Depression Research Update Suicide

Perfectionist Self-Presentation and Suicide in a Young Woman with Major Depressive and Psychotic Features

What is Perfectionist Self Presentation Scale (PSPS)?

Perfectionist self-presentation scale (PSPS) is a 27-item multidimensional scale that is used to assess an individual’s need to appear perfect to others (PSPS; Hewitt et al., 2003). It has divided into 3 subscales. The first subscale is called the perfectionist self-promotion which directly assesses the need of an individual to appear perfect before others. Here, patients strive by whatever available means to look prefect. The second subscale is the non disclosure of imperfection where patients try not to disclose their imperfect nature to others. This is considered as the worst thing that can happen to them. Severe guilt, anxiety, emotional trauma can occur if they feel others can see their imperfection.

The third subscale is the non-display of imperfection. The need to avoid appearing imperfect to others is high. The third subscale is a reverse score i.e. the score in reality assess the perception one has for making mistakes before others. People with perfectionist self-presentation care a lot about making mistakes before others and they consciously try to prevent it from happening.

The PSPS scale has been extensively researched and studied hence its reliability and validity has been proven.

Summary of the Paper

A case study of a woman in her mid-twenties admitted for the first time on account of severe major depressive episode with frank psychotic symptoms and suicide tendency. Weeks before her admission, she developed severe depression and anxiety, delusional guilt, disturbed sleep and ability and an intense wish to end her life. She had a significant social and family history. About a year to her admission, she lost her romantic partner to terminal illness and she developed severe depression and psychosis afterwards. Family history revealed that one of her parent had died from suicide and two siblings attempting suicide. Also, several of her family members were diagnosed with bipolar disease or schizophrenia.

History of symptoms dates back to her teenage days was she had attention deficit hyperactive disorder. However, she had no history of substance abuse or suicidal ideation. On admission, her Global Assessment of Functioning score (GAF) was 30, but 5 weeks after admission, her GAF was 55 indicating improvement of symptoms.  Two weeks after discharge, she participated in a research study alongside other patients with schizophrenia and schizoaffective disorder. Using the Brief Psychiatric Rating Scale, her total score was 42 (mild symptoms), with the Scale for the Assessment of Negative Symptoms she had a score of 17 (moderate symptoms), on the Calgary Depression scale for Schizophrenia, she scored 15 indicating mild suicide risk and severe hopelessness. She also scored 16/28 and 14/28 in perfectionist self promotion and non-disclosure of imperfection respectively.

Further evaluation showed her to be highly concerned about her imperfect behavior being observable by others. Less than a month after discharge home, she died by committing suicide. The sudden was well researched and she devised means to ensure that she succeeds without leaving any clue to family members.

She had a consistent behavior of perfectionist self presentation which reflecting in answers given to specific questions. She didn’t want to seen as a bad person and she tactically left no clue in her answers with the aim of creating a perfect self image. Also, her fear of failure and belief of personal incompetence were consistent with perfectionist believes.

Suicide rates seems to be much higher in patients with perfectionist self presentation. The risk is even much higher with the presence of severe depression and hopelessness. However, other factors like longstanding worries and family history of suicides also played significant role in her medical condition. In this woman, it is difficult to determine the major determining factor for her suicide, the risk factors combine together greatly increased her chance of committing suicide.

Her perfectionist cognitive rigidity made it difficult for her to cope with the loss of a loved one, challenging her view of the world. She lacked cognitive flexibility hence inability to consider other coping measures once she conceived the idea of committing suicide. He choice of method for her suicide and careful planning further buttress her perfectionist self presentation. She may have been mindful of her family members failed attempts at committing suicide, not wanting a failed suicide attempt because she would then have to face with the shame of a botched suicide.

This woman is a classical case of how perfectionist self-presentation, chronic depression, high degree of hopelessness and psychosis influences one decision in committing suicide. It is recommended that more clinical studies and researches are conducted to ascertain the relationship between perfectionism, psychotic symptoms and depression as factors that determine suicide. With deeper understanding of how perfectionism may interact with other risk factors for suicide, further studies can then have background studies to explore whether addressing perfectionist tendencies and other risk factors can reduce the rate of suicides.

You have just read a summary of the research paper: Hassan, S., Flett, G. L., Ganguli, R., & Hewitt, P. L. (2014). Perfectionistic Self-Presentation and Suicide in a Young Woman with Major Depression and Psychotic Features. Case reports in psychiatry2014.

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