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Ronningstam E, Schechter M, Herbstman B, Goldbalatt M. Chronic suicidal ideations: a risk or a protection. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024. [PMID: 38904642 DOI: 10.4081/ripppo.2024.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
Chronic suicidal ideations can be consistently present as part of the individual's sense of identity and self-regulation or as a reoccurring pattern to control intense feelings and communicate and relate experiences or intentions. While they can be the precursor to self-harm and suicide attempts, requiring a thorough risk assessment, they can also represent a way to control, avoid, or contain intolerable feelings and experiences. In addition, suicidal ideations can be either deeply internalized and hidden or indirectly or directly conveyed to others. This article focuses on understanding and approaching chronic suicidal ideations that specifically relate to self- and interpersonal characterological functioning, i.e., sense of identity, self-regulation, emotion regulation, and interpersonal intentions. Suicidal ideations must be identified and assessed both in terms of intention, i.e., motivation, plans, and means to harm oneself or end one's life, as well as in terms of function, i.e., related to selfregulatory strategies for counterbalancing or protecting against overwhelming, painful, and frightening external, interpersonal, or internal experiences. Therapeutic strategies and challenges will be discussed, including engaging patients in the therapeutic alliance and building consistency, trust, and reliability.
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Affiliation(s)
- Elsa Ronningstam
- Department of Psychiatry, Harvard Medical School, Boston, MA; Mass General Brigham McLean Hospital, Belmont, MA; Boston Psychoanalytic Society and Institute, Newton, MA; Boston Suicide Study Group, Cambridge, MA.
| | - Mark Schechter
- Department of Psychiatry, Harvard Medical School, Boston, MA; Boston Psychoanalytic Society and Institute, Newton, MA; Boston Suicide Study Group, Cambridge, MA; Mass General Brigham Salem Hospital, MA.
| | - Benjamin Herbstman
- Department of Psychiatry, Harvard Medical School, Boston, MA; Mass General Brigham McLean Hospital, Belmont, MA; Boston Psychoanalytic Society and Institute, Newton, MA; Boston Suicide Study Group, Cambridge, MA.
| | - Mark Goldbalatt
- Department of Psychiatry, Harvard Medical School, Boston, MA; Mass General Brigham McLean Hospital, Belmont, MA; Boston Psychoanalytic Society and Institute, Newton, MA; Boston Suicide Study Group, Cambridge, MA.
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Russolillo A, Spidel A, Kealy D. Lack of Identity and Suicidality: The Mediating Role of Emotion Regulation Difficulties. J Nerv Ment Dis 2024; 212:122-128. [PMID: 38290106 DOI: 10.1097/nmd.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Identity disturbance has been connected to both psychological distress and suicidality, and associated with emotion dysregulation. However, despite empirical evidence of a relationship between lack of identity and poor psychiatric outcomes, the link between impaired identity and emotion dysregulation in suicide risk remains underexplored, particularly among individuals seeking outpatient mental health services. Using data from a large clinical sample (n = 246), the present study examined the association between lack of identity and suicidality and the role of emotion dysregulation within this process. Findings indicated that the mediation model was significant, with emotion regulation difficulties significantly mediating the association between lack of identity and future suicidal behavior. Furthermore, the indirect effect of lack of identity on anticipated suicidality remained significant beyond general distress and past suicide attempt. Our findings add to the literature examining the complex relationship among lack of identity, emotion regulation, and suicidality.
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Affiliation(s)
| | - Alicia Spidel
- Criminology Department, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AGC. Suicidal urges and attempted suicide at multiple time scales in borderline personality disorder. J Affect Disord 2023; 329:581-588. [PMID: 36781143 PMCID: PMC10693674 DOI: 10.1016/j.jad.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND There is strong evidence for an enduring suicidal diathesis among individuals with a history of suicide attempts, particularly among people diagnosed with borderline personality disorder (BPD). However, the progression of suicidal crises among people predisposed to suicidal behavior remains poorly understood. METHODS Via multilevel structural equation modeling we tested the hypothesis that a history of attempted suicide predicts a stronger dynamic link between affect and impulsivity with suicidal ideation (i.e., suicidal urges) - both moment-to-moment and day-to-day. 153 patients diagnosed with BPD, 105 of whom had a history of medically serious suicide attempts completed a 21-day ecological momentary assessment protocol (17,926 total assessments). RESULTS Individuals with higher average levels of negative affect reported more suicidal thoughts. Moments characterized by more negative affect, hostility, impulsivity, and less positive affect were also characterized by elevated suicidal ideation. For hostility and positive affect, these significant links generalized to the daily level. At the same time, for negative affect and hostility the within-person coupling was stronger among attempters in comparison to non-attempters, and these effects did not significantly differ across timescales. LIMITATIONS Follow-up studies replicating our findings of the dysregulation-suicidality nexus in clinically more diverse samples are needed. CONCLUSIONS The diathesis for suicidal behavior manifests in tighter dynamic links between negative affect or hostility and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, differential coupling patterns may index potentially lethal processes that generalize beyond BPD reflecting distinct diathesis components.
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Affiliation(s)
| | | | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
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Obegi JH. Hazards of Using Constant Observation With Suicidal Patients. J Psychiatr Pract 2022; 28:485-491. [PMID: 36355588 DOI: 10.1097/pra.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Constant observation is a necessary albeit controversial procedure. Although widely used in psychiatric hospitals to maintain the safety of patients experiencing acute suicidality, constant observation is associated with many medicolegal hazards. Some hazards threaten patients directly, others undermine the effectiveness of treatment, and still others challenge clinical decision-making and suicide risk assessment. Nevertheless, clinicians can take proactive steps to minimize potentially adverse effects of constant observation on patients, preserve the integrity of treatment, and limit legal exposure.
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Affiliation(s)
- Joseph H Obegi
- OBEGI: California Department of Corrections and Rehabilitation, California Correctional Health Care Services, Statewide Mental Health Program, Elk Grove, CA
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Reynoso JS. The celebrity as teaching object: Using Kanye West and Kim Kardashian to explain Freud. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2022. [DOI: 10.1002/aps.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Harari E, Grant DC. Clinical wisdom, science and evidence: The neglected gifts of psychodynamic thinking. Aust N Z J Psychiatry 2022; 56:594-602. [PMID: 35172624 DOI: 10.1177/00048674221077622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We review five key areas of contemporary psychodynamic practice and research to highlight the contributions psychodynamic concepts can make to clinical psychiatry. These areas are as follows: (1) Contributions to understanding the development of subjectivity. (2) The psychodynamic understanding of the effects of early childhood trauma and their consequences in adult life. (3) The vital importance of the psychodynamic notion of the 'holding environment' based on an understanding of the dynamics of the development of subjectivity and trauma which, if applied, might improve the quality of psychiatric care in the public mental health system and enhance both the clinical competence and morale of clinicians in the system. (4) The emerging scientific disciplines of Neuropsychoanalysis and Affective Neuroscience, which illustrate the importance of seriously studying the mind as well as the brain. (5) A brief summary of some research into the clinical effectiveness and efficacy of psychoanalysis and its related psychodynamic therapies.
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Affiliation(s)
- Edwin Harari
- Department of Psychiatry, St Vincent's Area Mental Health Services, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part II: An Integration of Theory, Research, and Clinical Practice. J Am Psychoanal Assoc 2022; 70:139-166. [PMID: 35451319 DOI: 10.1177/00030651221087158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Part I contemporary psychoanalytic concepts about suicide were synthesized with other theories and empirical research findings. Here the focus is on applying those principles and describing an integrative psychodynamic approach to treatment, one emphasizing the therapeutic alliance, unconscious and implicit processes, exploration of fantasy, and use of the therapeutic relationship as an implicitly interpretive vehicle for change. It is "integrative" because it draws on ideas and techniques described in dialectical behavioral therapy (DBT) and cognitive-behavioral therapy (CBT), as well on developmental and social psychology research. Psychotherapy with suicidal patients is inherently challenging, requiring the therapist to bear intense emotional pain while attending to potentially derailing countertransference pressures. The therapist plays an active role in helping the patient navigate affect storms and counter harsh self-attack, and instilling hope that treatment can lead to meaningful change. The integrative psychodynamic approach offers a pathway to a lessening of harsh self-judgment, greater connection with the body, improvement in continuity of experience, positive changes in narrative identity, emergence of the patient's genuine capacities, and more satisfying interpersonal relationships. These changes promote affect tolerance, improve life satisfaction, and decrease the likelihood of suicidal behavior.
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part I: An Integration of Contemporary Theory and Research. J Am Psychoanal Assoc 2022; 70:103-137. [PMID: 35451317 DOI: 10.1177/00030651221086622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychodynamic psychotherapy has an important role in suicide prevention. The psychoanalytic study of suicide has taught us a great deal about the human experience and the process of suicidality. There is also much to be learned from other fields of study and from empirical research that can be integrated into psychoanalytic therapies. Central to the psychoanalytic approach to suicide has been understanding the patient's internal subjective experience of unbearable emotional or psychic pain and the urgent need for relief. Emotional pain can include intense affects such as shame, humiliation, self-hate, and rage. Factors that can increase vulnerability to suicidal states include problems with early attunement, dissociation and deficits in bodily love and protection, conscious and unconscious fantasy, and certain character traits and dynamics. Empirical research has confirmed many basic psychoanalytic concepts about suicide, including escape from unbearable pain as the primary driver of suicidal behavior, the role of dissociation in increasing risk of bodily attack, and the importance of unconscious processes. Further research into implicit processes and their role in the suicidal process holds potential to improve suicide risk assessment and to enhance psychotherapy by bringing otherwise inaccessible material into the treatment.
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The Road from Pathological Narcissism to Suicidality in Adolescence: An Empirical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189761. [PMID: 34574681 PMCID: PMC8469779 DOI: 10.3390/ijerph18189761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
Background: Clinical and empirical research evidenced a complex link between pathological narcissism and the suicidal process in adulthood. Given the relevance of suicidality and the peculiar narcissistic vicissitudes of adolescence, the proposed research investigated the relationship between pathological narcissism analyzed from the multi-dimensional perspective of the Diagnostic Interview for Narcissism (DIN) and suicidal ideation conducted in a sample of Italian Adolescents. Methods: One hundred and three Italian male and female adolescents between 12 and 18 were administered the DIN, SCIDII, CSSRS, and Kiddie-SADS with six months follow-up. Results: The correlation, t-test, multiple regression analyses evidenced the association of narcissistic affective states and mood with both suicidal ideation and lethality of conduct. The increase in the dimension of grandiosity is associated with the passage to potentially highly lethal suicidal gestures. Conclusions: Suicidal ideation and conduct seem to serve the function of restoring a sense of control and self-esteem in narcissistic individuals experiencing a state of affective dysregulation. Narcissistic pathological functioning seems to play an important role in the adolescent suicidal process, quite like adulthood. Assessing an adolescent’s narcissistic functioning may provide useful clinical information in understanding and managing the suicidal risk in this phase of life.
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Ernst M, Kallenbach-Kaminski L, Kaufhold J, Negele A, Bahrke U, Hautzinger M, Beutel ME, Leuzinger-Bohleber M. Suicide attempts in chronically depressed individuals: What are the risk factors? Psychiatry Res 2020; 287:112481. [PMID: 31377008 DOI: 10.1016/j.psychres.2019.112481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
Chronically depressed individuals have a high suicide risk. However, it is an open question whether previously observed risk factors for suicide attempts also apply to chronic depression or whether there are specific risk factors related to chronic-recurrent illness. We drew from a large group of chronically depressed individuals seeking psychotherapy to investigate demographic and psychological factors related to previous suicide attempts. Participants took part in the SCID and filled out established questionnaires. Among 368 chronically depressed individuals (68.7% women; Mage = 40.95 years), 75 participants (19.4%) reported previous suicide attempts. Men were more likely to have used violent methods. We tested the links of having attempted suicide with different variables using logistic regression analyses. Our findings corroborate previously observed risk factors (e.g. sexual abuse, personality disorders) and suggest other risk factors which could be especially relevant in chronic depression (e.g. depression severity, interpersonal problems, self-injurious behavior, and overall years of depression). Other risk factors from previous studies were not related to suicidal behavior within our sample (e.g. anxiety disorders, PTSD). Thus, mental health professionals should be aware that risk factors for suicidal behavior might vary between diagnosis groups and that chronic illness might be a risk factor in itself.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | | | | | - Alexa Negele
- Frankfurt Psychoanalytic Institute, Frankfurt, Germany
| | - Ulrich Bahrke
- Frankfurt Psychoanalytic Institute, Frankfurt, Germany; Sigmund-Freud-Institute Frankfurt, Frankfurt, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marianne Leuzinger-Bohleber
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Frankfurt Psychoanalytic Institute, Frankfurt, Germany
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13
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Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group. ACTA ACUST UNITED AC 2019; 55:medicina55060303. [PMID: 31238582 PMCID: PMC6631841 DOI: 10.3390/medicina55060303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022]
Abstract
Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient’s internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors’ extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors’ reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient’s internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient’s genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity.
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Goldblatt MJ, Ronningstam E, Herbstman B, Schechter M. John Terry Maltsberger - Suicidologist Extraordinaire. CRISIS 2019; 40:67-71. [PMID: 30311797 DOI: 10.1027/0227-5910/a000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mark J Goldblatt
- 1 Department of Psychiatry at McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Elsa Ronningstam
- 1 Department of Psychiatry at McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin Herbstman
- 1 Department of Psychiatry at McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Schechter
- 2 North Shore Mental Health Center, Harvard Medical School, Salem, MA, USA
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Goldblatt MJ, Herbstman B, Schechter M, Ronningstam E. John Terry Maltsberger, American Psychoanalyst: Contributions to the Development of Studies of Suicide and Self-attack. J Am Psychoanal Assoc 2018; 66:861-882. [PMID: 30384787 DOI: 10.1177/0003065118801596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
John Terry Maltsberger (1933-2016) was an American psychoanalyst who greatly influenced studies of the suicidal patient, and a suicidologist whose contributions significantly impacted psychoanalysis. Through his devotion to the understanding and treatment of suicidal people he exerted a major influence in both areas. Throughout a long and productive career, Maltsberger focused on an uncomfortable area of the psyche, that sphere that impels the attack on the self. His position in psychoanalysis stands out for his early emphasis on the patient's internal subjective experience and the dynamics of the therapeutic engagement. He had a broad range of knowledge and interests beyond psychoanalysis and was able to integrate perspectives from empirical studies with his empathic understanding of clinical material and a striking ability to make complex and impenetrable intrapsychic processes lucidly understandable.
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Balasubramaniam M. Rational Suicide in Elderly Adults: A Clinician's Perspective. J Am Geriatr Soc 2018; 66:998-1001. [DOI: 10.1111/jgs.15263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kramer U, Pascual-Leone A, Rohde KB, Sachse R. The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study. Clin Psychol Psychother 2017; 25:272-282. [PMID: 29265698 DOI: 10.1002/cpp.2160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/24/2022]
Abstract
This process-outcome study aims at exploring the role of shame, self-compassion, and specific therapeutic interventions in psychotherapy for patients with narcissistic personality disorder (NPD). This exploratory study included a total of N = 17 patients with NPD undergoing long-term clarification-oriented psychotherapy. Their mean age was 39 years, and 10 were male. On average, treatments were 64 sessions long (range between 45 and 99). Sessions 25 and 36 were rated using the Classification of Affective Meaning States and the Process-Content-Relationship Scale. Outcome was assessed using the Symptom Check List-90 and Beck Depression Inventory-II. Between Sessions 25 and 36, a small decrease in the frequency of shame was found (d = .30). In Session 36, the presence of self-compassion was linked with a set of specific therapist interventions (process-guidance and treatment of behaviour-underlying assumptions; 51% of variance explained and adjusted). This study points to the possible central role of shame in the therapeutic process of patients with NPD. Hypothetically, one way of resolving shame is, for the patient, to access underlying self-compassion.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy and General Psychiatry Services, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Windsor, ON, Canada
| | | | - Kristina B Rohde
- Bern University Hospital and University of Bern, Bern, Switzerland
| | - Rainer Sachse
- Institute for Psychological Psychotherapy, Bochum, Germany
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Perry SA. Excruciating Mental States. EVOLUTIONARY PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-60576-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ronningstam E. Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment. Borderline Personal Disord Emot Dysregul 2017; 4:3. [PMID: 28191317 PMCID: PMC5296946 DOI: 10.1186/s40479-017-0054-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022] Open
Abstract
Building an alliance with patients with pathological narcissism or narcissistic personality disorder, NPD, can be challenging and include avoidance, negative reactivity and disruptions. A main contributing factor can be the complex interaction between emotion and self-esteem regulation, which affects patients' ability to engage in a therapeutic alliance and treatment. Recent studies, especially in neuroscience have identified functional characteristic and compromises in self-esteem and emotion regulation related to NPD. Self-enhancement, hyper reactivity and need for control, which patients within the range of disordered narcissism often present, can have different roots and underpinnings that require thorough exploration in the process of building the therapeutic alliance and promote change in treatment. Clinical examples with treatment implications and strategies will be discussed to highlight both internal fluctuations and external features and shifts in narcissistic personality functioning.
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Affiliation(s)
- Elsa Ronningstam
- Harvard Medical School, Belmont, USA.,McLean Hospital, AOPC Mailstop 109,115 Mill Street, Belmont, MA 02478 USA
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Fartacek C, Schiepek G, Kunrath S, Fartacek R, Plöderl M. Real-Time Monitoring of Non-linear Suicidal Dynamics: Methodology and a Demonstrative Case Report. Front Psychol 2016; 7:130. [PMID: 26913016 PMCID: PMC4753305 DOI: 10.3389/fpsyg.2016.00130] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/25/2016] [Indexed: 12/02/2022] Open
Abstract
In recent years, a number of different authors have stressed the usefulness of non-linear dynamic systems approach in suicide research and suicide prevention. This approach applies specific methods of time series analysis and, consequently, it requires a continuous and fine-meshed assessment of the processes under consideration. The technical means for this kind of process assessment and process analysis are now available. This paper outlines how suicidal dynamics can be monitored in high-risk patients by an Internet-based application for continuous self-assessment with integrated tools of non-linear time series analysis: the Synergetic Navigation System. This procedure is illustrated by data from a patient who attempted suicide at the end of a 90-day monitoring period. Additionally, future research topics and clinical applications of a non-linear dynamic systems approach in suicidology are discussed.
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Affiliation(s)
- Clemens Fartacek
- Suicide Prevention Research Program, Paracelsus Medical UniversitySalzburg, Austria; Department of Suicide Prevention, University Clinic of Psychiatry and Psychotherapy, Christian Doppler ClinicSalzburg, Austria; Department of Clinical Psychology, Christian Doppler ClinicSalzburg, Austria; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical UniversitySalzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University Salzburg, Austria
| | - Sabine Kunrath
- Suicide Prevention Research Program, Paracelsus Medical UniversitySalzburg, Austria; Department of Suicide Prevention, University Clinic of Psychiatry and Psychotherapy, Christian Doppler ClinicSalzburg, Austria
| | - Reinhold Fartacek
- Suicide Prevention Research Program, Paracelsus Medical UniversitySalzburg, Austria; Department of Suicide Prevention, University Clinic of Psychiatry and Psychotherapy, Christian Doppler ClinicSalzburg, Austria
| | - Martin Plöderl
- Suicide Prevention Research Program, Paracelsus Medical UniversitySalzburg, Austria; Department of Suicide Prevention, University Clinic of Psychiatry and Psychotherapy, Christian Doppler ClinicSalzburg, Austria; Department of Clinical Psychology, Christian Doppler ClinicSalzburg, Austria; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical UniversitySalzburg, Austria
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Ronningstam E. Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0060-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Rasmussen ML, Dyregrov K, Haavind H, Leenaars AA, Dieserud G. The Role of Self-Esteem in Suicides Among Young Men. OMEGA-JOURNAL OF DEATH AND DYING 2015; 77:217-239. [PMID: 29940831 DOI: 10.1177/0030222815601514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.
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Affiliation(s)
| | - Kari Dyregrov
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway.,2 Center for Crisis Psychology, Bergen, Norway
| | - Hanne Haavind
- 3 Department of Psychology, University of Oslo, Norway
| | - Antoon A Leenaars
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
| | - Gudrun Dieserud
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
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Goldblatt MJ, Briggs S, Lindner R, Schechter M, Ronningstam E. Psychodynamic psychotherapy with suicidal adolescents. PSYCHOANALYTIC PSYCHOTHERAPY 2015. [DOI: 10.1080/02668734.2015.1004188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Schechter M, Goldblatt M, Maltsberger JT. The Therapeutic Alliance and Suicide: When Words Are Not Enough. BRITISH JOURNAL OF PSYCHOTHERAPY 2013. [DOI: 10.1111/bjp.12039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Pathological narcissism is associated with significant interpersonal problems, which are unlikely to be acknowledged by narcissistic patients as clinical issues. Although a substantial clinical and theoretical literature deals with narcissism, a succinct overview of core narcissistic interpersonal problems is lacking, particularly in terms of their presentation in clinical settings. This article provides a descriptive overview of the major types of interpersonal problems associated with pathological narcissism: dominance, vindictiveness, and intrusiveness. We outline how these problems can manifest in patients' relations with others and in treatment situations. Clinical vignettes are provided to highlight the presentation of narcissistic interpersonal dysfunction in various types of clinical encounters, and to facilitate discussion of treatment implications.
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Affiliation(s)
- David Kealy
- Fraser Health Authority, Surrey Mental Health and Addictions, British Columbia, Canada.
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Goldblatt MJ. Suicide and masochism: The evolving relationship between guilt, suffering, self-attack and suicide. PSYCHOANALYTIC PSYCHOTHERAPY 2010. [DOI: 10.1080/02668731003707733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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