The acquired capability for suicide: A comparison of suicide attempters, suicide ideators, and non-suicidal controls

Abstract

Background The Interpersonal Theory of Suicide states that to make a serious or lethal suicide attempt a person must experience reductions in fear and pain sensitivity sufficient to overcome self preservation reflexes (i.e., the acquired capability for suicide). The purpose of the current study was to examine the fearlessness component of the acquired capability for suicide using self-report assessment instruments and an objective measure of aversion (the affectively modulated startle reflex task). Methods Depressed suicide ideators (n = 15), depressed suicide attempters (n = 15), and a group of control participants (n = 14) were compared on their self-report of acquired capability and painful and provocative life events and completed the affectively modulated startle reflex task. This task compared electromyography recordings of participants’ eye-blink response to a startle probe while viewing pictures of varying hedonic valence (neutral, positive, negative, and suicide-related). Results Suicide attempters reported the highest levels of fearlessness and pain insensitivity and a greater history of painful and provocative life events. While no group differences were found on the psychophysiology data, participants reacted to suicide-related images with less aversion compared to neutral images with no differences between suicide-related and positive images. Conclusions Self-reported fearlessness and pain insensitivity can differentiate suicide attempters and suicide ideators. Results suggest that one’s self-perception (i.e., cognitions regarding fear and pain tolerance) are more functionally related to suicide attempts than psychophysiological reactivity to suicide-related stimuli.

Differentiating suicide attempters from suicide ideators using the Integrated Motivational–Volitional model of suicidal behaviour

“…We also provide further support for research (Orbach, Mikulincer, & King et al, 1997;Smith et al, 2010) indicating that suicide attempters have higher fearlessness about injury and death than do non-suicidal controls, and suicide ideators.…”

“…There is also emerging evidence that suicide capability is elevated among suicide attempters relative to suicide ideators (Smith, Cukrowicz, Poindexter, Hobson, & Cohen, 2010;Van Orden, Witte, Gordon, Bender, & Joiner, 2008), and that restricted physical access to lethal means may reduce the likelihood of suicide attempts (Baber & Miller, 2014).…”

Current suicidality and previous suicidal attempts in patients with schizophrenia are associated with different dimensions of temperament and character

“…Even though closely associated, different biological mechanisms may underlie these phenomena and may be linked to distinct patient populations and personality dimensions (Huang et al, 2000;Gil, 2005;Conrad et al, 2009;Smith et al, 2010). In comparison with previous research published by Gil (2005) Our results correspond to the data regarding lifetime prevalence of suicide attempts in chronic schizophrenic samples (Radomsky et al, 1999;Kasckow et al, 2011) …”

A structural test of the Integrated Motivational-Volitional model of suicidal behaviour

“…Taliaferro and Muehlenkamp (2014) found that hopelessness and depression were higher among adolescent ideators than non-suicidal adolescents, but comparable between ideators and attempters; conversely, a self-injury history (a volitional phase factor) was more likely among attempters than ideators. There is also evidence to suggest that suicide capability is elevated among suicide attempters relative to suicide ideators (Smith, Cukrowicz, 2010;Van Orden, 2008), and that restricted physical access to lethal means may reduce the likelihood of suicide attempts (Baber and Miller, 2014 Most students described their sexual orientation as heterosexual/straight (84.7%).…”