This book concerns the issue of evaluation of auto-aggressive, and specifically suicidal, behavior. The work promotes the principal of taking individual approach to anyone who exhibits suicidal tendencies and related phenomena of deliberate self-harm. The author develops the new terminology necessary for suicidological analysis of each particular case of auto-aggressive behavior.
Auto-aggressive behavior is divided as follows: suicidal and non-suicidal. Suicidal behavior includes suicide itself and parasuicide. The author identifies the main variants of the character of subjective side of auto-aggressive behavior. 1 — suicide, 2 — parasuicide with no possibility to verify intention of suicide, 3 — parasuicide which reflects so-called «indirect intention» to die described as «parasuicidal break of consciousness», desire «to switch off», «to rest», 4 — parasuicide which includes display of suicidal intentions with absence of real intent, 5 — auto-aggression, not related to suicide, that has other motives.
Introduction of the concept of suicidal determinant is explained from the need to delineate in the field of different terms, all reflecting on the reasons of suicidal behaviors, the ones that determine the group of sui-cidogenic factors having the most bearing on the occurrence of suicide. These determinants, grouped by categories, facilitate suicidological analysis by focusing on separate characteristics of the suicide victim, including his/her state of mind immediately prior to the suicide attempt or specific psychosocial situation, in the frame of which these determinants are defined. Theses categories of determinants comprise the areas of likely appearance of suicidal tendencies.
Determinants differ from the motives and direct reasons given by the victim of the suicide attempt and explicitly expressed by him/her. Unlike these components of the motivation of suicide which are presented by the patient himself, the determinants of suicidal behavior are identified by the specialist (doctor, psychologist, etc.), who analyses the event. These factors reflect the data collected in the process of the interview and review of patient
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history. In each case of the suicide attempt identification of the main forces, described above as suicidal determinants, is one of the critical aspects in understanding the event.
The author considers the concept of ahedonia as substantially enriching the group of concepts related to the dynamics of suicidal behavior. This term, which is commonly used in psychiatry, describes a specific presuicidal change of psychic life immediately preceding the formation of anti-vital tendencies, obsessional thoughts, fantasies, and dreams related to the topic of death and suicide and, as a final stage, suicidal ideation and intent. Ahedonia, as a characteristic of psychic life, develops in conditions of combination of different suicidogenic factors (situational, personality, clinical) and can exist among the psychiatrically healthy, but can also accompany the development of different psychiatric disorders (depression, schizophrenia) as a common phenomena.
According to the author, most of the suicide victims, which are analyzed in the chapter of this book related to suicidal behavior of people with borderline psychiatric disorders and mentally healthy, during the time of suicide, exhibit the signs and symptoms of mental disorder.
Among the population that exhibits symptoms of personality disorder or are mentally healthy, before and after the suicide, regular one-dimensional psychiatric diagnosis may not be adequate. In these situations it is more appropriate, in the view of current psychiatric nomenclature, to use the principals of multi-axial classification of psychiatric condition, which include five main axes. The axes are: syndrome and condition, personality disorder, medical conditions, currently psychosocial stressors, level of social adaptation. Each of these axes acquires a suicidological characteristic during the suicide assessment. In some cases suicidological analysis requires not only the evaluation of the clinical syndrome, but also separate symptoms, and even its' analogies, which are important in understanding the genesis of the suicidal tendencies and fuller evaluation of the situation, but are not currently included as psychiatric and behavioral disturbances in the current ICD-10 nomenclature.
The suicide that occurs in the initial stages of the development of different psychiatric disorders quite frequently appears as a factor presenting the psychiatric disorder and translating a sub-clinical illness into clinically significant phenomena from the point of the observer. The character of suicidal behavior, including its motivation, can help to evaluate the symptoms of psychopathology and determine a psychiatric diagnosis. Suicidological analysis presents itself not only as an opportunity of possible prophylaxis of recurrent suicide attempts, but also as an important element of diagnosis and related treatment of each particular patient.
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In general, clarification of the internal motivation of suicidal behavior in schizophrenia and other psychiatric disorders can serve as a diagnostic tool, as well as help to evaluate the level of dangerousness to self or others. These factors, described above, determine the value of clinical suicidological analysis in each particular patient whose condition at some point presents itself with suicidal tendencies.