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PTSD and Self-Directed Violence

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Book cover Comprehensive Guide to Post-Traumatic Stress Disorders

Abstract

Although posttraumatic stress disorder is a well-established risk factor for suicide ideation and suicide attempts (i.e., suicidal self-directed violence), very little is understood about the mechanisms that account for this relationship. Early research examining potential mechanisms connecting posttraumatic stress disorder with suicidal self-directed violence has generally not been based on empirically supported psychological models, which may explain in part inconsistent results to date. The recent application of two contemporary models for suicidal self-directed violence, the interpersonal-psychological theory of suicide (Joiner 2005) and the fluid vulnerability theory of suicide (Rudd 2000), has led to new discoveries with more consistent findings. Both models are discussed, as are preliminary findings from clinical trials suggesting that trauma-focused therapies contribute to reduced risk for suicide ideation, in contrast to general assumptions about treatment safety with individuals who have posttraumatic stress disorder.

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Abbreviations

CPT:

Cognitive processing therapy

FVT:

Fluid vulnerability theory

IPTS:

Interpersonal-psychological theory of suicide

PE:

Prolonged exposure

PTSD:

Post-traumatic stress disorder

SSDV:

Suicidal self-directed violence

References

  • Becker CB, Zayfert C, Anderson E. A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behav Res Ther. 2004;42:277–92.

    Article  PubMed  Google Scholar 

  • Bell JB, Nye EC. Specific symptoms predict suicidal ideation in Vietnam combat veterans with chronic post-traumatic stress disorder. Mil Med. 2007;172:1144–7.

    Article  PubMed  Google Scholar 

  • Bernert RA, Joiner TE, Cukrowicz KC, Schmidt NB, Krakow B. Suicidality and sleep disturbances. Sleep. 2005;28:1135–41.

    PubMed  Google Scholar 

  • Bryan CJ. The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel. J Clin Psychol. 2011;67:981–92.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Anestis M. Reexperiencing symptoms and the interpersonal-psychological theory of suicidal behavior among deployed service members evaluated for traumatic brain injury. J Clin Psychol. 2011;67:856–65.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Cukrowicz KC. Associations between types of combat violence and the acquired capability for suicide. Suicide Life Threat Behav. 2011;41:126–36.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Johnson LG, Rudd MD, Joiner TE. Hypomanic symptoms among first-time suicide attempters predict future multiple attempt status. J Clin Psychol. 2008;62:519–30.

    Article  Google Scholar 

  • Bryan CJ, Cukrowicz KC, West CL, Morrow CE. Combat experience and the acquired capability for suicide. J Clin Psychol. 2010;66:1044–56.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Clemans TA, Hernandez AM. Perceived burdensomeness, fearlessness of death, and suicidality among deployed military personnel. Personal Individ Differ. 2012;52:374–9.

    Article  Google Scholar 

  • Bryan CJ, Clemans TA, Hernandez AM, Rudd MD. Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury (mTBI). J Head Trauma Rehabil. 2013a;28:13–20.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Hernandez AM, Allison S, Clemans T. Combat exposure and suicide risk in two samples of military personnel. J Clin Psychol. 2013b;69:64–77.

    Article  PubMed  Google Scholar 

  • Bryan CJ, Rudd MD, Wertenberger E, Etienne N, Ray-Sannerud BN, Peterson AL, Young-McCaughon S. Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: an evaluation of the Suicide Cognitions Scale. J Affect Disord. 2014a;159:15–22.

    Article  PubMed  Google Scholar 

  • Bryan AO, Bryan CJ, Morrow CE, Etienne N, Ray-Sannerud B. Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology. 2014b; Advance online publication. http://dx.doi.org/10.1037/h0099852

  • Bryant RA, Creamer M, O’Donnell M, Silove D, McFarlane AC. Heart rate after trauma and the specificity of fear circuitry disorders. Psychol Med. 2011;41:2573–80.

    Article  PubMed  Google Scholar 

  • Clemans TA, Bryan CJ, Resick PA, Mintz J, Evans BB, Young-McCaughan S, the STRONG STAR Consortium. Impact of cognitive processing therapy on trauma-related guilt and suicidality. Symposium conducted at the annual convention of the Association for Behavioral and Cognitive Therapies, National Harbor, 2012.

    Google Scholar 

  • Crosby AE, Ortega L, Melanson C. Self-directed violence surveillance: uniform definitions and recommended data elements, version 1.0. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2011.

    Google Scholar 

  • Drescher KD, Foy DW, Kelly C, Leshner A, Schutz A, Litz BT. An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology. 2011;17:8–13.

    Article  Google Scholar 

  • Friedman MJ, Resick PA, Bryant RA, Strain J, Horowitz M, Spiegel D. Classification of trauma and stressor-related disorders in DSM-5. Depression Anxiety. 2011;28:737–49.

    Article  PubMed  Google Scholar 

  • Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sorensen HT, Lash TL. Posttraumatic stress disorder and completed suicide. Am J Epidemiol. 2010;171:721–7.

    Article  PubMed  Google Scholar 

  • Gradus JL, Suvak MK, Wisco BE, Marx BP, Resick PA. Treatment of posttraumatic stress disorder reduces suicidal ideation. Depression Anxiety. 2013;30:1046–53.

    PubMed  Google Scholar 

  • Guerra VS, Calhoun PS. Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample. J Anxiety Disord. 2011;25(1):12–8.

    Google Scholar 

  • Hendin H, Haas AP. Suicide and guilt as manifestations of PTSD. Am J Psychiatry. 1991;148:586–91.

    Google Scholar 

  • Johnson LR, McGuire J, Lazarus R, Palmer AA. Pavlovian fear memory circuits and phenotype models of PTSD. Neuropharmacology. 2012;62:638–46.

    Article  PubMed  Google Scholar 

  • Joiner TE. Why people die by suicide. Cambridge, MA: Oxford University Press; 2005.

    Google Scholar 

  • Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, Rudd MD. Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults. J Abnorm Psychol. 2009;118:634–46.

    Article  PubMed  PubMed Central  Google Scholar 

  • Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29:695–706.

    Article  PubMed  Google Scholar 

  • Maguen S, Litz BT. Moral injury in veterans of war. Natl Cent PTSD Res Q. 2012;23:1–6.

    Google Scholar 

  • Mahan AL, Ressler KJ. Fear conditioning, synaptic plasticity, and the amygdala: implications for posttraumatic stress disorder. Trends Neurosci. 2012;35:24–35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struning EL. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatr. 2008;158:1467–73.

    Article  Google Scholar 

  • Morris S, Kitsmiller E, McLean CP, Foa EB, Litz BT, Stein NR, STRONG STAR Consortium. Predictors of suicidal ideation in active duty soldiers: the role of PTSD, depression, and trauma-related guilt. Poster presented at the annual meeting of the Association of Behavioral and Cognitive Therapies, National Harbor, 2012.

    Google Scholar 

  • Panagioti M, Gooding P, Tarrier N. Posttraumatic stress disorder and suicidal behavior: a narrative review. Clin Psychol Rev. 2009;29:471–82.

    Article  PubMed  Google Scholar 

  • Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2012;136(3):743–50.

    Google Scholar 

  • Rudd MD. The suicidal mode: a cognitive-behavioral model of suicidality. Suicide Life Threat Behav. 2000;30:18–33.

    PubMed  Google Scholar 

  • Rudd MD, Goulding J, Bryan CJ. Student veterans: a national survey exploring psychological symptoms and suicide risk. Prof Psychol Res Pract. 2011;42:354–60.

    Article  Google Scholar 

  • Tarrier N, Gregg L. Suicide risk in civilian PTSD patients–predictors of suicidal ideation, planning and attempts. Soc Psychol Psychiatr Epidemiol. 2004;39:655–61.

    Google Scholar 

  • Theriault JL, Bryan AO, Bryan CJ. Dispositional forgiveness of self, suicidal ideation, and suicide attempts in a sample of military personnel and veterans. Poster presented at the annual meeting of the American Association of Suicidology, Los Angeles, 2014.

    Google Scholar 

  • Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE. Suicidal desire and the capability for suicide: test of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008;76:72–83.

    Article  PubMed  Google Scholar 

  • Vargas AF, Hanson T, Kraus D, Drescher K, Foy D. Moral injury themes in combat veterans’ narrative responses from the National Vietnam Veterans’ Readjustment Study. Traumatology. 2013;1534765613476099.

    Google Scholar 

  • Weathers FW, Keane TM. The criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma. J Trauma Stress. 2007;20:107–21.

    Article  PubMed  Google Scholar 

  • Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Arch Gen Psychiatry. 2009;66:305–11.

    Article  PubMed  Google Scholar 

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Disclosure

This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. W81XWH-10-2-0181. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the MSRC, the US Government, or the Department of Defense.

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Correspondence to Craig J. Bryan .

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© 2016 Springer International Publishing Switzerland

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Bryan, C.J. (2016). PTSD and Self-Directed Violence. In: Martin, C., Preedy, V., Patel, V. (eds) Comprehensive Guide to Post-Traumatic Stress Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-08359-9_2

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