Normal development of adolescents involves many ordinary crises. Severe suicidal tendencies can be the result of normal adolescents’ difficulties, emotional and cognitive problems and problematic/dysfunctional family (Orbach, 1997). In 2006 suicide was found to be the 3rd reason of death among youth 10–24 years of age. As suicidal behaviour of adolescents is a current and growing problem, I would like to introduce and inform the reader a little about the global characterization of the suicidal adolescent.
A suicidal attempter is globally characterized by the combination of self-devaluation, self-blame, worthlessness and low-self esteem. Self-devaluation involves social and emotional withdrawal, minimization of own needs and desires and negative evaluation of the self. An individual, who does not believe that he deserves to live and that he is worthy, can turn to self-destructive behaviour. Self-destructive behaviour is an internalized form of self-abuse. This behavioural tendency reduces self-love and well-being and is the result of deep and unbearable psychological pain. Constant mood changes raise feelings of loss of control over the emotional reactions. Painful emotions that persist decrease the adolescent’s ability to tolerate stresses and frustrations and as a result a desire arises to escape.
The suicidal adolescent displays an extreme form of perfectionism. Perfectionism can be perceived as a psychological form of self-destructiveness. The adolescent sets himself unattainable goals and a failure to achieve them leaves the adolescent feeling anxious, angry and depressed. Subjective feelings of failure and defeat are often experienced as humiliation and hopelessness. Suicidal adolescents also tend to be self-critical. Self- criticism involves anger and aggression towards the self and the inability to cope with failure (Tangney et al., 1997). In regards to others the suicidal adolescent often feels shame, guilt, abandonment and loneliness.
The suicidal adolescent has a rigid personality structure. He is oversensitive, ambitious, mistrusts others and is unwilling to ask for help nor accept it (Orbach, 1997). When frustrated the adolescent tend to be impulsive, aggressive and acts out. Firesone (1997) asserts that suicidal adolescents have inward personality traits. The adolescent focuses on himself and his own inner voice. Retreat to own self helps avoiding some of the pain and frustrations. When feeling hurt the adolescent withdraws his emotions from the external object and transfers them towards himself. The aggression is directed towards the emptiness of the self. The more psychological pain experienced, the more the adolescent punishes himself, which end up being a vicious cycle. There is also a display of cynical attitude towards others, tendency to self- isolate, high preoccupation with fantasy, victimization as well as feelings of guilt and obligation to others. The isolation and avoidance of others originates from the feelings of unworthiness and self- hate, which is rarely conscious to the adolescent. The suicidal adolescent has difficulties expressing his emotions. The suicidal adolescent is rarely assertive nor does the adolescent stand up and fights for his rights or needs. This contributes to the habit of avoidance, repressed behaviour and suffering in silence, which they their possess.
A more recent research by Cross, Westen and Bradley (2011) yielded 6 distinct personality subtypes of suicidal adolescents. Most suicidal adolescent were in the externalizing subtype. This group also contained many younger and mostly male adolescents. These adolescents tend to be rebellious, hostile, aggressive, impulsive, unreliable and irresponsible. They blame others or circumstances for their own failures and actions. The risk of suicide in this subtype was associated with substance abuse, attachment disruption and childhood physical abuse. The internalizing subtype contains adolescents who are depressed, shy, self-conscious, isolated, hopeless and helpless. These adolescents believe that life is meaningless and that their lives have no value. They think that they are inadequate and inferior in comparison to others. The group was largely female. The third group was labelled the emotionally dysregulated subtype. These adolescents often find themselves in unstable and turbulent relationships. They become attached quickly and can be intense, needy and dependent on others. They depended on others for self-soothing, self-evaluation and stability. Unfulfillment of their needs will lead to feelings of rejection and abandonment. They have difficulties regulating their emotions, which also increases impulsivity. The authors assert that adolescents in this group are at the highest suicidal risk. The background of these adolescents was associated with school problems, borderline personality pathology, childhood sexual abuse, substance abuse and mood disorders. Adolescents in the narcissistic subtype were highly functioning and performing and behaving well at school. There have very few problems with substance use and conduct disorder. They appear to be in control and to feel privileged and entitled. These adolescents cannot accept criticism and become very upset and extremely emotional to the point that they feel mistreated and victimized. Simultaneously they tend to have criticism against others and even appear to be rejecting of others. The high-functioning subtype contains healthy, highly functioning, adaptive and well- articulated adolescents who commonly enjoy challenges, activities and have humour. They focus on their abilities, talents and responsibilities. They set high standards and goals for themselves. They tend to be perfectionists and may also experience guilt and anxiety. Their suicide attempts tend to be less lethal and their actual desire to die is lower than the other subtypes. The last subtype, immature, contains adolescents who are immature, unassertive, childish, anxious and passive. They lack psychological insight into their own thoughts, feelings, motives and behaviour. Their lack of social skills reduces their ability to form friendships, which rises isolation and anxiety. These adolescents share similar characteristics found among individuals with autism, schizoid personality disorder and are also at risk of development of psychotic disorders.
The information above does not include all possible characteristics or risk factors but a small illustration of the suicidal adolescent. Research of suicidal behaviour in general and of suicidal behaviour of adolescents is a continuous challenging journey. Needless to say that all the vast knowledge acquired throughout the last decades still does not cover it all nor enables us to prevent and predict suicidal behaviour in individuals. It is the acquirement of more knowledge and the spreading of that knowledge that will enable us to save lives.
CDC, National Center for Injury Prevention and Control Web-based Injury Statistics Query and Reporting System (WISQARS) Available at: www.cdc.gov/ncipc/wisqars Accessed March 31, 2008.
Cross, D., Westen, D.,& Bradley, B. (2011). Personality Subtypes of Adolescents Who Attempt Suicide. Journal of Nervous & Mental Disease, 199,10, 750-756.
Firestone, R.W.(1997). Troubled men- the psychology, emotional, conflicts and therapy of men. San Francisco: Jossey-Bass Publishers.
Orbach, I.(1997). Suicidal behaviour in adolescrnts. Italian journal of suicidology, 7, 2, 87-98.