OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF PSYCHOPATHOLOGY Journal of Editor-in-chief: Alessandro Rossi Special Issue VOL. 25 - 2019 NUMBER Cited in: EMBASE - Excerpta Medica Database • Index Copernicus • PsycINFO • SCOPUS • Google Scholar, ESCI (WoS) Further exploration of suicidal behavior Guest Editor: M. Pompili, A. Rossi Periodico trimestrale POSTE ITALIANE SpA - Spedizione in Abbonamento Postale - D.L. 353/2003 conv.in L.27/02/2004 n°46 art.1, comma 1, DCB PISA - Aut. Trib. di Pisa n. 9 del 03/06/95 - September ISSN 2284-0249 (Print) di Pisa n. ISSN 2499-6904 (Online) Trib. Aut. DCB PISA - comma 1, L.27/02/2004 n°46 art.1, 353/2003 conv.in Abbonamento Postale - D.L. SpA - Spedizione in Periodico trimestrale POSTE ITALIANE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF PSYCHOPATHOLOGY Journal of Editor-in-chief: Alessandro Rossi International Editorial Board D. La Barbera (University of Palermo, Italy) D. Baldwin (University of Southampton, UK) M. Maj (University of Campania “Luigi Vanvitelli”, Naples, Italy) D. Bhugra (Emeritus Professor, King’s College, London, UK) P. Rocca (University of Turin, Italy) J.M. Cyranowski (University of Pittsburgh Medical Center, USA) R. Roncone (University of L’Aquila, Italy) V. De Luca (University of Toronto, Canada) A. Rossi (University of L’Aquila, Italy) B. Dell’Osso (“Luigi Sacco” Hospital, University of Milan, Italy) E. Sacchetti (University of Brescia, Italy) A. Fagiolini (University of Siena, Italy) P. Santonastaso (University of Padova, Italy) N. Fineberg (University of Hertfordshire, Hatfield, UK) S. Scarone (University of Milan, Italy) A. Fiorillo (University of Campania “Luigi Vanvitelli”, Naples, Italy) A. Siracusano (University of Rome Tor Vergata, Italy) B. Forresi (Sigmund Freud Privat Universität Wien GmbH, Milan, Italy) E. Smeraldi (Università Vita-Salute San Raffaele, Milan, Italy) T. Ketter (Professor Emeritus, Stanford University, Stanford, USA) A. Vita (ASST Spedali Civili, Brescia, Italy) G. Maina (University “San Luigi Gonzaga”, Turin, Italy) V. Manicavasagar (Black Dog Institute, Randwick, Australia) Italian Society of Psychopathology P. Monteleone (University of Salerno, Italy) Executive Council D. Mueller (University of Toronto, Canada) President: A. Rossi • Past President: A. Siracusano S. Pallanti (Stanford University Medical Center, USA) Secretary: E. Aguglia •Treasurer: S. Galderisi C. Pariante (King’s College, London, UK) Councillors: M. Biondi, B. Carpiniello, M. Di Giannantonio, C.A. Altamura, J. Parnas (University of Copenhagen, Denmark) E. Sacchetti, A. Fagiolini, M. Amore, P. Monteleone, P. Rocca S. Pini (University of Pisa, Italy) P. Rucci (“Alma Mater Studiorum” University of Bologna, Italy) Founders: Giovanni B. Cassano, Paolo Pancheri N. Sartorius (Emeritus Professor, University of Geneva, Switzerland) J. Treasure (King’s College, London, UK) Editorial Assistant: Roberto Brugnoli, Francesca Pacitti, Milena Mancini Managing Editor: Patrizia Alma Pacini Advisory Board E. Aguglia (University of Catania, Italy) Editorial and Scientific Secretariat: Valentina Barberi, Pacini Editore Srl, Via Gherardesca 1, 56121 C. Altamura (University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Pisa •Tel. 050 3130376 • Fax 050 3130300 • [email protected] Policlinico, Milan, Italy) © Copyright by Pacini Editore Srl M. Amore (University of Genoa, IRCCS Ospedale Policlinico San Martino, Publisher: Pacini Editore Srl, Via Gherardesca 1, 56121 Pisa • www.pacinimedicina.it Genoa, Italy) L. Bellodi (Ospedale San Raffaele, Milan, Italy) A. Bertolino (University of Bari “Aldo Moro”, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy) M. Biondi (Sapienza University of Rome, Italy) VOL. 25 - 2019 B. Carpiniello (University of Cagliari, Italy) F. Catapano (University of Campania “Luigi Vanvitelli”, Naples, Italy) NUMBER D. De Ronchi (University of Bologna, Italy) L. Dell’Osso (University of Pisa, Italy) Cited in: M. Di Giannantonio (University of Chieti, Italy) EMBASE - Excerpta Medica Database • Index Copernicus A. Favaro (University of Padova, Italy) S. Galderisi, University of Campania “Luigi Vanvitelli”, Naples, Italy) PsycINFO • SCOPUS • Google Scholar • Emerging Sources Citation Index P. Girardi (Sapienza, University of Rome, Italy) (ESCI), a new edition of Web of Science Contents Editorial Further exploration of suicidal behavior: from mental to psychopathological perspectives M. Pompili, A. Rossi .........................................................................................................................................125 Perspective article A plea for the understanding of the suicidal mind M. Pompili .........................................................................................................................................................126 Original articles Personality, mental functioning, and symptoms: assessing suicidal risk with the Psychodynamic Diagnostic Manual, 2nd ed. (PDM-2) V. Lingiardi, G. Di Cicilia, T. Boldrini .................................................................................................................132 Suicide in obsessive-compulsive related disorders: prevalence rates and psychopathological risk factors U. Albert, L. Pellegrini, G. Maina, A.-R. Atti, D. De Ronchi, Z. Rhimer ............................................................139 Risk factors for suicide in bipolar disorder G. Maina, F. Quarato, S. Bramante ..................................................................................................................149 Epilepsy and suicide: a narrative review R. Ciuffini, A. Marrelli, E. Perilli, P. Stratta .........................................................................................................155 Dissociation in stress-related disorders and self-harm: a review of the literature and a systematic review of mediation models R. Rossi, L. Longo, D. Fiore, A. Carcione, C. Niolu, A. Siracusano, G. Di Lorenzo ...........................................................................................................................162 Case report A complex phenotype of suicidal behavior: a case of post brain injury dissociative disorder L. Longo, R. Rossi, C. Niolu, A. Siracusano, G. Di Lorenzo ............................................................................. 172 VOLUME 25 - SEPTEMBER 2019 3 JOURNAL OF PSYCHOPATHOLOGY Editorial 2019;25:125 M. Pompili1, A. Rossi2 Further exploration of suicidal behavior: 1 Department of Neurosciences, Mental Health from mental to psychopathological perspectives and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Italy; 2 Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, Italy Suicide is a major public health problem on a global scale, with large regional variations. According to the World Health Organization, about 880,000 sui- cides are reported each year 1. This estimate represents the tip of an iceberg that hides self-injurious behavior, hospitalization for self-inflicted injuries, sui- cide ideation and attempts. In fact, it is estimated that suicide attempts rep- resent 30 times the estimate of suicide deaths 2. Although, mental disorders are important contributing factors to suicide risk, new trends in neuroscience, psychiatry, and suicidology suggest that neurodevelopmental factors are of crucial importance. Of course, among mental disorders, mood disorders, sub- stance use disorders, and psychoses as well as some personality disorders heighten the risk for suicide. Knowledge of these aspects is important in order to address and prevent sui- cide through comprehensive assessment and management strategies. In this issue, Pompili suggests that a phenomenological approach is of crucial importance for a proper understanding of the human experience of mental pain. Although an empathic understanding of the pain of the suicidal individ- ual is not sufficient, it is the first step of a process that may eventually prevent suicide in unique individuals. Following the multiaxial organization of current diagnostic systems, the fea- tures and main innovations that can guide clinicians in their assessment and clinical management of suicide risk are examined by Lingiardi et al. Recent systematic reviews and meta-analyses confirmed that Obsessive- Compulsive Disorder (OCD), historically considered to be associated with a relatively low risk of suicide, is actually in itself associated with considerable risk for lifetime suicide attempts and suicidal ideation (Albert et al.). Maina et al. reported on the high rate of suicide attempts and deaths in bipolar disorder patients and the social impact of this behaviour, suggesting the need for the early recognition and treatment of such patients. Among medical disor- ders, Ciuffini et al. reported that epilepsy represents a challenge for life expec- tancy and quality of life either for social and relational consequences due to stigma than for the consequences of the disorder itself. Suicidal behaviors are more frequent among individuals with epilepsy than in the general population. Rossi et al. systematically reviewed evidence on the mediating role of dis- sociation between trauma and non-suicidal self-injury that has not been ad- dressed in the literature and needs further exploration/examination/investiga- tion (one of these words would be better) © Copyright by Pacini Editore Srl This special issue dedicated by the Journal of Psychopathology to ‘suicide’ OPEN ACCESS addresses