I'm Sick of Being Me: Developmental Themes in a Suicidal Adolescent

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INTRODUCTION

Although suicidal ideation and behavior is relatively rare for those under the age of 13, rates increase dramatically as children make the transition into adolescence. Recent statistics support the severity of this problem as approximately 16.9% of adolescents seriously consider attempting suicide, 16.5% develop a suicide plan, 8.5% attempt suicide, and 2.9% require emergency medical treatment following a serious suicide attempt (CDC, 2004). Despite commonalties in suicidal behavior across the lifespan, suicide rates, patterns, and the variables influencing suicidal behavior all vary according to developmental stage (Stillion & McDowell, 1991). Examining developmental tasks may be helpful in determining why the prevalence of suicidal ideation and behavior is so high during the teen years.

Adolescence is a period of important developmental change. In addition to the biological events of puberty, enormous social, emotional, and cognitive transitions take place. Although the importance of developmental factors in adolescent emotional distress has been generally recognized, research into the role of developmental processes and their influences on suicidality has been limited (Aro, Marttunen, & Lolnnqvist, 1993; Borst, Noam, & Bartok, 1991). Increasing our understanding of the developmental processes most prominent during adolescence may enhance our conceptualization of adolescent suicidality (Bar-Joseph & Tzuriel, 1997). An examination of age- or maturity-related developmental influences may also illuminate our understanding of underlying reasons for suicidal tendencies, teens' abilities to cope with suicidality, as well as risk and protective factors (Pfeffer, 1994).

The limited literature in this area suggests that three major developmental processes, cognitive development, identity formation, and autonomy-seeking, may have an important impact on adolescent suicidality. Using a case study approach, the purpose of this paper is to illustrate the role these factors played in one teenager's experience of becoming and overcoming being suicidal. Recently, researchers have argued for qualitative investigations to increase our understanding of suicidal processes (Cutcliffe, 2003). Due to the limited research in this area, understanding developmental factors through qualitative methods is well suited for building the foundation for future research. The case study methodology provides the opportunity to explore suicidal behavior and developmental issues from the perspective of the suicidal person. This method offers unique insight into an adolescent's thoughts, feelings, and perceptions.

Cognitive Development

Adolescence is characterized by rapid transitions in cognitive development. This shift brings with it the start of formal operational thinking, allowing for the emergence of logical, hypothetical, and abstract reasoning abilities (Piaget & Inhelder, 1969). However, the progression of cognitive development occurs in a maturational pattern unique to each individual and mature perspectives may vary depending upon situational and emotional contexts. Inconsistent cognitive development in some domains may complicate adolescents' adjustment to normal social and physical changes and abilities to cope with increasing stresses in various circumstances. Cognitive changes may also influence the psychological and emotional states of individuals in this age group and play a role in the development of suicidal thinking and behavior.

Hypothetical reasoning abilities provide adolescents with the capability of thinking beyond the present and envisioning idealized worlds, future possibilities, and situations different from actual reality. However, as immature cognitive abilities can limit teens' abilities to reasonably evaluate the world, many see their lives solely from their own perspective. Disillusionment, frustration, and unhappiness may result from this type of thinking as adolescents begin to see the discrepancy between "what is" and "what could be" (Stillion & McDowell, 1996).

The development of formal operational thought allows adolescents to take the perspective of others and anticipate the reactions of those around them. Teens' new capacity for perspective-taking is often characterized by the assumption that those around them are as preoccupied with their appearance and behaviors as they are, resulting in the formation of an imaginary audience (Elkind, 1981). While teens gain the ability to think about the thoughts of others, they lack the skill of determining congruence between their beliefs and the actual opinions of others. As adolescents increasingly focus on their bodily changes and appearance, they become more self-conscious and egocentric. Often, small embarrassments become huge traumas as they feel they are "on stage" to those around them.

Studies have found adolescent egocentrism to be more prevalent among females than males and to continue into late adolescence (Peterson & Roscoe, 1991; Rycek, Stuhr, McDermott, Benker, & Swartz, 1998). Recently, it has been suggested that self-consciousness during adolescence exists because of strong pressures to live up to social and behavioral standards that have real social and personal consequences (Bell & Brommick, 2003). It has been argued that young people's belief that they are being watched and judged is an accurate perception that emerges as a result of actually being under constant scrutiny (Vartanian, 2000). Real or imagined, adolescents' self-conscious focus can result in the development of negative feelings, criticisms, and low self-worth often associated with adolescent suicidality (Stillion & McDowell, 1996).

Elkind (1981) also suggested that adolescents develop a personal fable, exaggerating their importance in the world and viewing themselves and their feelings as unique and different. Adolescents often become disillusioned, alienated, and lonely, believing they will never be understood. The lack of life experience to see that others have survived similar problems with positive outcomes results in stressful situations being viewed as unique and inescapable. Additionally, teens are vulnerable to feelings of hopelessness because of the perception that all future situations will produce continual negative outcomes.

Adolescents tend to become introspective and spend time focusing on their thoughts and feelings. As their …