Kaslow N J, Reviere S L, Chance S E, Rogers J H, Hatcher C A, Wasserman F, Smith L, Jessee S, James M E, Seelig B
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA 30335, USA.
J Am Psychoanal Assoc. 1998;46(3):777-96. doi: 10.1177/00030651980460030701.
This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.
本文呈现了一项对自杀行为的四个关键精神动力学概念（自我导向攻击、客体丧失、自我功能障碍、病理性客体关系）进行实证研究的结果。样本包括自杀未遂后住院的精神科患者（未遂者：n = 52）以及在人口统计学特征上与之相似但无自杀行为史的住院精神科患者（对照组：n = 47）。该研究旨在确定未遂者在假设与自杀相关的四个精神动力学结构方面是否与匹配的精神科对照患者存在差异。研究预测，未遂者会表现出更高水平的抑郁和自我指向的愤怒、更显著的丧失史、适应性防御更少以及更原始的客体表征。结果有力地支持了自杀行为的客体关系观点。此外，在识别一种特定的丧失组合时发现了对丧失假设的支持。具体而言，与非未遂者相比，未遂者更有可能报告童年丧失史并伴有近期成年期的丧失。在区分自杀性与非自杀性重症精神科患者时，对其他两个假设的支持有限。对这一意外发现进行了审视，并针对自杀行为病因的精神动力学理论的完善和更具体说明提出了建议，目的是将倾向于此类行为的个体与具有相似精神病理学和动力学问题但实际未尝试自杀的个体区分开来。讨论了该研究的局限性，并阐述了研究结果对自杀行为理论和治疗的启示。
