The Suicidal Crisis: Clinical Guide to the Assessment of Imminent Suicide Risk

Cover......Page 1
The Suicidal Crisis......Page 4
Copyright......Page 5
Dedication......Page 6
Contents......Page 8
Foreword......Page 14
Acknowledgments......Page 16
 Our Inability to Predict Imminent Suicide......Page 18
 Long-​Term and Imminent Suicide Risk......Page 19
 Lack of Tests for Suicide Prediction......Page 20
 Clinical Approach to the Assessment of Imminent Risk......Page 21
 Multimodal Assessments......Page 22
 One-​Informant Versus Multi-​Informant Assessments......Page 23
 How to Use The Suicidal Crisis......Page 25
 A Roadmap for Comprehensive Assessment......Page 26
 Introduction......Page 27
 Shneidman’s Theory of Psychache......Page 28
 The Suicide crisis syndrome......Page 30
 The Cry of Pain/​Arrested Flight Model......Page 32
 Cognitive Vulnerability Model......Page 34
 Fluid Vulnerability Model......Page 35
 Beck’s Diathesis–​Stress Model......Page 36
 Mann’s Stress–​Diathesis Model......Page 38
 Joiner’s Interpersonal Model......Page 39
 O’Connor’s Integrated Motivational–​Volitional Model of Suicide......Page 41
 Summary......Page 43
 Trait Versus State Risk Factors......Page 45
 Overview of the Narrative-Crisis Model......Page 46
 The Trait Vulnerability Component......Page 47
  The Suicidal Narrative Component......Page 48
 The Suicidal Crisis Component......Page 49
 Summary......Page 50
  Age, Race, and Ethnicity......Page 53
  Gender......Page 54
  History of Mental Illness......Page 55
  Childhood Trauma......Page 57
  Parenting Style (Parental Bonding)......Page 58
  Attachment Style......Page 59
  Perfectionism......Page 60
  Cultural Attitudes and Immigration......Page 61
  Moral, Philosophical, and Religious Objections......Page 62
  Suicide in the Family......Page 63
  Suicide Clusters......Page 64
  Suicide Exposure and Practicing......Page 65
 Case Examples......Page 66
 Test Case......Page 75
 Introduction......Page 78
  Economic Hardship......Page 79
  Loss of Home......Page 80
 Romantic Rejection......Page 82
 Intimate Relationship Conflict......Page 83
 Parents in Conflict with Children......Page 84
 Children in Conflict with Parents......Page 85
 Ongoing Childhood and Adolescent Abuse and Neglect......Page 87
 Bullying......Page 89
 Recent Diagnosis......Page 91
 Prolonged and Debilitating Illness......Page 92
 Acute and Chronic Pain......Page 94
 Recent Diagnosis......Page 95
 Recent Hospitalization......Page 96
 Recent Suicide Attempts......Page 99
 Attempt Lethality......Page 101
 Exacerbation and Acute Episodes......Page 103
 Medication Changes......Page 104
 Drug and Alcohol Use Disorder......Page 107
 Acute Alcohol Intoxication and Recent Drug Use......Page 108
 Drug or Alcohol Withdrawal......Page 110
 The Seven Phases of the Suicidal Narrative......Page 113
 Phase 1: Unrealistic Life Goals......Page 115
 Phase 2: Entitlement to Happiness......Page 119
 Phase 3: Failure to Redirect to More Realistic Goals......Page 123
 Phase 4: Humiliating Personal or Social Defeat......Page 126
 Phase 5: Perceived Burdensomeness......Page 129
 Phase 6: Thwarted Belongingness......Page 132
 Phase 7: Perception of No Future......Page 136
 Constructing the Suicidal Narrative......Page 138
 Probing the Suicidal Narrative: An Interview Algorithm......Page 141
 Case Examples......Page 143
 Test Case......Page 153
 Suicide Warning Signs......Page 158
 Suicide Crisis Syndrome......Page 160
 Suicidal Ideation and Intent......Page 161
  Suicide Intent and Plan......Page 162
 Entrapment......Page 167
 Desperation......Page 168
 Affective Disturbance......Page 171
  Depressive Turmoil......Page 172
  Extreme (Frantic) Anxiety......Page 173
  Fear of Dying......Page 174
  Panic–Dissociation......Page 175
  Acute Anhedonia......Page 176
 Loss of Cognitive Control......Page 181
  Cognitive Rigidity......Page 182
  Ruminative Flooding......Page 183
 Agitation and Insomnia......Page 187
 Suicidal Crisis Assessment Algorithm......Page 189
  Interview Algorithm......Page 190
 Case Examples–​Continued from Chapter 5......Page 193
 Test Case......Page 211
 Emotional Response as a Diagnostic Tool......Page 218
 Emotional Differentiation......Page 219
 Mindfulness......Page 220
 From Rescue Fantasy to Helplessness and Anger......Page 221
 Countertransference Love......Page 224
 Countertransference Hate......Page 225
  Reaction Formation......Page 226
 Assessing One’s Own Emotional Response......Page 230
 Case Examples......Page 232
 Clinicians’ Feelings and Suicidal Patients......Page 236
  Long-Term Risk Factors......Page 238
  Stressful Life Events......Page 240
  Suicidal Narrative......Page 242
  Suicidal Crisis......Page 243
 Suicidal Ideation and Intent: Self-​Report and Its Limitations......Page 245
  Short-Term Risk Assessment Instruments and the SAD PERSONS Scales......Page 247
  The Modular Assessment of Risk for Imminent Suicide Clinical Tool......Page 249
 Risk Assessment Interview Strategies......Page 252
  Comprehensive Interview......Page 253
  Suicidal Narrative Summary......Page 259
  Suicide Crisis Syndrome Summary......Page 260
  Explicit Suicide Risk Assessment Summary......Page 261
 The Case of Eerie Calm......Page 273
  Clozapine (Antipsychotics)......Page 277
  Dialectical Behavior Therapy......Page 278
  Collaborative Assessment and Management of Suicidality......Page 279
  Safety Planning Intervention......Page 280
  Mindfulness Meditation......Page 281
  Risk Assessment and Self-Care......Page 282
 Summary......Page 283
Conclusion: Being Vigilant......Page 284
Appendix: Answers to Test Cases......Page 286
References......Page 290
Index......Page 326