Are major repeater patients addicted to suicidal behavior?

  1. Blasco Fontecilla, Hilario
  2. Artieda Urrutia, Paula
  3. Berenguer Elias, Nuria
  4. García Vega, Juan Manuel
  5. Fernández Rodríguez, Mónica
  6. Rodríguez Lomas, César
  7. González-Villalobos Rincón, Isabel
  8. Iruela Cuadrado, Luis Miguel
  9. de León, José
Journal:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Year of publication: 2014

Volume: 26

Issue: 4

Pages: 321-333

Type: Article

DOI: 10.20882/ADICCIONES.38 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Adicciones: Revista de socidrogalcohol

Sustainable development goals

Abstract

The literature provides support for the hypothesis that some major repeaters (individuals with ?5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta de Hierro University Hospital (Madrid, Spain) recruited 118 suicide attempters including 8 major repeaters (7%, 8/118), who were all females. The association between each SB addiction criterion, physiological dependence and total dependence with major repeater status was tested for significance and for effect size with odds ratios (ORs) and their 95% confidence intervals. As hypothesized, major repeaters met significantly higher frequency of criteria for total dependence on SB, OR=62.9 (6.4-615). A backward stepwise logistic regression model was used to provide an OR between major repeater status and total dependence status corrected by confounding variables. Age, panic disorder without agoraphobia, borderline personality disorder, history of psychiatric inpatient admission, and total dependence on SB were introduced as independent variables with major repeater status as the dependent variable. The model selected total dependence and age as the remaining significant variables in the last step. Accordingly, major repeaters appear to be addicted to SB.

Bibliographic References

  • Barnes, R.A. (1986). The recurrent self-harm patient. Suicide Life Threatening Behavior, 16, 399-408. Beck, A.T. (1996). Beyond belief: A theory of modes, personality, and psychopathology. In: Salkovskis, P.M. (Ed.), Frontiers of cognitive therapy. Guildford Press, New York, pp. 1-25.
  • Beck, A.T., Resnik, H.L.P., Lettieri, D.J. (1974). The prediction of suicide. Charles Press Plublishers.
  • Bille-Brahe, U., Kerkhof, A., De Leo, D., Schmidtke, A., Crepet, P., Lonnqvist, J.,…, & Egebo, H. (1996). A repetition-prediction study on European parasuicide populations. Part II of the WHO/Euro Multicentre Study on Parasuicide in cooperation with the EC Concerted Action on Attempted Suicide. Crisis, 17, 22-31.
  • Blasco-Fontecilla, H. (2012). The addictive hypothesis of suicidal behavior. Medical Hypotheses, 78, 350. doi: 10.1016/j.mehy.2011.11.005.
  • Blasco-Fontecilla, H., Baca-Garcia, E., Courtet, P., Garcia-Nieto, R., & de Leon, J. (2014a). Horror vacui: Emptiness may be a core pathway in major suicide repeaters. A pilot study. Psychotherapy & Psychosomatics (at press).
  • Blasco-Fontecilla, H., Delgado-Gomez, D., Ruiz-Hernandez, D., Aguado, D., Baca-Garcia, E., & Lopez-Castroman, J. (2012). Combining scales to assess suicide risk. Journal of Psychiatric Research, 46, 1272-1277. doi: 10.1016/j.jpsychires.2012.06.013.
  • Blasco-Fontecilla, H., Jaussent, I., Olié, E., Béziat, S. Guillaume, S., Artieda-Urrutia, P.,… & J., Courtet, P. (2014b). Major repeaters: a distinct phenotype of suicidal behavior? Prim Care Companion CNS Disord 16. doi:10.4088/ PCC.14m01633
  • Bradvik, L., & Berglund, M. (2011). Repetition of suicide attempts across episodes of severe depression. Behavioural sensitisation found in suicide group but not in controls. BMC Psychiatry, 11, 5.
  • Cassin, S.E., & von Ranson, K.M. (2007). Is binge eating experienced as an addiction? Appetite, 49, 687-690.
  • Christie, M.J., & Chesher, G.B. (1982). Physical dependence on physiologically released endogenous opiates. Life Sciences, 30, 1173-1177.
  • Coid, J., Allolio, B., & Rees, L.H. (1983). Raised plasma metenkephalin in patients who habitually mutilate themselves. Lancet, 2, 545-546.
  • Davis, A.T. (1990). Short-term course of depression following attempted suicide: a preliminary report. Acta Psychiatrica Scandinavica, 81, 345-351.
  • Esposito, C., Spirito, A., Boergers, J., & Donaldson, D. (2003). Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Suicide Life Threatening Behavior, 33, 389-399.
  • Farberow, N.L. (1950). Personality patterns of suicidal mental hospital patients. Genetic Psychology Monographs, 42, 3-79.
  • Favazza, A.R. (1989). Why patients mutilate themselves. Hospital Community Psychiatry, 40, 137-145.
  • Forman, E.M., Berk, M.S., Henriques, G.R., Brown, G.K., & Beck, A.T. (2004). History of multiple suicide attempts as a behavioral marker of severe psychopathology. American Journal of Psychiatry, 161, 437-443.
  • Franklin, J.C., Hessel, E.T., & Prinstein, M.J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189, 362-367.
  • Goodman, A. (1990). Addiction: definition and implications. British Journal of Addiction, 85, 1403-1408.
  • Goodman, A. (1992). Sexual addiction: designation and treatment. Journal of Sex & Marital Therapy, 18, 303-314.
  • Gordon, K.H., Selby, E.A., Anestis, M.D., Bender, T.W., Witte, T.K., Braithwaite, S.,… & Joiner, T.E., Jr. (2010). The reinforcing properties of repeated deliberate selfharm. Archives of Suicide Research, 14, 329-341.
  • Grant, J.E., Brewer, J.A., & Potenza, M.N. (2006). The neurobiology of substance and behavioral addictions. CNS Spectrum, 11, 924-930.
  • Grassi-Oliveira, R., Ashy, M., & Stein, L.M. (2008). Psychobiology of childhood maltreatment: effects of allostatic load? Revista Brasileira de Psiquiatria, 30, 60-68.
  • Grigson, P.S. (2002). Like drugs for chocolate: separate rewards modulated by common mechanisms? Physiology Behavior, 76, 389-395.
  • Hagen, E.H. (2003). The bargaining model of depression. In: Hammerstein, P. (Ed.), Genetic and cultural evolution of cooperation. MIT Press in cooperation with Dahlem University Press, Cambridge, Mass, pp. 95-123.
  • Haw, C., Bergen, H., Casey, D., & Hawton, K. (2007). Repetition of deliberate self-harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suicide Life Threatening Behavior, 37, 379-396.
  • Hertzog, M.A. (2008). Considerations in determining sample size for pilot studies. Research in Nursing & Health, 31, 180-191.
  • Hicks, K.M., & Hinck, S.M. (2008). Concept analysis of self-mutilation. Journal of Advanced Nursing, 64, 408-413.
  • Hjelmeland, H. (1996). Repetition of parasuicide: a predictive study. Suicide Life Threatening Behavior, 26, 395-404.
  • Hyman, S.E. (2005). Addiction: a disease of learning and memory. American Journal of Psychiatry, 162, 1414-1422.
  • Ibanez-Cuadrado, A. (2008). [The genetics of addictions]. Adicciones, 20, 103-109.
  • Jallade, C., Sarfati, Y., & Hardy-Bayle, M.C. (2005). Clinical evolution after self-induced or accidental traumatism: a controlled study of the extent and the specificity of suicidal catharsis. Journal of Affective Disorders, 85, 283-292.
  • Joiner, T.E., Jr., Conwell, Y., Fitzpatrick, K.K., Witte, T.K., Schmidt, N.B., Berlim, M.T.,… & Rudd, M.D., (2005). Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. Journal of Abnormal Psychology, 114, 291-303.
  • Joiner, T.E., Jr., & Rudd, M.D. (2000). Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Journal of Consulting Clinical Psychology, 68, 909-916.
  • Joiner, T.E., Jr., Rudd, M.D., Rouleau, M.R., & Wagner, K.D. (2000). Parameters of suicidal crises vary as a function of previous suicide attempts in youth inpatients. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 876-880.
  • King, C.A., Segal, H., Kaminski, K., Naylor, M.W., Ghaziuddin, N., & Radpour, L. (1995). A prospective study of adolescent suicidal behavior following hospitalization. Suicide Life Threatening Behavior, 25, 327-338.
  • Koob, G.F. (2006). The neurobiology of addiction: a neuroadaptational view relevant for diagnosis. Addiction, 101, 23-30.
  • Kourosh, A.S., Harrington, C.R., & Adinoff, B. (2010). Tanning as a behavioral addiction. American Journal of Drug & Alcohol Abuse, 36, 284-290.
  • Kreek, M.J., & Koob, G.F. (1998). Drug dependence: stress and dysregulation of brain reward pathways. Drug Alcohol Dependence, 51, 23-47.
  • Kreitman, N., & Casey, P. (1988). Repetition of parasuicide: an epidemiological and clinical study. British Journal of Psychiatry, 153, 792-800.
  • Lewinsohn, P.M., Rohde, P., & Seeley, J.R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting Clinical Psychology, 62, 297-305.
  • Linehan, M.M. (1993). Cognitive behavioral treatment of borderline personality disorder. Guilford Press, New York.
  • Lovallo, W.R. (2006). Cortisol secretion patterns in addiction and addiction risk. International Journal of Psychophysiology, 59, 195-202.
  • Maltsberger, J.T. (2004). The descent into suicide. International Journal of Psychoanalysis, 85, 653-667.
  • Monnin, J., Thiemard, E., Vandel, P., Nicolier, M., Tio, G., Courtet, P.,… & Haffen, E. (2011). Sociodemographic and psychopathological risk factors in repeated suicide attempts: Gender differences in a prospective study. Journal of Affective Disorders, 136, 35-43. doi: 10.1016/j. jad.2011.09.001.
  • Mynatt, S. (2000). Repeated suicide attempts. Journal of psychosocial nursing and mental health services, 38, 24-33.
  • Negron, R., Piacentini, J., Graae, F., Davies, M., & Shaffer, D. (1997). Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1512-1519.
  • O’Carroll, P.W., Berman, A.L., Maris, R.W., Moscicki, E.K., Tanney, B.L., & Silverman, M. (1996). Beyond the Tower of Babel: a nomenclature for suicidology. Suicide Life Threatening Behavior, 26, 237-235.
  • Orbach, I., Mikulincer, M., Gilboa-Schechtman, E., Sirota, P. (2003). Mental pain and its relationship to suicidality and life meaning. Suicide Life Threatening Behavior, 33, 231-241.
  • Reisch, T., Seifritz, E., Esposito, F., Wiest, R., Valach, L., & Michel, K. (2010). An fMRI study on mental pain and suicidal behavior. Journal of Affective Disorders, 126, 321-325.
  • Reynaud, M., Karila, L., Blecha, L., & Benyamina, A. (2010). Is love passion an addictive disorder? American Journal of Drug & Alcohol Abuse, 36, 261-267.
  • Saiz, P.A., & Bobes, J. (2014). Suicide prevention in Spain: an uncovered clinical need. Revista de Psiquiatria y Salud Mental, 7, 1-4.
  • Sanchez-Carbonell, X., Beranuy, M., Castellana, M., Chamarro, A., & Oberst, U. (2008). [Internet and cell phone addiction: passing fad or disorder?]. Adicciones, 20, 149-159.
  • Sarfati, Y., Bouchaud, B., & Hardy-Bayle, M.C. (2003). Cathartic effect of suicide attempts not limited to depression: a short-term prospective study after deliberate self-poisoning. Crisis, 24, 73-78.
  • Sarnyai, Z., Shaham, Y., & Heinrichs, S.C. (2001). The role of corticotropin-releasing factor in drug addiction. Pharmacological Reviews, 53, 209-243.
  • Schnyder, U., Valach, L., Bichsel, K., & Michel, K. (1999). Attempted suicide. Do we understand the patients’ reasons? General Hospital Psychiatry, 21, 62-69.
  • Shaffer, H.J., LaPlante, D.A., LaBrie, R.A., Kidman, R.C., Donato, A.N., & Stanton, M.V. (2004). Toward a syndrome model of addiction: multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.
  • Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.,… & Dunbar, G.C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.
  • Shneidman, E.S. (1993). Suicide as psychache. Journal of Nervous and Mental Disease, 181, 145-147.
  • Silverman, M.M., Berman, A.L., Sanddal, N.D., O’Carroll P, W., & Joiner, T.E. (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threatening Behavior, 37, 264-277.
  • Spittal MJ, Pirkis J, Miller M, Carter G, Studdert DM (2014). The Repeated Episodes of Self-Harm (RESH) score: A tool for predicting risk of future episodes of self-harm by hospital patients. Journal of Affective Disorders,161, 36-42.
  • Stanley, B., Gameroff, M.J., Michalsen, V., & Mann, J.J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158, 427-432.
  • Suominen, K., Isometsa, E., Suokas, J., Haukka, J., Achte, K., & Lonnqvist, J. (2004). Completed suicide after a suicide attempt: a 37-year follow-up study. American Journal of Psychiatry, 161, 562-563.
  • Tantam, D., & Whittaker, J. (1992). Personality disorder and self-wounding. British Journal of Psychiatry, 161, 451-464.
  • Tao, R., Huang, X., Wang, J., Zhang, H., Zhang, Y., & Li, M. (2010). Proposed diagnostic criteria for internet addiction. Addiction, 105, 556-564.
  • Tossani, E. (2013). The concept of mental pain. Psychotherapy & Psychosomatics, 82, 67-73.
  • Tullis, K. (1998). A theory of suicide addiction. Sexual Addiction & Compulsivity, 5, 311-32
  • Van Orden, K.A., Witte, T.K., Cukrowicz, K.C., Braithwaite, S.R., Selby, E.A., Joiner, & T.E., Jr., (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600.
  • Van Orden, K.A., Witte, T.K., Gordon, K.H., Bender, T.W., & Joiner, T.E., Jr. (2008). Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72-83.
  • van Praag, H., & Plutchik, R. (1985). An empirical study on the “cathartic effect” of attempted suicide. Psychiatry Research, 16, 123-130.
  • Volkow, N.D., & Wise, R.A. (2005). How can drug addiction help us understand obesity? Nature Neuroscience, 8, 555-560.
  • Walker, R.L., Joiner, T.E., Jr., & Rudd, M.D. (2001). The course of post-crisis suicidal symptoms: how and for whom is suicide “cathartic”? Suicide Life Threatening Behavior, 31, 144-152.
  • Wise, R.A., & Koob, G.F. (2014). The development and maintenance of drug addiction. Neuropsychopharmacology, 39, 254-262.
  • Ystgaard, M., Hestetun, I., Loeb, M., & Mehlum, L. (2004). Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? Child Abuse & Neglect, 28, 863-875.
  • Zhang, Y., Law, C.K., & Yip, P.S. (2011). Psychological factors associated with the incidence and persistence of suicidal ideation. Journal of Affective Disorders, 133, 584-590.
Data source: Dialnet