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Key Points: Question: Is the inability to explore multiple alternatives and take advantage of the best options associated with suicidal behavior? Findings: In 2 case-control studies of adults with borderline personality disorder and depression, inability to fully explore available options was associated with medically serious suicide attempts. In an ambulatory study, this pattern predicted suicidal ideation. Meaning: The findings suggest that the inability to explore a full range of solutions in a state of suicidal crisis may prevent one from discovering alternatives to attempting suicide; exploring novel ways to cope may help individuals build their safety plans. This case-control study explores the exploration-exploitation dilemma in suicidal behavior. Importance: Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives. Objective: To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning. Design, Setting, and Participants: Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation. Main Outcomes and Measures: Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation. Results: The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P <.001) and MDD (χ24 = 36.34; P <.001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P <.001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity. Conclusions and Relevance: The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By contrast, individuals in this study who engaged in low-lethality suicidal behavior displayed a low threshold for taking potentially disadvantageous actions. [ABSTRACT FROM AUTHOR]

Human cognitive capacities that enable flexible cooperation may have evolved in parallel with the expansion of frontoparietal cortical networks, particularly the default network. Conversely, human antisocial behavior and trait antagonism are broadly associated with reduced activity, impaired connectivity, and altered structure of the default network. Yet, behaviors like interpersonal manipulation and exploitation may require intact or even superior social cognition. Using a reinforcement learning model of decision-making on a modified trust game, we examined how individuals adjusted their cooperation rate based on a counterpart's cooperation and social reputation. We observed that learning signals in the default network updated the predicted utility of cooperation or defection and scaled with reciprocal cooperation. These signals were weaker in callous (vs. compassionate) individuals but stronger in those who were more exploitative (vs. honest and humble). Further, they accounted for associations between exploitativeness, callousness, and reciprocal cooperation. Separately, behavioral sensitivity to prior reputation was reduced in callous but not exploitative individuals and selectively scaled with responses of the medial temporal subsystem of the default network. Overall, callousness was characterized by blunted behavioral and default network sensitivity to cooperation incentives. Exploitativeness predicted heightened sensitivity to others' cooperation but not social reputation. We speculate that both compassion and exploitativeness may reflect cognitive adaptations to social living, enabled by expansion of the default network in anthropogenesis. [ABSTRACT FROM AUTHOR]

There is strong evidence for an enduring suicidal diathesis among individuals with a history of suicide attempts, particularly among people diagnosed with borderline personality disorder (BPD). However, the progression of suicidal crises among people predisposed to suicidal behavior remains poorly understood. Via multilevel structural equation modeling we tested the hypothesis that a history of attempted suicide predicts a stronger dynamic link between affect and impulsivity with suicidal ideation (i.e., suicidal urges) — both moment-to-moment and day-to-day. 153 patients diagnosed with BPD, 105 of whom had a history of medically serious suicide attempts completed a 21-day ecological momentary assessment protocol (17,926 total assessments). Individuals with higher average levels of negative affect reported more suicidal thoughts. Moments characterized by more negative affect, hostility, impulsivity, and less positive affect were also characterized by elevated suicidal ideation. For hostility and positive affect, these significant links generalized to the daily level. At the same time, for negative affect and hostility the within-person coupling was stronger among attempters in comparison to non-attempters, and these effects did not significantly differ across timescales. Follow-up studies replicating our findings of the dysregulation-suicidality nexus in clinically more diverse samples are needed. The diathesis for suicidal behavior manifests in tighter dynamic links between negative affect or hostility and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, differential coupling patterns may index potentially lethal processes that generalize beyond BPD reflecting distinct diathesis components. • Assessed the risk for suicidal behavior across timescales in daily life • Used a 21-day ambulatory assessment protocol • Used a case-control design including suicide attempters and non-attempters • Dynamic links between affect and suicidal ideation were tighter among attempters. • Models are useful for identifying who and when is at the highest risk for dying by suicide. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigates the neurobehavioral mechanisms associated with antidepressant placebo effects over time using a reinforcement learning framework. Key Points: Question: What makes antidepressant placebo effects persist over time? Findings: Results of this cross-sectional study of 60 patients with major depressive disorder suggest that, on a timescale of minutes, antidepressant placebo effects are maintained by positive feedback loops and reinforcement learning between expectancies and mood improvement. During learning, representations of placebos and their perceived effects are enhanced in primary and secondary sensory cortices; latent learned placebo expectancies are encoded in the salience network. Meaning: Results suggest that far from being inert, antidepressant placebos set off positive feedback loops between expectancies and learning, resulting in mood improvement. Importance: Despite high antidepressant placebo response rates, the mechanisms underlying the persistence of antidepressant placebo effects are still poorly understood. Objective: To investigate the neurobehavioral mechanisms underlying the evolution of antidepressant placebo effects using a reinforcement learning (RL) framework. Design, Setting, and Participants: In this acute within-patient cross-sectional study of antidepressant placebos, patients aged 18 to 55 years not receiving medication for major depressive disorder (MDD) were recruited at the University of Pittsburgh between February 21, 2017, to March 1, 2021. Interventions: The antidepressant placebo functional magnetic resonance imaging task manipulates placebo-associated expectancies using visually cued fast-acting antidepressant infusions and controls their reinforcement with sham visual neurofeedback while assessing expected and experienced mood improvement. Main Outcomes and Measures: The trial-by-trial evolution of expectancies and mood was examined using multilevel modeling and RL, relating model-predicted signals to spatiotemporal dynamics of blood oxygenation level–dependent (BOLD) response. Results: A bayesian RL model comparison in 60 individuals (mean [SE] age, 24.5 [0.8] years; 51 females [85%]) with MDD revealed that antidepressant placebo trial-wise expectancies were updated by composite learning signals multiplexing sensory evidence (neurofeedback) and trial-wise mood (bayesian omnibus risk <0.001; exceedance probability = 97%). Placebo expectancy, neurofeedback manipulations, and composite learning signals modulated the visual cortex and dorsal attention network (threshold-free cluster enhancement [TFCE] = 1 − P >.95). As participants anticipated antidepressant infusions, learned placebo expectancies modulated the salience network (SN, TFCE = 1 – P >.95), positively scaling with depression severity. Conclusions and Relevance: Results of this cross-sectional study suggest that on a timescale of minutes, antidepressant placebo effects were maintained by positive feedback loops between expectancies and mood improvement. During learning, representations of placebos and their perceived effects were enhanced in primary and secondary sensory cortices. Latent learned placebo expectancies were encoded in the SN. [ABSTRACT FROM AUTHOR]

Background: Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. Methods: A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. Results: Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. Conclusion: This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI. [ABSTRACT FROM AUTHOR]

Background: Individuals diagnosed with borderline personality disorder (BPD) often describe their lives as stressful and unpredictable. However, it is unclear whether the adversity faced by those with BPD is a product of stress reactivity or stress generation. Here, we examined the dynamic, prospective associations between BPD and stressful life events over 3 years. Given the heterogeneity present in BPD, we sought to understand which empirically derived dimensions of this heterogeneous disorder explain stress reactivity v. stress generation. Methods: Participants included 355 individuals diagnosed with BPD and followed longitudinally at three annual assessments. Auto-regressive cross-lagged panel models were used to examine prospective associations between stressful life events and three latent dimensions implicated in BPD: negative affect, disinhibition, and antagonism. Results: Antagonism and disinhibition, but not negative affect, prospectively predicted dependent stressful life events (events the individual may have some role in). Evidence for decompensation under stress was more tenuous, with independent stressful life events (those presumably outside the individual's control) predicting increases in negative affect. Conclusions: Our longitudinal study of a well-characterized clinical sample found more evidence for stress generation than for stress-induced decompensation in BPD. Stress generation in BPD is driven by externalizing dimensions: antagonism and disinhibition. These results highlight the utility of empirically derived dimensions for parsing heterogeneity present in BPD, leading to improvements in diagnostic evaluation, clinical prediction, and individualized approaches to treatment planning. [ABSTRACT FROM AUTHOR]

Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value‐based choices. Can individual‐level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case–control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision‐making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood‐congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case–control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real‐time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under:Economics > Individual Decision‐MakingPsychology > Emotion and MotivationPsychology > LearningNeuroscience > Behavior [ABSTRACT FROM AUTHOR]

Humans seek admiration to boost their social rank and engage in rivalry to protect it when fearing defeat. Traits such as narcissism and affective states such as depression are thought to influence perception of rank and motivation for dominance in opposite ways, but evidence of the underlying behavioral mechanisms is scant. We investigated the effects of dimensionally-assessed narcissism and depression on behavioral responses to social defeat in a rigged video game tournament designed to elicit rivalry (stealing points from opponents) and admiration-seeking (paying for rank). We tested an undergraduate sample (N = 70, mean age = 21.5 years) and a clinical sample of predominantly depressed elderly (N = 85, mean age = 62.6 years). Both rivalry and admiration-seeking increased with time on task and were particularly enhanced in individuals high in narcissism. Participants engaged in more rivalry when pitted against high-ranked opponents, but depression partially mitigated this tendency. Our findings provide behavioral evidence that narcissism manifests in increased rivalry and admiration-seeking during social contests. Depression does not suppress general competitiveness but selectively inhibits upward-focused rivalry. [ABSTRACT FROM AUTHOR]

Objectives: While suicidal behavior often manifests in adolescence and early adulthood, some people first attempt suicide in late life, often with remarkable lethal intent and determination. Given these individuals' more adaptive functioning earlier in life, they may possess traits that hinder adjustment to aging, such as high conscientiousness, rather than impulsive‐aggressive traits associated with suicidal behavior in younger adults. Methods: A cross‐sectional case‐control study was conducted in older adults aged ≥50 (mean: 65), divided into early‐ and late‐onset attempters (age at first attempt ≤ or >50, mean: 31 vs 61), suicide ideators as well as non‐suicidal depressed and healthy controls. Personality was assessed in terms of the five‐factor model (FFM, n = 200) and five DSM personality disorders analyzed on the trait level as continuous scores (PDs, n = 160). Given our starting hypothesis about late‐onset attempters, the FFM dimension conscientiousness was further tested on the subcomponent level. Results: All clinical groups displayed more maladaptive profiles than healthy subjects. Compared to depressed controls, higher neuroticism, and borderline traits characterized both suicide ideators and early‐onset attempters, while only early‐onset attempters further displayed lower extraversion and higher antisocial traits. Late‐onset attempters were similar to depressed controls on most measures, but scored higher than them on orderliness, a conscientiousness subcomponent. Conclusions: While neuroticism, introversion, and cluster B traits are prominent in early‐onset suicidal behavior, late‐onset cases generally lack these features. In contrast, higher levels of orderliness in late‐onset suicidal behavior are compatible with the age‐selective maladjustment hypothesis. Key points: Personality of elderly attempters differed between those with early‐ and late‐onset first attempts.Early‐onset attempters possessed personality traits generally found in younger suicidal populations (high neuroticism, low extraversion, antisocial, and borderline PD traits), supporting that constitutional suicide risk factors persist into late life in some individuals.Late‐onset suicide attempters had higher levels of orderliness than non‐suicidal depressed participants, suggesting that this generally adaptive trait may facilitate suicidal behavior in a subset of depressed elderly. [ABSTRACT FROM AUTHOR]

Theoretical accounts of narcissism emphasize the dynamic shifting of self-states in response to social feedback. Status threats are thought to set narcissism's dynamics in motion. Naturalistic ecological momentary assessment (EMA) studies have characterized dynamics of narcissistic grandiosity and vulnerability in relation to perceptions of the interpersonal environment. Experimental studies have emphasized the behavioral responses of narcissistic individuals to putative threats to status. Naturalistic and experimental studies suffer from opposing limitations, namely, a potential for confounding variables to impact results versus ambiguous generalizability to real-life and longer time scales, respectively. Integrating naturalistic and experimental studies has the potential to provide a comprehensive model of how dynamics within narcissism unfold in response to status threat. The present study examined shifts in grandiosity and vulnerability in both naturalistic EMA and experimentally controlled (rigged tournament game) social interactions (N = 437). Grandiosity decreased and vulnerability increased in response to both naturalistic and experimental status threats. Further, the same people who responded with decreased grandiosity in response to status threat in daily life responded with similar decreases in grandiosity to experimental defeat. Trait narcissistic agency amplified many of the observed links between narcissism and status threat experimentally and naturalistically. Given that warmth (in addition to dominance) emerged as an important predictor of shifts in narcissism, implications for status-threatening environments are discussed. The present study elucidates important differences with respect to expressions of grandiosity and vulnerability across naturalistic and experimental methods. [ABSTRACT FROM AUTHOR]

Objective: While loss of socioeconomic status (SES) has been linked to suicidal behavior, it is unclear whether this experience is merely a downstream effect of psychopathology ("downward drift"), a sign of hardship, or an independent psychological contributor to suicide risk. We examined the association between the subjective experience of status loss and suicidal behavior and ideation in old age, while accounting for potential confounders. We were also interested in whether status loss was associated with mere thoughts of suicide vs. suicidal behavior.Methods: Fifty older (55+) depressed suicide attempters, 29 depressed suicide ideators with no history of attempted suicide, 38 nonsuicidal depressed participants, and 45 nonpsychiatric controls underwent detailed clinical characterization and reported their current and highest lifetime SES.Results: Suicide attempters were more likely to report a decline in their SES compared to healthy controls and nonsuicidal depressed older adults, while not differing from suicide ideators. This difference was not explained by objective predictors of SES, including education, financial difficulties, and the presence of addiction. Interestingly, while the current SES of suicide attempters was much lower than that of comparison groups, their reported highest lifetime SES was just as high, despite the differences in education.Conclusion: In older adults, the experience of status loss is associated with contemplated and attempted suicide even after accounting for objective indicators of social status and psychopathology. It is possible that suicidal individuals retrospectively inflate their previous status, making their current standing appear even worse by comparison. [ABSTRACT FROM AUTHOR]

Background: Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior. methods: We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior via a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality", "suicide" and "elderly". Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/ DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained. Results: Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples. conclusion: Maladaptive personality manifests in milder, subthreshold and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders. [ABSTRACT FROM AUTHOR]