I was discussing impulsive suicides with a colleague the other day. We talked about suicidal behavior and risk factors. Then it turned into philosophic discussion of terminology and whether impulsivity is the right term. I decide to post the topic as I thought the readers might find it interesting. Some food for thought as they say…
When emotions/behaviors are being expressed without control, thought or any inhibition then it is an impulse problematic. Impulsive individuals are spontaneous and have difficulties restraining their behavior. Impulsivity involves various components such as risk taking, lack of control over affects, inability to sustain attention, inability to resist urges, especially of aggressive or sexual nature and inability to delay gratification (Hollander & Stein, 1995).
Suicide risk is strongly correlated to impulsivity as it represents a disorder, in which control is lost. Generally speaking, suicidal individuals often score significantly higher on impulsivity than non-suicidal individuals (Kotler et al., 1993). Impulsive suicide attempters tend to report telling someone of their plans within 5 minutes, in which they decide to attempt suicide. They also report leaving clues behind and having low expectations of actual death.
Impulsivity does not answer the question why the choice of action is per se suicide rather than another behavior. By definition impulsion means acting without thought or plan. If suicide is indeed an impulsive act, then why do many attempters report having communicated their ideations with someone in their environment? Having suicide ideations and talking about them, in the majority of the cases, indicates that the suicide is a premeditated act. Preoccupation with thoughts of death and the planning of the perfect attempt which suites the individual personal choice, also contradicts the idea of impulsiveness. Choosing one method instead of another is an additional indication that the attempt was not done without any prior thought. An individual chooses to commit suicide when he or she believes that no alternative solution exists. Some fantasies of suicide include the abolishment of psychic pain, escaping unbearable life, restoration of peace, coherence, inner security and self-worth. Suicide attempts become tempting to people who feel helpless, hopeless, lost and when they mistakenly perceive it as the ultimate control over one’s own life and death. These fantasies intertwine with the thoughts/plans of a suicide attempt. Even if they briefly occur, they are still products of thought and imagination thus cognitive processing does occur.
If impulsion means acting without a thought or plan then there are indications that the term is misleading or is neither quite suitable nor right. In my opinion naming suicide attempts as impulsive is just inaccurate terminology. Suicide is not a random act that has no purpose. To the individual who considers suicide, the purpose is clear. It is a solution to an excruciating, overwhelming and agonizing emotional painful situation. The opinions in the scientific and psychological world regarding this issue are still quite divers and indecisive. Apter et al. (1995) tried to distinguish and solve the issue by suggesting that impulsive suicide attempts are the results of only momentary thoughts or feelings. They also added that in well thought-out and planned attempts the desire for death is stronger. The fact that there is still no unanimous agreement is perhaps an additional indication to the fact that further suicidal behavior research is required.
Apter, A., Gothelf, D., Orbach, I., Weizman, R., Ratzoni, G., Har-Even, D., & Tyano, S. (1995). Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients. Journal of the American Academy of Child and Adolescent, 34, 912-918.
Hollander, E. & Stein, D. (1995). Impulsivity and aggression. New York: John Wiley and sons.
Kotler, M., Finkelstein, G., Molocho, A., Botsis, A. J., Plutchik, R., Brown, S. L., & van Praag, H. M. (1993). Correlates of suicide and violence risk in an inpatient population coping styles and social support. Psychiatry Research, 47, 3, 281-290.