An fMRI study on mental pain and suicidal behavior

Abstract Background Suicide is a poorly understood phenomenon. A clinical model of suicide conceptualizes suicidal behavior as a solution to an unbearable state of mind, experienced as mental pain. Methods In order to investigate the neural correlates of suicidal behavior, we used fMRI during presentation of autobiographical scripts extracted from personal narratives reactivating patients' memories of a recent episode of attempted suicide. Brain activation was measured during three recalled conditions: mental pain, suicide action, and neutral activity. Results Recall of suicidal episodes, that is, mental pain plus suicide action, compared to neutral activity, was associated with deactivation in the prefrontal cortex (BA 6, 10, and 46). Recall of suicide action, however, compared to mental pain, was associated with increased activity in the medial prefrontal cortex, the anterior cingulate cortex, and the hippocampus. Limitations This is a pilot study with eight female subjects. Conclusions Clinical and fMRI data suggest that mental pain triggering suicidal behavior may have the quality of traumatic stress, associated with decreased prefrontal activity. Planning and acting out suicidal impulses in response to mental pain, however, is associated with increased activity in the frontal cortex, suggesting that goal-directed suicidal behavior is associated with a reduction of mental pain.