by Michael D. Anestis, M.S.
I have a small window here at the end of my work week to put together a quick post, so I wanted to spend a little time talking with PBB readers about a study I just published with Thomas Joiner (Anestis & Joiner, in press) in the Journal of Affective Disorders. The study took a new look at the interpersonal-psychological theory of suicidal behavior (IPTS), taking emotion dysregulation in general (and negative urgency in particular) into consideration.
Click on the IPTS link above for a more thorough description of the theory, but here is a quick summary of what the theory says:
- We must differentiate between the desire for death by suicide and the capability for death by suicide
- Few who desire have the capability and few with the capability have the desire.
- The desire is comprised of two variables: thwarted belongingness and perceived burdensomeness. The former refers to a distorted belief of an individual that he or she has no meaningful connections to others and the latter refers to a distorted belief of an individual that he or she makes no meaningful contributions to the world.
- The acquired capability for suicide is comprised of a diminished fear of death and a heightened tolerance for physical pain. This is developed through repeated exposure to painful and/or provocative events.
All of these points have been supported through extensive research and many of those studies have been written about previously on PBB (click here to access all PBB articles that discuss suicide). Despite all of this great research on the IPTS, there are a number of important areas for which we simply do not yet have data. Dr.Joiner and I addressed a couple of those in this study:
- What role might emotion dysregulation have in suicide risk?
- Does the IPTS work the same for everyone?
The way we approached this was by gathering data from 492 patients at an outpatient community mental health clinic on a number of variables relevant to this topic. For emotion dysregulation, we looked at negative urgency, which is defined as the tendency to act rashly in an effort to diminish negative emotions (click here for a more thorough description of this idea). We hypothesized that the three-way interaction of the IPTS components (perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide) would predict participants' lifetime number of suicide attempts, even when controlling for sex and depression severity. In other words, we believed that individuals with high levels of all three of those variables would have a greater number of lifetime suicide attempts and that effect would not be better accounted for by being male or female or being depressed. This, in fact, turned out to be the case.
Going a step further, we made our own heads spin and hypothesized that the four-way interaction of the IPTS components and negative urgency would also predict lifetime number of suicide attempts. In other words, we anticipated that individuals who not only had high levels of thwarted belongingness, perceived burdensomeness, and the acquired capability, but also high levels of negative urgency, would have the greatest number of lifetime suicide attempts. Again, the data supported our hypothesis. Four-way interactions are not something you typically see, as they are highly complicated and a bit confusing, but think of it this way: we understand from multiple studies now that when individuals have elevations on all three IPTS components, they're likely to be at greater risk for suicide and, as we showed here, are likely to have a more extensive history of suicidal behavior. The question though is, do elevations on those variables have the exact same level of impact for everyone or are there some people for whom this is a bigger deal? This is like stress and depression. Anyone who becomes stressed is more vulnerable to becoming depressed, but folks with a genetic vulnerability to mood disorders might be more likely to become depressed in response to stress than would somebody without that vulnerability. In this case, we're saying that anyone with elevations on the IPTS components is likely to have a more extensive history of suicide attempts, but folks with high levels of negative urgency are at particular risk in that scenario.
Why might this be? There are a bunch of potential answers here. The first might simply be that these folks are also more likely to have Cluster B personality disorders like borderline personality disorder. Another might be that a lifetime of struggling to manage negative emotions leaves these individuals more likely to consider harmful methods for regulating how they feel because, faced with this problem over and over throughout the years leaves them ready to accept highly imperfect options in frequent moments of desperation. As it turns out, I have some new data that leaves me thinking the answer is something else entirely; however, while the initial paper discussing those results is under review at a journal, I have to hold off on discussing them in order to avoid shooting my own legs out from under me.
All this being said, I will be discussing these results at the Association for Behavioral and Cognitive Therapies conference in San Francisco this November on a panel with PBB contributors Tracy Witte, Kim Van Orden, and Kelly Cukrowicz, so if you plan on attending the conference, I'll look forward to hearing your thoughts.
If you would like to learn more about this or other topics discussed on PBB, please consult our online store for scientifically-based psychological resources.