existing depressive symptoms so as to decrease morbidity and mortality (Chaudhary, Kumar & Mishra, 2016). Another large longitudinal study found patients with OCD are 10-times more likely to die by suicide. A 2016 study shows that the main predictor of suicide in OCD patients is a previous suicide attempt, which offers opportunities for prevention (Karolinska Institute, 2016). OCD has a lifetime prevalence of about 2 percent in the general population, generally runs a chronic course, and is often associated with a significantly- reduced quality of life. The risk of suicide in OCD had previously been considered low. In order to estimate the risk of suicide among people affected by OCD and identify risk and protective factors associated Trauma and stress-related disorders Trauma- and stress-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion (APA, 2013). These include reactive attachment disorder, disinhibited social engagement disorder, post-traumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders. The placement of this chapter in the DSM-5 reflects the close relationship between these diagnoses and disorders in surrounding chapters on anxiety disorders, obsessive-compulsive and related disorders, and dissociative disorders. Suicide is often considered to be caused by pervasive psychological pain and hopelessness, however many suicides have been established as occurring during periods of increased stress, notably periods of crises, such as illness, chronic pain, financial stress, and bad relationship breakups. Stress is a part of life, but many people have difficulty coping with stress and do not come forward for help. They may feel that it is a sign of weakness to admit they are suffering from emotional issues due to stress and feel that they must handle issues on their own. Society seems to suggest it is more natural for women to experience emotion and thus they are allowed to talk about it, but “real men” should not cry, so men may bottle up their emotions, pretend they are not there, and try to manage alone with no knowledge and no model from society of how to do so (Price, 2017). Gender stereotypes are prevalent in Western society, with phrases like, “Be a man,” or “Suck it up,” that discourage men from showing their emotions. They may also feel societal pressure to work long hours and advance their careers to fulfill their role as the successful, strong provider in the family even though these roles are changing. Dr. Kate Price (2017) explains: In the course of my career I have worked in mental health services, traditional health services, male prisons and corporations, large and small. In all, I have seen similar attitudes from men, amounting to the repression of emotion and the unwillingness to admit to distress for fear of being seen as unable to cope or weak. It is concealed under a veneer, of happiness, of love, of successful coping or even success and power. But it is there, unseen and thus unchallenged. Gender stereotypes, the need to conform to societal norms, high-pressure careers and long hours can lead to stress that becomes detrimental to physical and mental health. When Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD), is a more severe response to trauma and is diagnosed after individuals experience symptoms for at least one month following a traumatic event. The disorder is characterized by three main types of symptoms: 1. Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks and nightmares. 2. Avoidance of places, people, and activities that are reminders of the trauma, and emotional numbness.
with suicidal behavior in this group, the researchers at the Karolinska Institute analyzed data from the Swedish national registers, spanning over 40 years (Karolinska Institute, 2016). They identified 36,788 OCD patients in the Swedish National Patient Register between 1969 and 2013, of whom 545 had died by suicide and 4,297 had attempted suicide. The risk of death by suicide was approximately 10 times higher, and the risk of attempted suicide five times higher, than that of the general population. After adjustment for other psychiatric disorders, the risk was reduced, but remained substantial. Having a personality disorder or a substance use disorder also increased the risk; however, being female and of higher socioeconomic levels were found to be protective factors. people experience stress, the adrenal glands that sit on top of the kidneys release a steroid hormone called cortisol . Research from one study shows that people who have experienced high levels of trauma in childhood, and who have attempted suicide, tend to release less cortisol when put under stress (O’Connor, 2018). In the study, O’Connor grouped 160 people according to whether they had a history of previous suicide attempt, had thoughts of suicide but did not attempt suicide, or had neither attempted nor considered suicide (the controls). Their results showed that people who attempted suicide in the past released low levels of cortisol when stressed compared with controls. The lowest levels were in people who had tried to take their own life within the past year. More alarmingly, those people who released lower cortisol when stressed in the laboratory reported higher levels of wanting to die – suicide ideation – four weeks later. Other results showed very high levels of childhood trauma in people vulnerable to suicide, especially in people who had previously made a suicide attempt. Nearly 80% of people who attempted suicide had experienced at least one type of childhood trauma compared with less than 40% of those who had thought about suicide only, and less than 20% in the controls. People who reported more than one moderate or severe type of childhood trauma released the lowest amount of cortisol during the stress test and during rest. Importantly, these effects were not explained by current depression. O’Connor states that the reason the results are important is because people’s inability to release cortisol when stressed has been linked to poor cognitive control (ability to inhibit or stop inappropriate or maladaptive behavior and responses), emotional processing (ability to control emotions), and at-risk behavior (such as drug taking, alcoholism and being impulsive), all factors associated with suicide risk. The findings from this research showed that the stress-response system may be “faulty” or “damaged” in people who have recently tried to take their own life. Altered reactivity to stress, either in the direction of exaggerated reactivity or diminished reactivity, may signal a dysregulation of systems intended to maintain homeostasis and a state of good health (Josephs et al., 2017), providing a pathway from early-life adversity to low-stress reactivity that forms a basis for risky behaviors and poor health outcomes, including an increased risk of substance abuse and suicidal ideation. 3. Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered. (APA, 2013) DSM-5 diagnostic criteria that apply to adults, adolescents and children older than six include the following symptoms: ● Criterion A : Exposure to a traumatic event, defined as one of the following:
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