Treatment of Trauma-Related Suicidal Self-Directed Violence: Expanding Knowledge Base with a Focused Case Study

Post-traumatic stress disorder (PTSD) is a relatively common diagnosis in military service members, especially those who have deployed to a combat zone. Comorbidities in this population often include depression and/or substance use disorders, which, like PTSD, are associated with suicidal ideation and suicidal self-directed violence. The current case study describes the pathways between the reexperiencing symptoms of PTSD, suicide ideation, and subsequent suicidal self-directed violence in a combat veteran with a history of multiple severe traumas, alcohol dependence, opioid abuse, pornography addiction, panic attacks, depression, and serious non-suicidal self-directed violence (i.e., self-mutilation). Treatment consisted of seven 90-min inpatient individual sessions of cognitive behavioral therapy (CBT) for suicide prevention aimed at educating the patient about the pattern of his suicidal behavior, improving emotion regulation, modifying negative cognitions, and reducing the frequency of subsequent self-directed violence. This case demonstrates the implementation of a manualized treatment for suicide prevention, Post-Admission Cognitive Therapy, in a psychiatric inpatient setting and outlines direct and indirect links between PTSD symptomatology and suicidal thoughts and behaviors in a traumatized individual.