prevention study at the University of Pennsylvania. He discussed data from his career in cognitive behavioral therapy and suicide research showing suicide can be reduced by changing unhealthy habits of thought (cognitions).

The patients who ultimately committed suicide seemed to be among those who were the most hopeless.

Aaron T.Beck

Approximately 30 years ago, Dr. Beck and his colleagues developed the first nomenclature for suicidal behaviors, distinguishing contemplating suicide (suicide ideation), from attempting (but not committing suicide), from committing (completing) suicide. Dr. Beck described instruments they developed to measure characteristics of suicidal behavior, including the degree of intent to kill oneself, suicidal ideations, and the medical lethality of attempts. Dr. Beck reported that suicidal ideation and intent scores did not correlate highly with the medical lethality of attempts. However, Dr. Beck found that the person’s belief in the lethality of the method was significantly correlated with intent. Out of this early work, Dr. Beck and his colleagues developed two additional scales: The Beck Hopelessness Scale and The Beck Depression Inventory. According to Dr. Beck, The Hopelessness Scale “was a very good predictor of ultimate suicide.”

In addition to the emotional disturbances in psychiatric disorders, there are abnormalities in thinking and reasoning, collectively called cognitive disturbances. Dr. Beck described two types of cognitive disturbances observed in suicidal people. There are cognitive disturbances that occur for brief periods of time and resolve when other symptoms of the psychiatric disorder diminish. These are referred to as “state” cognitive disturbances. Trait cognitive disturbances are those which remain relatively constant, even when other symptoms have diminished or resolved. Dr. Beck found that hopelessness—unwavering pessimism even in the face of contrary evidence—is one such cognitive distortion expressed both in state and trait forms in suicidal people. He also found that state hopelessness is more often associated with suicidality in people with borderline personality disorder, and that trait hopelessness is more frequently associated with depressive disorders.

Our theory is that the [borderline] patients learned enough in therapy so that when they got out, they were able to deal better with their fear of abandonment

Aaron T.Beck

Dr. Beck described findings of past and current studies of his and his collaborators. These studies included psychiatric inpatient and outpatient populations. Dr. Beck reported robust differences in suicide rate and clinical course of suicidal behaviors depending on the diagnosis of borderline personality disorder. In a prospective study of patients admitted to a hospital emergency room for a suicide attempt, Dr. Beck found that a diagnosis of personality disorder was



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement