Suicidal Behavior After Severe Trauma. Part 2: The Association Between Methods of Torture and of Suicidal Ideation in Posttraumatic Stress Disorder

Abstract

This second part of the study on suicidal behavior after severe trauma investigates the relationship between specific methods of torture and the content of suicidal ideation among refugees diagnosed with post-traumatic stress disorder (PTSD). The study comprised 65 refugees with PTSD and manifest suicidal behavior, drawn from the larger clinical population examined in Part 1. Of these patients, 40% had a history of suicide attempts, 29% had formulated a detailed suicide plan, and 31% reported recurrent suicidal thoughts. Eighty-six percent identified torture as their principal traumatic stressor. The central hypothesis was that the nature of the traumatic experience might be reflected in the suicide method contemplated, planned, or attempted by PTSD patients. The findings revealed significant associations between particular forms of torture and particular methods represented in suicidal behavior. Blunt-force violence to the head and body was strongly associated with thoughts of jumping from heights or in front of trains; water torture with drowning; and sharp-force torture with self-inflicted stabbing or cutting. Associations were also observed between electric-shock torture and drug overdose, and between asphyctic torture and hanging. The article discusses these findings in relation to traumatic memory and the re-experiencing phenomena characteristic of PTSD. It proposes several possible explanatory mechanisms, including the reactivation of the perceived threat of death associated with the original torture, survivor guilt and shame, attempts to suppress traumatic memories, and the psychodynamic concept of compulsive repetition of trauma. The findings suggest that the content of suicidal ideation among survivors of torture may contain clinically meaningful traces of the original traumatic experience. The study therefore points to the potential importance of examining not only the presence and severity of suicidality in PTSD, but also the specific method and imagery represented in suicidal thoughts, plans, and attempts. Original publication: Journal of Traumatic Stress, Vol. 11, No. 1, 1998.Authors: Marcello Ferrada de Noli, Marie Åsberg, and Kari Ormstad. Keywords PTSD; post-traumatic stress disorder; torture; severe trauma; suicidal behavior; suicidal ideation; suicide attempts; traumatic memory; refugees; asylum seekers; torture survivors; suicide methods; trauma re-experiencing; refugee mental health