Suicidal behavior is a major problem worldwide and at the same time has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current paper presents the Interpersonal Theory of Suicidal Behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further, that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current paper, the theory’s hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory’s hypotheses.

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) makes two overarching predictions: 1) that perceptions of burdening others and of social alienation combine to instill the desire for death; and 2) that individuals will not act on the desire for death unless they have developed the capability to do so -a capability that develops through exposure and thus habituation to painful and/or fearsome experiences, and which is posited by the theory to be necessary to overcome powerful self-preservation pressures. Two studies test these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling like one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the three-way interaction between a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed.Address correspondence to: Thomas E. Joiner, Jr., Florida State University, Tallahassee, Florida 32306-1270, joiner@psy.fsu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2010 August 1. Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior: Empirical Tests in Two Samples of Young AdultsThe interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless s/he has both the desire to die by suicide as well as the ability to do so. What is the desire for suicide, and what are its component parts? What is the ability to die by suicide and in whom and how does it develop?In answer to the first question of who desires suicide, the theory asserts that when people hold two specific psychological states in their minds simultaneously, and when they do so for long enough, they develop the desire for death. The two psychological states are perceived burdensomeness and a sense of low belongingness or social alienation. In answer to the second question regarding capability for suicide, self-preservation is a powerful enough instinct that few can overcome it by force o...

The Interpersonal Theory of Suicide proposes that suicidal behavior is so frightening that in order for an individual to engage in suicidal behavior, desire for suicide must be accompanied by the capability to do so. The capability for suicide is characterized by both a sense of fearlessness about death and elevated physiological pain tolerance. The primary aim of the current project was to reevaluate and revise the Acquired Capability for Suicide Scale (ACSS) and offer a revision to the scale. Expert review of the scale items resulted in retaining seven items assessing fearlessness about death. The recommendation is made to refer to the revised scale as the ACSS-Fearlessness about Death (ACSS-FAD) to reflect its content more specifically. A model with the 7 retained items provided good fit to the data across three independent samples of young adults. Multiple group analyses examining measurement invariance across men and women found that the latent structure of the scale is comparable across gender. Data are also presented demonstrating convergent and discriminant validity for the scale in young adults and an inpatient psychiatric sample. Findings support the viability of the ACSS-FAD, indicating the scale has a replicable factor structure that generalizes across males and females and is substantively related to the construct of fearlessness about death. Taken together, the present work extends our knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general.

No abstract

Theories of borderline personality disorder (BPD) have often considered it a disorder involving both emotional and behavioral dysregulation (Linehan, 1993), yet the connection between these phenomena has been elusive. The following paper proposes the Emotional Cascade Model, a model that attempts to establish a clear relationship between emotional dysregulation and the wide array of dysregulated behaviors found in BPD. In this model, subsequent to an emotional stimulus, ruminative processes result in a positive feedback loop that increases emotional intensity, and this emotional intensity leads to ensuing behavioral dysregulation. These behaviors then provide negative feedback, in the form of distraction, which induces temporary reduction of negative emotion and thus relief. The model is presented in a framework in which BPD is considered an emergent phenomenon (Lewin, 1992), where the disorder arises from the total interactions of a network containing emotional cascades and other important factors. The model is then evaluated in light of various theories and therapeutic traditions, including both cognitive-behavioral and psychodynamic, indicating that it is a model that may transcend traditional theoretical and therapeutic doctrines. Keywordsborderline personality disorder; rumination; emotion dysregulation; non-suicidal self-injury; dialectical behavior therapy Linehan (1993) has proposed a comprehensive biopsychosocial theory of BPD in which she asserts that individuals who develop BPD are surrounded by an invalidating environment, one in which communication of emotional experience is met by erratic, inappropriate, and extreme responses by others. In combination with biological predispositions, individuals with BPD then develop an emotional vulnerability that results in: 1) heightened sensitivity to emotional stimuli, 2) experiencing emotions as extremely intense, and 3) a slow return to emotional baseline. Linehan also posits that this development of emotion dysregulation results in the development of subsequent behavioral dysregulation (defined here as behaviors that are difficult to control and result in impairment in the affected individual's functioning) because Cascades of Emotion: The Emergence of Borderline Personality Disorder from Emotional and Behavioral Dysregulation

The Emotional Cascade Model proposes that the emotional and behavioral dysregulation of individuals with borderline personality disorder (BPD) may be fundamentally linked through emotional cascades, vicious cycles of intense rumination and negative affect that may induce aversive emotional states. In order to reduce this aversive emotion, dysregulated behaviors such as nonsuicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in a sample enriched with subjects meeting diagnostic criteria for BPD. The first part of the study explored a structural equation model that examined the mediational effects of emotional cascades on the relationship between BPD symptoms and dysregulated behavior and found evidence for full mediation, even after controlling for symptoms of depression and other Cluster B disorders. The second part of the study examined the effects of a rumination induction conducted with the intention of eliciting emotional cascades in those diagnosed with BPD. The results demonstrated that individuals with BPD experienced greater reactivity and intensity of negative affect, but not of positive affect, following the procedure -even when controlling for current depressive symptoms. Future directions and clinical implications for the Emotional Cascade Model are discussed. Keywordsborderline personality disorder; emotion regulation; rumination; suicide attempts; binge-eating An Exploration of the Emotional Cascade Model in Borderline Personality DisorderBorderline personality disorder (BPD) is a disorder in which affected individuals experience difficulties with affective instability and regulation (Koenigsberg, et al., 2002;Yen, Zlotnick, & Costello, 2002) as well as dysregulated behaviors, such as non-suicidal self-injury (NSSI) and binge-eating (Brown, Comtois, & Linehan, 2002;Marino & Zanarini, 2001). Yet, the specific nature of this relationship between emotional and behavioral dysregulation has been somewhat elusive. A recent theoretical model, the Emotional Cascade Model (Selby & Joiner, in press;Selby, Anestis, & Joiner, 2008), suggests that the relationship between emotional and behavioral dysregulation in BPD may be explained by rumination. This is because intense Address correspondence to: Thomas E. Joiner, Jr., Florida State University, Tallahassee, Florida 32306-1270, joiner@psy.fsu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2...

Non-suicidal self-injury (NSSI) disorder has been suggested for inclusion into the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, in preparation), yet there is concern that NSSI is primarily a function of high borderline personality disorder (BPD) symptoms. The purpose of this study was to examine the characteristics of NSSI disorder and compare it to BPD and other DSM Axis I diagnoses commonly seen in clinical practice to aid in the determination of whether NSSI should be considered a separate, valid diagnostic entity. Chart data were analyzed from the screening, intake, and termination information of 571 treatment-seeking patients in a general practice clinic. Patients were classified into one of three groups: NSSI without BPD, BPD (with and without NSSI) or a comparison condition for those who did not meet criteria for the first 2 groups. Participants in these 3 groups were compared on functioning at intake, psychopathology, and diagnostic co-occurrence. Results indicated important group differences regarding diagnostic co-occurrence rates, patient history of associated features, and impairment at intake. The NSSI group displayed similar levels of functional impairment as the BPD group, including on indices of suicidality. The BPD group reported increased experiences with abuse and fewer men relative to the NSSI group. Most in the NSSI group did not exhibit subthreshold BPD symptoms or personality disorder not otherwise specified. In conclusion, a potential NSSI disorder may be characterized by high levels of depressive symptoms, anxiety, suicidality, and low functioning relative to other Axis I diagnoses.

No abstract