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G. Pilyagina

* Publication details:
Pilyagina, G. (2004). The treatment of the different types of self-destructive behaviour. In: Attempted suicide: towards new and better therapies. 3rd Aeschi Conference (3–6 March 2004, Aeschi, Switzerland), p. 25. Aeschi.

Objectives. We interviewed 350 suicidal patients after suicidal attempt in the nearest postsuicidal term (external form of self-destructive behavior as EF SDB) and 70 patients with suicidal ideas without suicidal attempt (internal form of self-destructive behavior as IF SDB).

Methods. We used differential schemes of the emergent or short-term crisis psychotherapy (CP) for different forms of SDB. The methodological basis of CP is existential psychotherapy. We used the main principles of existential psychotherapy in our clinical practice. The procedure of emergent and short-term of CP was actualized in three stages: crisis support, crisis (suicidal) intervention and stage of adaptation rising.

Results. The methods of SDB treatment are based on clinical-pathogenetic typology of SDB. The psychotherapeutic tactics of external and internal forms of SDB directly depend on pathogenetic mechanisms of suicidogenesis, from character of autoagressive signs.

We created the criteria of typology of SDB for suicidal patients with EF SDB. These criteria based on the clinical-pathogenetic mechanisms of SDB development. They contain: availability or absence of the program on a self-destruction; correlation with stages of deployment of an adaptative syndrome; features of the reactive answer: behavioural, neurophysiological and neurochemical aspects; availability of an unpsychotic (neurotic) or psychotic level of alienations; features of personal pathopsychological motivation; specific SDB features alone. We used the emergent form of CP for suicidal patients with external form of SDB.

The pathopsychological basis of suicidogenesis of all SDB forms was a high level of the internal aggression, psyache, impulsiveness and lower internal locus of the awareness control. These feelings were stipulated by childhood traumas. They promoted amplification of existential anxiety, formation of tunnel cognition and of exhaustion of adaptive psychic reserves.

Under the data of our research the psychotherapeutic intervention for suicidal patients with parasuicidal and pseudosuicidal types SDB has great effectiveness in most cases. CP reduced the autoagressive signs in these types of SDB. The patients with suicidal type of SDB required a long-lived personal psychotherapy (short-term CP). An asuicidal type of SDB hindered the application of CP, and in some cases it was impossible in connection with the expression of psychotic disorders.

Patients with IF SDB had lower level of impulsiveness, higher level of internal locus of the awareness control and chaotic style of coping behaviour strategies than patients with EF SDB. These factors suppressed growth of frustrative dissatisfaction and didn’t allow affective distress to externalise. The coping activity was implemented only in patients’ imagination. This promoted transformation of a psychache and affective distress either in the personal disorders, or enhanced somatization, psychosomatic disturbances. This “virtual” abreaction and thus in both versions the expressiveness of psychopathological distresses had the most autodestructive effect on the psyche of patients with IF SDB. The research confirmed the significance of IF SDB autodestructive effect as a main paradox and basic problem of suicidogenesis.

The aim of CP was directed at fast re-shaping of cognition, and transformation of a suicidogenic conflict in a crisis situation.

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