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I. Introduction: Understanding Psychological Disorders Psychopathology is the scientific study of the origins, symptoms, and development of psychological disorders. 1. Critical Thinking: Are People with a Mental Illness as Violent as the Media Portray Them? a. People with mental disorders are often depicted on TV as helpless victims or evil villains who are unpredictable, dangerous, and violent. b. One study indicated that, overall, former mental patients did not have a higher rate of violence than a matched comparison group. c. People with severe mental disorders who are experiencing bizarre delusional ideas and hallucinated voices do have a slightly higher level of violent and illegal behavior than do “normal” people. d. “. . . there is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental isorder.” A. What Is a Psychological Disorder? 1. A psychological disorder or mental disorder is a pattern of behavioral and psychological symptoms that causes significant personal stress, impairs the ability to function in one or more important areas of daily life, or both. 2. DSM-IV-TR is the abbreviation for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, which was published by the American Psychiatric Association in 2000. It describes the specific symptoms and diagnostic guidelines for 250 or so specific psychological disorders. The DSM-IV-TR provides mental health professionals with a. a common language for labeling mental disorders, and b. comprehensive guidelines for diagnosing mental disorders. 3. The DSM-IV-TR represents the consensus of a wide range of mental health professionals and organizations. B. The Prevalence of Psychological Disorders: A 50–50 Chance? 1. In 1994, two surprising findings were provided by the National Comorbidity Survey (NCS): a. The prevalence of psychological disorders was much higher than previously thought: 48 percent of adults surveyed had experienced the symptoms of a psychological disorder at some point in their lifetime. b. Eighty percent of those with the symptoms of a psychological disorder in the previous year had not sought any type of treatment. 2. There are two ways to view these findings: a. Many people who could benefit from mental health treatment do not seek it. b. Most people seem to weather the symptoms without becoming completely debilitated and without professional intervention. 3. The NCS also found that the prevalence of certain mental disorders differed for men and women. a. Women had a higher prevalence of anxiety and depression. b. Men had a higher prevalence of substance abuse disorders and antisocial personality disorder. II. Anxiety Disorders: Intense Apprehension and Worry Anxiety is an unpleasant emotional state characterized by physical arousal and feelings of tension, apprehension, and worry. 1. Anxiety puts us on physical alert, preparing us to defensively “fight” or “flee” potential dangers, and on mental alert, making us focus our attention squarely on the threatening situation. 2. In anxiety disorders, the anxiety is maladaptive, disrupting everyday activities, moods, and thought processes. 3. Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is a. irrational—it is provoked by perceived threats that are exaggerated or nonexistent, and the anxiety response is out of proportion to the actual importance of the situation. b. uncontrollable—the person can’t shut off the alarm reaction even when he or she knows it’s unrealistic. c. disruptive—it interferes with relationships, job or academic performance, or everyday activities. A. Generalized Anxiety Disorder: Worrying About Anything and Everything Generalized anxiety disorder (GAD) is characterized by excessive, global, and persistent symptoms of anxiety; it is sometimes referred to as free-floating anxiety. B. Panic Attacks and Panic Disorder: Sudden Episodes of Extreme Anxiety 1. A panic attack is a sudden episode of extreme anxiety that rapidly escalates in intensity. Panic disorder is an anxiety disorder in which the person experiences frequent and unexpected panic attacks. 2. Explaining panic disorder Both biological and psychological causes seem to be implicated. a. Panic disorder tends to run in families. b. People with panic disorder are unusually sensitive to the signs of physical arousal. c. According to the cognitive-behavioral theory of panic disorder, people with panic disorder tend to misinterpret the physical signs of arousal as catastrophic and dangerous. After their first panic attack, they become even more attuned to physical changes, increasing the likelihood of future panic attacks. 3. Other cultures have reported syndromes resembling panic disorder. One example is ataque de nervios, which also is characterized by hysteria. C. The Phobias: Fear and Loathing 1. A phobia is a strong or irrational fear of something, usually a specific object or situation, that does not necessarily interfere with the ability to function in daily life. 2. Specific phobia (formerly called simple phobia) is characterized by an extreme and irrational fear of a specific object or situation that interferes with the ability to function in daily life. Generally, the objects or situations that produce specific phobias tend to fall into four categories: a. Fear of particular situations—flying, driving, tunnels, bridges, elevators, crowds b. Fear of features of the natural environment—heights, water, thunderstorms c. Fear of injury or blood—injections, needles, medical or dental procedures d. Fear of animals and insects—snakes, spiders, dogs, cats, slugs, bats 3. Agoraphobia involves the extreme and irrational fear of experiencing a panic attack in a public situation and being unable to escape or get help. 4. Social phobia (or social anxiety disorder) involves the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations. In the Japanese culture, taijin kyofusho is similar except the person worries that he or she will somehow offend, insult, or embarrass other people. 5. Explaining phobias: Learning theories a. Classical conditioning may be involved in the development of a specific phobia that can be traced back to some sort of traumatic event. People with specific phobias may have developed a conditioned response of fear to a conditioned stimulus that has generalized to similar stimuli. b. Operant conditioning can be involved in the avoidance behavior that characterizes phobias. People with phobias may have been negatively reinforced by the relief from anxiety or fear associated with avoiding the object or situation. c. Observational learning can be involved in the development of phobias. People with phobias may have observed and modeled the fearful reactions of others. d. Humans seem biologically prepared to acquire fears of certain animals and situations that were survival threats in human evolutionary history. D. Posttraumatic Stress Disorder: Reexperiencing the Trauma 1. In posttraumatic stress disorder (PTSD), chronic and persistent symptoms of anxiety develop in response to an extreme physical or psychological trauma, such as military combat, natural disasters, physical or sexual assault, random shooting sprees, or terrorist attacks. In a given year, more than 5 million American adults experience PTSD. 2. Three core symptoms characterize PTSD. a. Frequent, intrusive recall of the event b. Avoidance of stimuli or situations that tend to trigger memories of the experience and a general numbing of emotional responsiveness c. Increased physical arousal associated with anxiety 3. Several factors influence the likelihood of a person’s developing PTSD, which even well-adjusted people and psychologically healthy people can do. a. A personal or family history of psychological disorders b. The magnitude of the trauma c. Experiencing multiple traumas E. Obsessive–Compulsive Disorder: Checking It Again . . . and Again 1. In obsessive–compulsive disorder (OCD), the symptoms of anxiety are triggered by intrusive, repetitive thoughts and urges to perform certain actions. a. Obsessions are repeated, intrusive, and uncontrollable irrational thoughts or mental images that cause extreme anxiety and distress. b. Compulsions are repetitive behaviors or mental acts that are performed to prevent or reduce anxiety. They may be (1) Overt physical behaviors, such as repeatedly washing your hands. (2) Covert mental behaviors, such as counting or reciting certain phrases to yourself. 2. Many people with obsessive–compulive disorder have the irrational belief that failure to perform the ritual action will lead to catastrophe or disaster. 3. People may experience obsessions or compulsions, but more commonly they experience both. 4. Obsessions and compulsions take a similar shape in different cultures around the world, but the content seems to mirror the specific culture’s concerns and beliefs. 5. Although researchers are far from a full understanding of the causes of obsessive–compulsive disorder, biological factors seem to be involved. a. A deficiency in the neurotransmitter serotonin. b. Dysfunction in specific brain areas, such as the frontal lobes and the caudate nucleus, which is involved in regulating movements. III. Mood Disorders: Emotions Gone Awry Mood disorders (also called affective disorders) are a category of mental disorders in which significant and persistent disruptions in mood or emotions cause impaired cognitive, behavioral, and physical functioning. A. Major Depression: “Like Some Poisonous Fogbank” 1. Major depression is characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness, causing impaired emotional, cognitive, behavioral, and physical functioning. a. Depression is often accompanied by the physical symptoms of anxiety. b. Suicide is always a potential risk. c. Abnormal sleep patterns are another hallmark of major depression. 2. To be diagnosed with major depression, a person must display most of the symptoms described in Figure 14.3 for two weeks or longer. 3. Dysthymic disorder a. Dysthymic disorder involves chronic, low-grade feelings of depression that produce subjective discomfort but do not seriously impair the ability to function. b. Some people with dysthymic disorder experience double depression, characterized by one or more episodes of major depression on top of their ongoing dysthymia. 4. The prevalence and course of major depression a. Often called “the common cold” of psychological disorders, major depression is the most common of all the psychological disorders. It affects some 13 to 14 million Americans annually. b. Women’s lifetime risk of major depression is one in four; men’s lifetime risk is one in eight. This is because women experience a greater degree of chronic stress, have a lesser sense of personal control, and are more prone to dwell on their problems. c. Left untreated, depression may recur and become progressively more severe. 5. In seasonal affective disorder (SAD), episodes of depression typically occur during the autumn and winter and subside during the spring and summer. B. Bipolar Disorder: An Emotional Roller Coaster 1. Bipolar disorder involves periods of incapacitating depression alternating with periods of extreme euphoria and excitement; formerly called manic depression. 2. A manic episode is a sudden, rapidly escalating emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech. a. For most people with bipolar disorder, a manic episode immediately precedes or follows a bout with major depression. b. During a manic episode, people sleep very little and display boundless energy; wildly inflated self-esteem; grandiose ideas, all of which may represent delusional, or false, beliefs; and flight of ideas. c. Because the ability to function during a manic episode is severely impaired, hospitalization is usually required. 3. Some people experience cyclothymic disorder, which is characterized by moderate but frequent mood swings for two years or longer that are not severe enough to qualify as bipolar disorder. 4. The prevalence and course of bipolar disorder a. Onset typically occurs in the person’s early twenties, affecting about 2 million Americans annually. b. For both men and women, the lifetime risk is about 1 percent. c. In the vast majority of cases, bipolar disorder is a recurring mental disorder; a small percentage of people with the disorder display rapid cycling, experiencing four or more manic or depressive episodes every year. C. Explaining Mood Disorders Multiple factors appear to be involved in the development of mood disorders. 1. Family, twin, and adoption studies suggest that some people inherit a genetic predisposition to mood disorders. 2. Disruption of the neurotransmitters norepinephrine and serotonin have been implicated in the development of major depression. Antidepressants lift the symptoms of depression by increasing the availability of these neurotransmitters. 3. Abnormal levels of glutamate may be involved in bipolar disorder. Lithium effectively eliminates symptoms of both mania and depression. 4. Major depression is often triggered by traumatic and stressful events. Chronic stress can also produce major depression. There is some evidence that stressful life events also play a role in the course of bipolar disorder. 5. Critical Thinking: Does Smoking Cause Depression and Other Psychological Disorders? a. People with mental illnesses are nearly twice as likely to smoke cigarettes as people with no mental illness. b. One possible explanation is that people with a mental illness smoke as a form of self-medication: Nicotine affects multiple brain structures and neurotransmitters, the same ones that are directly involved in many different mental disorders. c. Another explanation suggests that smoking triggers the onset of symptoms in people who are probably already vulnerable to the development of a mental disorder, especially major depression. IV. Eating Disorders: Anorexia and Bulimia Eating disorders involve serious and maladaptive disturbances in eating behavior. 1. The two types of eating disorders, anorexia nervosa and bulimia nervosa, usually begin in adolescence. 2. Ninety to 95 percent of people with eating disorders are female. A. Anorexia Nervosa: Life-Threatening Weight Loss 1. The four key features of anorexia nervousa are a. a 15 percent below normal body weight can drop to 12 or lower, b. extreme fear of gaining weight or becoming fat, despite being dangerously overweight, c. a distorted perception about one’s body size, and d. denial of how serious one’s weight loss is. 2. Anorexia disrupts body chemistry in ways similar to those caused by starvation. 3. People with anorexia are commonly perfectionistic, exhibit rigid thinking, have poor peer relationships, and experience social isolation as well as low self-esteem. B. Bulimia Nervosa: Bingeing and Purging 1. Like people with anorexia, those with bulimia nervosa fear gaining weight and are intensely preoccupied and unhappy with their bodies. 2. Unlike people with anorexia, those with bulimia are within a normal weight range or may even be slightly overweight; they also typically know they have an eating disorder. 3. People with bulimia experience extreme episodes of binge eating, which a. typically occur twice a week. b. are typically secret. c. are compensated for—to prevent weight gain—by purging, fasting, r excessive exercise that also serve to relieve guilt, shame, and self-disgust. C. Causes of Eating Disorders 1. Multiple factors are implicated in eating disorders, such as a. genetic factors. b. decreased activity of the neruotransmitter serotonin. c. disruption of chemical signals that normally regulate eating behavior. d. contemporary attitudes exalting thinness and dieting. V. Personality Disorders: Maladaptive Traits A. Personality disorders are characterized by inflexible, maladaptive patterns of thoughts, emotions, behavior, and interpersonal functioning that are stable over time and across situations and deviate from the expectations of the individual’s culture. Ten distinct personality disorders are categorized into three basic clusters: 1. the odd, eccentric cluster 2. the dramatic, emotional, erratic cluster 3. the anxious, fearful cluster B. Paranoid Personality Disorder: Pervasive Distrust and Suspiciousness Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of the motives of others without sufficient basis. 1. About 3 percent of the general population displays this disorder, which occurs more frequently in men. 2. Other characteristics include a belief that others are out to exploit, harm, or dupe them; inappropriate outbursts of anger; a strong tendency to blame others for their own shortcomings; and pathological jealousy in intimate relationships. 3. There is not much research on what causes this disorder; however, it tends to co-occur with schizotypal and avoidant personality disorders. C. Antisocial Personality Disorder: Violating the Rights of Others Antisocial personality disorder is characterized by a pervasive pattern of disregarding and violating the rights of others; such individuals are often referred to as psychopaths or sociopaths. 1. Evidence of this personality pattern is often seen in childhood or early adolescence when a child has repeated runins with the law or school authorities. Such behavior is typically diagnosed as conduct disorder. 2. Deceiving and manipulating others for one’s own personal gain is another hallmark of antisocial personality disorder. 3. People with antisocial personality disorder are contemptuous about the feelings or rights of others, blaming the victim for his or her own stupidity. 4. By middle to late adulthood, the antisocial tendencies tend to diminish. D. Borderline Personality Disorder: Chaos and Emptiness Borderline personality disorder is characterized by instability of interpersonal relationships, self-image, and emotions and marked impulsivity. 1. It is the most commonly diagnosed personality disorder. 2. Other characteristics include a pervasive feeling of emptiness, a desperate fear of abandonment, and selfdestructiveness. 3. Many borderline patients (in the United States, 75 percent are women) have experienced physical, sexual, or emotional abuse in childhood or a disruption in attachment relationships in early childhood. VI. The Dissociative Disorders: Fragmentation of the Self Dissociative disorders are a category of psychological disorders in which extreme and frequent disruptions of awareness, memory, and personal identity impair the ability to function. 1. A dissociative experience is a break or disruption in consciousness during which awareness, memory, and personal identity become separated or divided. 2. Mild dissociative experiences are quite common and completely normal. A. Dissociative Amnesia and Fugue: Forgetting and Wandering 1. Dissociative amnesia involves the partial or total inability to recall important personal information. 2. Dissociative fugue involves sudden and unexpected travel away from home, extensive amnesia, and identity confusion. 3. Both dissociative amnesia and dissociative fugue are associated with traumatic events or stressful periods. B. Dissociative Identity Disorder: Multiple Personalities 1. Dissociative identity disorder (DID), formerly known as multiple personality disorder, involves extensive memory disruptions along with the presence of two or more distinct identities, or “personalities.” a. Alternate personalities, often called alters or alter egos, may be of widely varying ages and different genders. b. Alters seem to embody different aspects of the individual’s personality that cannot be integrated into the primary personality. At different times, different alters take over. c. Symptoms of amnesia and memory problems are reported in virtually all cases of DID. Commonly, the person is unable to recall her behavior during specific time periods. d. People with DID typically have numerous other psychiatric and physical problems along with a chaotic personal history. e. Not all mental health professionals are convinced that DID is a genuine psychological disorder. 2. Explaining dissociative identity disorder a. According to one explanation, DID represents an extreme form of dissociative coping brought on by suffering trauma in childhood—often extreme physical or sexual abuse. b. Although widely accepted among therapists, the dissociative coping theory is difficult to test empirically—largely due to problems with the reliability of childhood memories. VII. Schizophrenia: A Different Reality Schizophrenia is a psychological disorder in which the ability to function is impaired by severely distorted beliefs, perceptions, and thought processes. A. Symptoms of Schizophrenia 1. Categories of symptoms a. Positive symptoms reflect excesses or distortions of normal functioning and include delusions, hallucinations, and severely disorganized thought processes, speech, and behavior. b. Negative symptoms reflect defects or deficits in normal functioning, including flat affect, alogia, and avolition. 2. Focus on Neuroscience: The Hallucinating Brain PET scans that recorded the brain activity of a person with schizophrenia as he hallucinated revealed acitivity in the left auditory and visual areas of his brain, but not in the frontal lobe, the area involved in organized thought processes. 3. Positive symptoms a. A delusion is a falsely held belief that persists in spite of compelling contradictory evidence. (1) Delusions of reference—the person believes that other people are constantly talking about her or that everything that happens is somehow related to her. (2) Delusions of grandeur—the person believes she is extremely important, powerful, or wealthy. (3) Delusions of persecution—the person believes that others are plotting against or trying to harm her or someone close to her. b. Hallucinations are false or distorted perceptions that seem vividly real to the person experiencing them. c. Other positive symptoms of schizophrenia include disturbances in sensation, thinking, and speech. d. Culture and Human Behavior: Travel Advisory: The JerusalemSyndrom This syndrome is described as a psychotic break that involves religious delusions and hallucinations. Usually, people suffering from this syndrome have a history of serious mental disorders, such as previous episodes of schizophrenia or bipolar disorder. 4. Negative symptoms a. Flat affect, or affective flattening—the person shows a dramatic reduction in emotional responsiveness and facial expressions. b. Alogia—greatly reduced production of speech. c. Avolition—the inability to initiate or persist in even simple forms of goal-directed behaviors. B. Types of Schizophrenia DSM-IV-TR includes three basic subtypes of schizophrenia: paranoid, catatonic, and disorganized. 1. The paranoid type is characterized by the presence of delusions, hallucinations, or both, but virtually no cognitive impairment, disorganized behavior, or negative symptoms. 2. The catatonic type is marked by highly disturbed movements or actions, including bizarre postures or grimaces, extremely agitated behavior, complete immobility, and waxy flexibility. 3. The disorganized type (formerly called hebephrenic schizophrenia) is characterized by extremely disorganized behavior, disorganized speech, and flat affect. 4. The label undifferentiated type is used when an individual displays some combination of positive and negative symptoms that does not clearly fit the criteria for the paranoid, catatonic, or disorganizedtypes. C. The Prevalence and Course of Schizophrenia 1. The onset of schizophrenia typically occurs during young adulthood. 2. Worldwide, about 1 percent of the population will experience at least one episode of schizophrenia at some point in life. 3. The course of schizophrenia is marked by enormous individual variability. a. About one-quarter of those who experience an episode of schizophrenia recover completely; another one-quarter experience recurrent episodes, but often with only minimal impairment of functioning. b. However, in the other one-half, schizophrenia becomes a chronic mental illness, and the ability to function normally may be severely impaired. D. Explaining Schizophrenia The causes of schizophrenia seem to be extremely complex. 1. Evidence from family, twin, and adoption studies has firmly established the role of genetic factors in many cases of schizophrenia. a. Family studies: Schizophrenia tends to cluster in certain families. b. Family and twin studies: The more closely related a person is to someone who has schizophrenia, the greater the risk that she will be diagnosed with schizophrenia at some point in her lifetime. c. Adoption studies: If either biological parent of an adopted individual has schizophrenia, the adopted individual is at greater risk to develop schizophrenia. d. Identical twin studies: There is an almost 50 percent risk rate for a person whose identical twin has schizophrenia. Obviously, nongenetic factors must play a role in explaining this finding. 2. Paternal age: Older fathers and the risk of schizophrenia a. Because schizophrenia often occurs in individuals with no family history of mental disorders, no genetic model explains all the patterns of schizophrenia. b. One explanation is that new cases of schizophrenia arise from genetic mutations carried in the sperm of the biological fathers, especially older fathers. c. Researchers in Jerusalem reviewed data on 87,000 people and found that paternal age was a strong and significant predictor of the schizophrenia diagnosis. (Mother’s age appeared to play no role.) d. Paternal age failed to account for three-quarters of the cases of schizophrenia. 3. Environmental factors: The viral infection theory a. According to this theory, exposure to a viral infection during prenatal development or early infancy affects the developing brain, making the individual more vulnerable to schizophrenia later in life. b. There is growing evidence to support this theory: People whose mothers were exposed to a flu virus during the first trimester of pregnancy and people born in the winter and spring months show an increased rate of schizophrenia. 4. Abnormal brain structure: Loss of gray matter a. About half of the people with schizophrenia will show some type of brain structure abnormality. b. The most consistent finding has been the enlargement of the fluid-filled cavities, called ventricles, located deep within the brain. c. Focus on Neuroscience: Schizophrenia: A Wildfire in the Brain Neuroscientists have mapped brain structure changes in normal adolescents and adolescents with early-onset schizophrenia. (1) Over the five-year study, gray matter loss ranged from about 1 percent in the normal teens to more than 5 percent in the schizophrenic teens. (2) Psychotic symptoms increased most in those who lost the greatest quantity of gray matter. (3) The pattern of loss mirrored the progression of neurological and cognitive deficits: loss in the temporal lobes was associated with more severe positive symptoms, and loss in the frontal lobes with more severe negative symptoms. d. The kinds of brain abnormalities seen in schizophrenia are also seen in other mental disorders. Also, researchers don’t know if brain abnormalities are the cause or consequence of schizophrenia. 5. Abnormal brain chemistry: The dopamine hypothesis a. According to the dopamine hypothesis, schizophrenia is related to, and may be caused by, excessive activity of the neurotransmitter dopamine in the brain. b. Two pieces of indirect evidence support this hypothesis. (1) Antipsychotic drugs that reduce or block dopamine activity in the brain reduce schizophrenic symptoms in many people. (2) Drugs such as amphetamines or cocaine that enhance dopamine activity in the brain can produce schizophrenialike symptoms. c. Although it seems likely that dopamine is somehow involved in schizophrenia, its exact role is unclear. 6. Psychological factors: Unhealthy families Individuals who are genetically predisposed to develop schizophrenia may be more vulnerable to the effects of disturbed family environments. a. The Finnish Adoptive Family Study of Schizophrenia found that children whose biological mother had schizophrenia had a much higher rate of schizophrenia than did the control group when they were raised in a psychologically disturbed adoptive family. When raised in a psychologically healthy adoptive family, they were no more likely than the control group to develop schizophrenia. b. One-third of the adopted children with no genetic history of schizophrenia developed symptoms of a serious psychological disorder if they were raised in a psychologically disturbed family environment. c. The conclusion from this study is that a healthy psychological environment may counteract a person’s inherited vulnerability for schizophrenia, but a psychologically unhealthy family environment can act as a catalyst for the onset of schizophrenia. VIII. Application: Understanding and Helping to Prevent Suicide A. Who commits suicide? 1. Each year, 500,000 people require emergency room treatment as a result of attempted suicide. 2. In 2002, suicide was the 11th leading cause of death, while homicide ranked 14th. 3. Women outnumber men by three to one in the number of suicide attempts. Men outnumber women by better than four to one in suicide deaths. 4. Although the suicide rate in young people has increased by almost 300 percent over the last four decades, the highest suicide rate consistently occurs in those age 75 and above. B. What risk factors are associated with suicidal behavior? 1. Feelings of hopelessness and social isolation 2. Recent relationship problems or a lack of significant relationships 3. Poor coping and problem-solving skills 4. Poor impulse control and impaired judgment 5. Rigid thinking or irrational beliefs 6. A major psychological disorder, especially depression, bipolar disorder, or schizophrenia 7. Alcohol or other substance abuse 8. Childhood physical or sexual abuse 9. Prior self-destructive behavior 10. A family history of suicide 11. Presence of a firearm in the house C. Why do people attempt or commit suicide? 1. Some people choose suicide in order to escape the pain of a chronic illness or the slow, agonizing death of a terminal disease. 2. Others commit suicide because of feelings of hopelessness, depression, guilt, rejection, failure, humiliation, or shame. D. How can you help prevent suicide? Suggestions for helping a friend who is feeling hopeless and suicidal include 1. Actively listen as the person talks and vents her feelings. 2. Don’t deny or minimize the person’s suicidal intentions. 3. Identify other potential solutions. 4. Ask the person to delay his decision. 5. Encourage the person to seek professional help.