after being exposed to a traumatic event, and the torturous thoughts that derive from the negative ideal. Thus, the traumatic encounter undergoes a new interpretation within the superego when it is interpreted by the negative ideal ego. Noshpitz’s emphasis on the negative ideal ego can shed light on many manifestations of self-destructive behaviors, and can contribute to work with adolescents and young adults who have lived through some type of traumatization. Two vignettes are presented that illustrate these tenets, including the transference-countertransference dynamics involved.
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Research Interests: Psychiatry, Mental Health, Depression, Medicine, Medical History, and 15 moreHumans, Affective Disorders, Hospitalization, Female, Male, Loneliness, Risk factors, Aged, Middle Aged, Adult, Risk Factors, Cohort Studies, Affective symptoms, Psychology and Cognitive Sciences, and Medical and Health Sciences
Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. Impulsivity is a long-known risk factor for suicide attempts. However, research based on clearer conceptual... more
Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. Impulsivity is a long-known risk factor for suicide attempts. However, research based on clearer conceptual refinement in this area is imperative. One emerging field of study is that of decision-making. Impulsivity involves a failure of higher-order control, including decision-making. Using standardized operational definitions that take into consideration relevant aspects of impulsivity, including state- and trait-components and a deeper understanding of the process of decision-making in the suicidal mind, we may come a step closer to understanding suicidality and winning the fight in this scourge of human suffering.
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Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from... more
Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from attachment theory to severe suicidal behavior. The results show that both anxious and avoidant attachment patterns predict medical lethality. Path analysis indicated that interpersonal difficulties mediated the paths between insecure attachment patterns and lethality of suicide attempts. These results suggest that the psychological mechanisms of medically serious suicide behavior involve high levels of mental pain amplified by insecure attachment patterns and interpersonal difficulties. Implications for prevention and therapeutic intervention strategies are discussed.
Research Interests: Psychology, Interpersonal Communication, Suicide, Injury Prevention, Attachment Theory, and 15 moreSuicide prevention, Medicine, Humans, Female, Male, Loneliness, Self Disclosure, Aged, Middle Aged, Suicidal Ideation, Adult, Poison Control, Attempted Suicide, Object Attachment, and Psychological pain
The parental presence as therapy agents, namely as a medium and support for the therapeutic process, is one of the paradoxical parameters of working with children. Parental presence serves as a reminder of the need to find a balance... more
The parental presence as therapy agents, namely as a medium and support for the therapeutic process, is one of the paradoxical parameters of working with children. Parental presence serves as a reminder of the need to find a balance between inner and outer reality. The door that is closed in the therapy room leaves a parent on the other side but at the same time provides the child’s inner world with more latitude to reveal itself. This paper examines the fabric of relations created in the therapeutic parent–child–therapist triangle (analogous to Britton’s conceptualisation of the parent–parent–child link). How does this triangular connection affect the ability to be with the silent self (Winnicott) when the parent remains (tangibly and symbolically) on the other side of the therapy door? This paper presents two clinical examples to illustrate the complex fabric of relations created in the therapeutic parent–child–therapist triangle and the interactions between the internal and external reality of the parent–child relationship.
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Suicidal behavior is an important health issue that caregivers must deal with on a very personal level. Researchers are continuing their efforts to evaluate its risk factors, cultural patterns, genetic and neurochemical underpinnings. The... more
Suicidal behavior is an important health issue that caregivers must deal with on a very personal level. Researchers are continuing their efforts to evaluate its risk factors, cultural patterns, genetic and neurochemical underpinnings. The prediction and prevention of suicide remains problematic, but work continues in these areas.
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Research Interests: Clinical Psychology, Psychiatry, Communication Disorders, Depression, Adolescent, and 15 moreMedicine, Impulsivity, Humans, Aggression, Female, Male, Mental Disorders, Clinical Sciences, Aged, Middle Aged, Adult, Psychological Models, Life Change Events, Impulsive behavior, and Neuropsychological Tests
The purpose of our study was to broaden the understanding regarding mental health professionals' willingness to treat and likeliness to refer suicidal patients to other professionals. More specifically, our aim was to examine the... more
The purpose of our study was to broaden the understanding regarding mental health professionals' willingness to treat and likeliness to refer suicidal patients to other professionals. More specifically, our aim was to examine the effect of the patient's gender and suicidal severity, as well as the mental health professionals' personal and professional characteristics, on the willingness to treat and likeliness to refer. A total of 331 mental health professionals were randomly exposed to one of four case descriptions of a hypothetical patient in a crisis. The cases shared a common background story; however, they differed in terms of the patient's gender and suicidal condition (high vs. low). The exposure was followed by questionnaires aimed to reflect the subject's evaluation of the patient's suicidal severity, the subject's sense of competence and responsibility, willingness to treat or likeliness to refer, emotional contagion, and depression. The results...
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Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed... more
Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.