Suicidal imagery in a previously depressed community sample

Abstract

This study sought to replicate previous findings of vivid suicide-related imagery in previously suicidal patients in a community sample of adults with a history of depression. Twenty-seven participants were interviewed regarding suicidal imagery. Seventeen participants reported prior suicidal ideation or behaviour in the clinical assessment, and the vast majority of these also reported experiencing suicide-related imagery when at their most depressed and despairing, in many cases in the form of flash-forwards to imagined future suicidal acts. Interestingly, five of the 10 participants who did not report suicidal ideation or behaviour in the clinical interview also described prominent imagery related to themes of death and suicide, but in several cases, these images were associated with meanings that seemed to act to reduce the likelihood of subsequent suicidal acts. Severity of prior suicidality was associated with lower levels of imagery-related distress and higher levels of imagery-related comfort. These findings support the idea that suiciderelated imagery is an important component in the phenomenology of depression and despair and hint at potentially important differences in the meaning associated with such imagery between those individuals who report experiencing suicidal ideation or behaviour when depressed and those who do not. The findings are consistent with Joiner's model of acquired capability for suicide through habituation to pain and fear of suicide and suggest that it may be useful to tackle such imagery directly in the treatment of suicidal patients.

Treatment of Intrusive Suicidal Imagery Using Eye Movements

“…Obsessive fantasies and imagination are focused on the belief that suicide is the only way to prevent worse things from happening. Examples of these fantasies include future-oriented (flash-forward) images or thoughts about jumping from a cliff or in front of a train, attending one's own funeral, reading one's own obituary, and so on [5,7,9]. These obsessive fantasies may initially start of as voluntary, controlled images created by the individual to escape from a negative situation and/or future, or to punish oneself or other people.…”

“…It becomes impossible to control them and the individual feels pushed towards suicide. Recently empirical studies verified this obsessive imagination and it is now referred to as 'suicidal mental imagery' [6,36,37] or flash-forwards to suicide [5,[7][8][9]. They include repetitive, intrusive, uncontrollable, vivid images that may occupy the suicidal mind with repetitive ideation, plans, and behavioral intentions.…”

“…While intrusions can possess a multitude of sensory qualities (visual, auditory, olfactory, touch, and movement), most literature is concerned with visual images [32]. Growing evidence supports the existence of intrusive suicidal ideas and images [5,[7][8][9]37]. Moreover, intrusive mental images seem to be an important feature in multiple psychological disorders like PTSD [27,46], agoraphobia [47], social phobia [48], see Holmes and Mathews [49] for a review.…”

“…These mental images related to suicide e.g. imagining a suicidal act, or one's own funeral, have also been referred to as 'flash-forwards' to suicide [5,[7][8][9].…”

“…An increasing number of studies have shown that patients diagnosed with unipolar depression [5,7] or bipolar disorder [8,9] report repetitive intrusive suicide-related images and thoughts. These suicidal images may be both distressing and comforting [5,20], and can be seen as a last visualized escape to protect oneself against future adversity [21,22].…”