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Objective Although individuals with eating disorders (EDs) often experience significant body dissatisfaction and perceptual body image distortions, the presence and impact of weight misperception in clinical samples have been minimally examined. The aims of this study were to quantify weight misperception in individuals with EDs, examine whether weight misperception predicts ED severity at treatment discharge, and explore changes in weight misperception across treatment. Method Participants were 98 women seeking residential treatment for their ED who reported weekly on their perceived weight. Objectively measured weight was subtracted from perceived weight to determine weekly "weight misperception." Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at intake and discharge to assess ED severity. Weight misperception at intake and change in weight misperception over treatment were examined as predictors of ED pathology at discharge. Results Approximately 74.5% of the sample overestimated their weight, with an average weight misperception of 2.7 (SD = 5.6) pounds (1.2 kg; SD = 2.5). Weight misperception spanned from -6.2 to 43.6 pounds (-2.8 to 19.8 kg) and did not differ based on ED diagnosis. On average, weight misperception increased throughout treatment. Greater weight misperception at intake as well as greater increases in weight misperception over treatment significantly predicted EDE-Q scores at discharge. Discussion Findings highlight that weight misperception is not limited to underweight patients. Misperceiving one's weight may predict symptom severity across a range of EDs, and future research is needed to examine whether targeting weight misperception during residential treatment could improve treatment outcomes for individuals with EDs.

A central question in psychological science concerns whether psychological constructs are best conceptualized as dimensional or consist of one or more categories. The present study uses contemporary taxometric procedures to examine the latent structure of suicidal thoughts, with implications for how suicidal thoughts and behavior (STB) ought to be conceptualized, assessed, measured, and managed. Three nonredundant taxometric procedures (MAMBAC, MAXEIG, and L-Mode) were performed on various sets of indicators, and analyses were replicated across two large samples that included large numbers of individuals reporting current and recent STB. Results provide further evidence that the latent structure of suicidal thoughts is best understood as dimensional. However, inconsistent findings across studies and the relatively small number of taxometric studies conducted to date both suggest that it is premature to draw clear or definitive conclusions about the latent structure of STB being dimensional or categorical based on taxometric evidence. We report a meta-analysis of the current literature which evidences this ambiguity. We provide a detailed, critical discussion of the STB taxometric literature and outline key directions for future taxometric studies in this area, particularly how taxometric analysis relates to testing "ideation to action" theoretical models, which hypothesize that the development of suicidal ideation and the progression from suicide desire to attempting suicide are distinct processes with distinct explanations/mechanisms. It remains entirely possible that qualitatively distinct types of STB (e.g., representing ideation vs. action) or populations have different latent structures indicating different levels of risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE Our primary aim was to test the Interpersonal Theory of Suicide's synergy hypothesis (i.e., the interaction between perceived burdensomeness and thwarted belongingness) in the proximal prediction of suicide ideation, while accounting for quadratic effects. METHOD We used MTurk to recruit participants (N = 478) with a lifetime history of suicidal thoughts and behaviors; they completed two batteries of self-report questionnaires three days apart. RESULTS Contrary to the synergy hypothesis, only suicide ideation and the quadratic effect of perceived burdensomeness at Time 1 were significant predictors of suicide ideation at Time 2. The quadratic effect of perceived burdensomeness indicated a u-shaped function, whereby scores at or above the 80th percentile on perceived burdensomeness at Time 1 had increasingly strong, positive associations with suicide ideation at Time 2, while scores under the 80th percentile were not predictive of suicide ideation at Time 2. Also, thwarted belongingness and suicide ideation at Time 1 were significant predictors of perceived burdensomeness at Time 2. CONCLUSIONS These findings add to a growing literature that does not support the synergy hypothesis and suggests the importance of including nonlinear terms when examining the Interpersonal Theory of Suicide's constructs.

OBJECTIVE Previous research shows that interoceptive deficits are associated with harmful behaviors such as nonsuicidal self-injury (NSSI), eating disorder pathology, and suicide attempts. The present study replicates and extends this area of research by examining the association between interoceptive deficits and suicidality in a military sample. METHOD In Study 1, respondents to an online survey (N = 134) answered self-report questionnaires related to interoceptive deficits. Study 2 consisted of a secondary data analysis of 3,764 military service members who had previously completed questionnaires on interoceptive indicators, NSSI, suicide thoughts and attempts, and other psychopathology. RESULTS Study 1 demonstrated that our interoceptive deficits latent variable had adequate psychometric properties. In Study 2, multigroup confirmatory factor analysis showed that scores on the interoceptive deficits latent variable were highest among suicide attempters, lowest among those with no suicide history, and intermediary among participants who had thought about but not attempted suicide. The interoceptive deficits latent variable was more strongly related to NSSI and suicidality than were posttraumatic stress disorder symptoms, hopelessness, gender, and age. CONCLUSIONS These results confirm-and extend to a military sample-previous research showing that interoceptive deficits can provide important information about suicide risk.

Research has examined suicide-related behaviors following exposure to suicide news articles, yet only a handful of studies utilized experimental designs. We aimed to address the limitations of these prior experimental studies by utilizing more realistic suicide articles and more empirically sound measures. 420 participants were randomly assigned to read a series of either suicide-related or neutral news articles, then complete a battery of questionnaires and the Death/Suicide Implicit Association Task. Overall, no significant differences between groups were observed, nor did we observe any moderation effect of individual vulnerabilities (e.g., lifetime suicidal ideation/behavior). We did not observe any immediate effects of exposure to suicide news articles. Further research examining potential mechanisms for imitative effects remains critically needed.

Although individuals with posttraumatic stress disorder (PTSD) are at an increased risk for suicidal ideation (SI), it is unclear what factors might influence this association. Investigators have hypothesized that posttraumatic cognitions (PTCs), such as self-blame (SB) or negative cognitions about the self (NCAS) or world (NCAW), would play a role, but this has not been investigated empirically. Accordingly, we evaluated a model in which the association between PTSD symptoms and SI was moderated by PTCs in a sample of trauma-exposed undergraduate students (N = 410). To identify the specific source of this hypothesized moderation effect, we ran the moderation model separately for PTSD total severity, PTSD total severity without the cognition-related items, and each of four DSM PTSD symptom clusters in combination with each of three types of PTCs (i.e., NCAS, NCAW, SB), accounting for quadratic effects. The results revealed that NCAW moderated the positive association between all six of the PTSD variables and SI, f2 s < .01 to .04. Analyses of simple slopes generally revealed strong positive associations between PTSD symptoms with SI at high levels of NCAW, no associations at moderate levels, and negative associations at low levels. We also found one statistically significant quadratic effect when examining avoidance and NCAW. In contrast, neither NCAS nor SB emerged as a significant moderator in any of our regression models. These findings highlight the importance of addressing PTCs-particularly NCAW-in trauma survivors.

BackgroundAs self-injurious thoughts and behaviors (SITB) remain a pressing public health concern, research continues to focus on risk factors, such as posttraumatic stress disorder (PTSD). Network analysis provides a novel approach to examining the PTSD-SITB relationship. This study utilized the network approach to elucidate how individual PTSD symptoms may drive and maintain SITB.MethodsWe estimated cross-sectional networks in two samples of trauma-exposed adults (Sample 1: N = 349 adults; Sample 2: N = 1307 Veterans) to identify PTSD symptoms that may act as bridges to SITB. Additionally, we conducted a cross-lagged panel network in Sample 2 to further clarify the temporal relationship between PTSD symptoms and SITB during a 2-year follow-up. Finally, in both samples, we conducted logistic regressions to examine the utility of PTSD symptoms in prospectively predicting SITB, over a 15-day period (Sample 1) and over a 2-year period (Sample 2), allowing us to examine both short- and long-term prediction.ResultsTwo PTSD symptoms (i.e. negative beliefs and risky behaviors) emerged as highly influential on SITB in both cross-sectional networks. In the cross-lagged panel network, distorted blame emerged as highly influential on SITB over time. Finally, risky behaviors, unwanted memories, and psychological distress served as the strongest predictors of SITB across the two samples.ConclusionsOverall, our results suggest that treatments targeting negative beliefs and risky behaviors may prevent SITB in community and Veteran populations, whereas treatments targeting distorted blame and unwanted memories may help reduce SITB for individuals with a history of combat trauma.

BackgroundOver half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors.MethodsWomen (N= 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment.ResultsStatistically significant within-person effects for burdensomeness (β= 0.06;p< 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation.ConclusionsThis study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.

Posttraumatic growth, defined as positive transformation following trauma, is commonly measured using the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) and is postulated to comprise five distinct domains: Changes in Relationships, Life Possibilities, Personal Strength, Spirituality, and Appreciation of Life. However, research has indicated that the model fit is not good and the factors are highly intercorrelated. Further, no studies have formally examined the heterogeneity of correlations of the five factors with external constructs. In an effort to examine the construct validity of the five-factor model of the PTGI, the present study aimed to examine the degree to which the theorized five factors demonstrate meaningful differential associations with relevant external correlates. Participants were 400 undergraduate students who reported having experienced a stressful event and completed the Life Events Checklist for DSM-5, PTGI, Posttraumatic Stress Disorder Checklist for DSM-5, Grit Scale-12, Connor-Davidson Resilience Scale-10, and Work and Social Adjustment Scale. We found few instances of significant differentiation, and effect sizes for pairwise comparisons were generally small, Cohen's qs = 0.01-0.35. Although factor analytic evidence suggests there are five distinct underlying constructs, our results indicated that these factors do not significantly differ in their associations with external correlates. Implications for use of the PTGI and future research directions are discussed.

This study evaluated the synergy hypothesis of the Interpersonal-Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at-risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.

People with eating disorders (EDs) have an elevated risk for both nonsuicidal self-injury (NSSI) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI, and examining interoceptive deficits, NSSI, fearlessness about death, and pain tolerance as risk factors for suicide. Ninety-six adult, treatment-seeking women with EDs completed self-report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI, and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI, fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self-harm among individuals with EDs.

Insomnia is robustly associated with suicidal behavior, but methodological limitations in existing studies hinder nuanced understanding of this relationship. The current study addressed these limitations by utilizing a longitudinal design and advanced statistical modeling. Participants who endorsed lifetime experience of suicidal behavior were recruited through Amazon's Mechanical Turk (N = 589) and completed self-report online surveys at 6 time points over a 15-day period. Latent difference score modeling was utilized to investigate whether levels and/or changes in insomnia symptoms drive subsequent changes in suicide ideation, or vice versa. Results revealed that previous level of insomnia symptoms was predictive of positive changes in suicide ideation (i.e., level of insomnia symptoms predicted lagged increases in suicide ideation). This relationship was not bidirectional (i.e., suicide ideation exerted no effects on insomnia symptoms). Additionally, only previous level, and not previous changes, in insomnia symptoms were predictive of changes in suicide ideation. Our results help clarify the nature of the relationship between insomnia symptoms and suicide ideation as one that is unidirectional, thereby offering evidence of insomnia symptoms as a variable risk factor for suicide ideation. These findings yield clinical implications, including the importance of screening for insomnia symptoms, and provide support for exploring the potential effectiveness of insomnia treatments to target suicide ideation. Moreover, our study design and methodology establish a foundation for more rigorous and nuanced investigations of imminent suicide risk in future studies, which can ultimately promote better clinical practice in the reduction of suicidal behavior. (PsycINFO Database Record

We evaluated the effects of exposure to a suicide news article on a variety of outcome variables and whether adhering to one specific media guideline (i.e., including psychoeducational information and preventative resources) buffered any of the negative effects of exposure. Participants were randomly assigned to read one of three articles and then asked to complete a battery of self-report questionnaires. Overall, we found no effect of exposure to a suicide news article, regardless of the inclusion of resources and information, with a few minor exceptions. Although researchers have demonstrated the effectiveness of media guidelines in the aggregate at reducing imitative suicidal behavior, it remains unclear which guidelines in particular are responsible for this effect.

This study used the interpersonal-psychological theory of suicide to explore the relationships among DSM-5 posttraumatic stress disorder (PTSD) symptom clusters derived from the six-factor anhedonia model and facets of acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.

Objective The current study tested whether the Interpersonal–Psychological Theory of Suicide (IPTS) provides a useful framework for understanding elevated suicide rates among individuals with eating disorders (EDs). Method Based on predictions of the IPTS, we tested whether the combination of thwarted belongingness and perceived burdensomeness was associated with suicidal desire, and whether the combination of thwarted belongingness, perceived burdensomeness, and fearlessness about death was associated with past suicide attempts in an ED sample (n = 100). We also compared these IPTS constructs in an ED sample versus general psychiatric inpatients (n = 85) and college students (i.e., non-clinical comparison group; n = 93). Results Within the ED sample, no hypothesized interactions were found, but perceived burdensomeness was associated with suicidal desire, and perceived burdensomeness and fearlessness about death were associated with past suicide attempts. The ED and psychiatric samples had greater thwarted belongingness, perceived burdensomeness, and suicidal desire than the non-clinical comparison group. Discussion The IPTS constructs of perceived burdensomeness and fearlessness about death appear to explain some facets of suicidality among people with EDs, but overall, support for the IPTS was limited. Future research on EDs and suicidality should look beyond the IPTS and consider other biological and sociocultural factors for suicide. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1082–1086)

Prior research has established a link between vegetarianism and disordered eating but has typically sampled vegetarians. This study examined prevalence of and variables related to vegetarianism in three samples with varying severity of eating pathology.Sample 1 consisted of female undergraduates who denied history of or current disordered eating (i.e., nonclinical; n=73), or engaged in disordered eating over past month (i.e., subclinical; n=136). Sample 2 included 69 female patients receiving residential treatment at an eating disorder center (i.e., clinical sample). Differences between groups were analyzed using Fisher's exact test.The prevalence of lifetime vegetarianism was lowest in the nonclinical group (6.80%) and highest in the clinical group (34.80%), with the subclinical group falling in between (17.60%). According to Fisher's exact test, all pairwise comparisons between groups were statistically significant (p's.05). Regarding current vegetarian status, the clinical group was more likely (11.10%) than both other groups to self-identify as current vegetarians.Endorsement of vegetarianism was highest among females with severe eating pathology. Future research should use longitudinal data to examine the temporal relationship between these variables, or other underlying factors that may contribute to the co-occurrence of eating pathology and vegetarianism. Clinically, endorsement of vegetarianism may also be an important variable to consider in treatment disordered eating.

According to the Interpersonal-Psychological Theory of Suicide, fearlessness about death is proposed to increase monotonically (i.e., either increasing or remaining stable) and thus, not be amenable to intervention; however, this assumption has not been explicitly tested. We utilized latent class growth modeling to examine the trajectory of this construct over a brief interval (i.e., data collected every three days over a 15-day time period) among college students (N = 716), and found evidence that fearlessness does not monotonically increase. Specifically, our analyses revealed three classes, each with distinct trajectories over time: a High/Increasing class (i.e., high intercept, significantly increasing slope), Average/Stable class (i.e., average intercept, flat and non-significant slope), and Low/Decreasing class (i.e., low intercept, significantly decreasing slope). The emergence of a Low/Decreasing group is in contrast to the assertion that fearlessness cannot decrease over time. Exploratory results also indicated that lifetime exposure to certain events (e.g., abuse, injury) was associated with membership in the Low/Decreasing class, suggesting that some individuals may be responding differently to painful and/or fear-inducing stimuli than the IPTS predicts. Our findings contradict the current conceptualization of fearlessness about death, and suggest instead that this construct fluctuates upward and downward over a brief interval.

The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ2 (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ2 (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ2 (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.

Factor analytic research has demonstrated consistently that the 3-factor DSM-IV model of posttraumatic stress disorder (PTSD) symptom structure provides a poorer fit than alternative 4- and 5-factor models. In the current study we examined whether order of item presentation accounts for these findings. In a large sample (N = 1,311) of trauma-exposed undergraduates we conducted a series of confirmatory factor analyses using the PTSD Checklist and Posttraumatic Stress Diagnostic Scale, which present symptom items in the same order as DSM-IV, and the Detailed Assessment of Posttraumatic Stress, which presents items in a different order. Across all 3 measures the 3-factor DSM-IV model provided a relatively worse fit and the 5-factor dysphoric arousal model provided a relatively better fit compared with other tested models. We also examined the distinctiveness of 2 pairs of symptom clusters that appear in the dysphoric arousal model--avoidance versus numbing and dysphoric arousal versus anxious arousal--by comparing their patterns of associations with external correlates. Avoidance and numbing demonstrated differential associations with external correlates, as did dysphoric arousal and anxious arousal. Taken together, results indicate that order effects are unlikely to account for differences in relative fit between leading models of PTSD symptom structure. We discuss the need for future research in this area, especially studies designed to evaluate order effects more directly.

The Military Suicide Research Consortium (MSRC) developed a 57-item questionnaire assessing suicide risk factors, referred to as the Common Data Elements (CDEs), in order to facilitate data sharing and improve collaboration across independent studies. All studies funded by MSRC are required to include the CDEs in their assessment protocol. The CDEs include shortened measures of the following: current and past suicide risk, lethality and intent of past suicide attempts, hopelessness, thwarted belongingness, anxiety sensitivity, posttraumatic stress disorder symptoms, traumatic brain injury, insomnia, and alcohol abuse. This study aimed to evaluate the psychometric properties of the CDE items drawn from empirically validated measures. Exploratory factor analysis was used to examine the overall structure of the CDE items, and confirmatory factor analyses were used to evaluate the distinct properties of each scale. Internal consistencies of the CDE scales and correlations with full measures were also examined. Merged data from 3,140 participants (81.0% military service members, 75.6% male) across 19 MSRC-funded studies were used in analyses. Results indicated that all measures exhibited adequate internal consistency, and all CDE shortened measures were significantly correlated with the corresponding full measures with moderate to strong effect sizes. Factor analyses indicated that the shortened CDE measures performed well in comparison with the full measures. Overall, our findings suggest that the CDEs are not only brief but also provide psychometrically valid scores when assessing suicide risk and related factors that may be used in future research. (PsycINFO Database Record

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, ) contains a dissociative subtype for posttraumatic stress disorder (PTSD) characterized by significant depersonalization and derealization. In this study the PTSD dissociative subtype was examined using latent profile analysis in a sample of 541 trauma-exposed college students. Items from the PTSD Checklist and Multiscale Dissociation Inventory were used as latent class indicators. Results supported a 3-class solution including a well-adjusted class, a PTSD class, and a PTSD/dissociative class characterized by elevated symptoms of PTSD, depersonalization, and derealization. Significant class differences were found on a number of measures of related psychopathology with Cohen's d effect size estimates ranging from 0.04 to 1.86. Diagnostic and treatment implications regarding the dissociative subtype are discussed.

Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs proposed to explain this relationship were examined, applying the framework of the interpersonal-psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma-exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understanding observed relationships between suicidal behavior and PTSD symptoms.

The present study investigated the role specific types of alcohol-related problems and life satisfaction play in predicting motivation to change alcohol use. Participants were 548 college students mandated to complete a brief intervention following an alcohol-related policy violation. Using hierarchical multiple regression, we tested for the presence of interaction and quadratic effects on baseline data collected prior to the intervention. A significant interaction indicated that the relationship between a respondent's personal consequences and his/her motivation to change differs depending upon the level of concurrent social consequences. Additionally quadratic effects for abuse/dependence symptoms and life satisfaction were found. The quadratic probes suggest that abuse/dependence symptoms and poor life satisfaction are both positively associated with motivation to change for a majority of the sample; however, the nature of these relationships changes for participants with more extreme scores. Results support the utility of using a multidimensional measure of alcohol related problems and assessing non-linear relationships when assessing predictors of motivation to change. The results also suggest that the best strategies for increasing motivation may vary depending on the types of alcohol-related problems and level of life satisfaction the student is experiencing and highlight potential directions for future research.

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; Van Orden, Witte, Gordon, Bender, & Joiner, 2008) and offer a revision to the scale. Expert review of the scale items resulted in retaining 7 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 3 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 knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general.

Veterinarians have an increased risk for suicide compared with the general population, yet there is little consensus regarding why this might be. We hypothesized that veterinarians become relatively fearless about death due to their repeated exposure to euthanasia. Accordingly, we predicted that there would be a positive relationship between experience with euthanasia and fearlessness about death, due to emotional habituation to the process of euthanasia. In a sample of 130 veterinary students, results conformed to expectation and indicated that the relationship with fearlessness about death was specific to euthanasia and did not generalize to experience with surgery or necropsy.

In a sample of 200 individuals diagnosed with body dysmorphic disorder (BDD), we utilized the interpersonal–psychological theory for suicide as a framework to examine BDD behaviors that might be associated with suicide risk, insofar as they might increase the acquired capability for suicide. We predicted that physically painful BDD behaviors (e.g., cosmetic surgery, restrictive eating) would be associated with suicide attempts but not suicide-related ideation because these behaviors increase capability for, but not thoughts about, suicide. Our hypothesis was partially confirmed, as BDD-related restrictive food intake was associated with suicide attempts (but not suicide-related ideation) even after controlling for numerous covariates.

A nonlinear indirect effects framework was used to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the nonlinear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m2 and above 28.00 kg/m2 . Our results provide novel information relevant for suicide risk screening in the context of weight- and health-related interventions and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.

Prior research has reported that negative urgency was positively associated with both the acquired capability for suicide and lifetime number of suicide attempts. Given the range of outcomes associated with negative urgency, we hypothesized that that prior work linking negative urgency both suicidal behavior and the acquired capability for suicide might be better accounted for by dysregulated behaviours. Results supported our hypotheses, as the addition of dysregulated behaviours, many of which could be considered painful and/or provocative, reduced those relationships to non-significance. These findings indicate that specific behaviours rather than negative urgency itself increase risk for the acquired capability or suicidal behaviour. Copyright © 2011 John Wiley & Sons, Ltd.

The current study tested hypotheses derived from Joiner's (2005) interpersonal theory of suicide, which proposes that deliberate self-harm (DSH) becomes increasingly more reinforcing with repetition. One hundred six participants with a history of DSH completed questionnaires about their emotions and experience of physical pain during their most recent DSH episode. Consistent with prediction, people with more numerous past DSH episodes felt more soothed, more relieved, and calmer following their most recent episode of DSH. Contrary to prediction, greater numbers of past DSH episodes were associated with more intense physical pain during the most recent episode. The findings suggest that the emotion regulation functions of DSH may become more reinforcing with repetition.

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.

Background: Although there has been a tremendous amount of research examining the risk conferred for suicide by depression in general, relatively little research examines the risk conferred by specific forms of depressive illness (e.g., dysthymic disorder, single episode versus recurrent major depressive disorder [MDD]). The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness. Methods: To accomplish this aim, we conducted a cluster analysis using the aforementioned suicide-related variables in a sample of 494 outpatients seen between January 2001 and July 2007 at the Florida State University Psychology Clinic. Patients were diagnosed using DSM-IV criteria. Results: Two distinct clusters emerged that were indicative of lower and higher risk for suicide. After controlling for the number of comorbid Axis I and Axis II diagnoses, the only depressive illness that significantly predicted cluster membership was recurrent MDD, which tripled an individual's likelihood of being assigned to the higher risk cluster. Limitations: The use of a cross-sectional design; the relatively low suicide risk in our sample; the relatively small number of individuals with double depression. Conclusions: Our results demonstrate the importance of both chronicity and severity of depression in terms of predicting increased suicide risk. Among the various forms of depressive illness examined, only recurrent MDD appeared to confer greater risk for suicide.

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.

Background: Suicide is a leading cause of death among individuals with anorexia nervosa (AN). In this paper, we examined competing explanations of the high rate of death by suicide among individuals with anorexia nervosa (AN). Methods: Nine case reports of individuals with AN who died by suicide were evaluated to determine whether death by suicide occurred a) because physical health was so compromised that what would be a non-lethal suicide attempt in a healthy adult became a fatal suicide attempt, or b) because highly lethal suicide attempts that would have killed any adult, healthy or medically compromised, were made. Results: The findings converged with the latter hypothesis, as predicted by Joiner's [Joiner, T., 2006. Why People Die By Suicide. Harvard University Press, Cambridge, MA] theory of suicide, which suggests individuals with AN may habituate to the experience of pain during the course of their illness and accordingly die by suicide using methods that are highly lethal. Limitations: This study utilized case reports instead of an experimental design, which impedes its ability to comment on whether there is a causal relationship between Joiner's theory and death by suicide among individuals with AN. Conclusions: Clinicians are encouraged to carefully assess suicidality in AN patients, paying particular attention to issues related to lethality.

Background Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal–Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. Method We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. Results The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. Limitations The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Conclusions Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.

Previous findings on the relationship between suicide ideation (SI) and alcohol misuse among college students are inconsistent, leading to conflicting clinical implications. We aimed to clarify this relationship in order to determine the utility of regarding alcohol misuse as a risk factor for SI in this population. Unselected college students (N = 545) completed an online survey including measures of alcohol consumption, problems, drinking motives, SI, and related variables. Our results suggest alcohol misuse is not a correlate of SI among college students; therefore, one should not assume that students who misuse alcohol are necessarily at increased risk for SI.

The issue of suicide warning signs on the Internet is considered. In addition to reviewing some of the relevant conceptual issues about warning signs, a random sample of Internet sites was selected and reviewed. Warning signs were grouped and agreement across sites was examined, with results confirming broad disparity in what is presented to the public. The implications of a lack of consensus on warning signs for suicide are discussed.

The current article addresses the issue of warning signs for suicide, attempting to differentiate the construct from risk factors. In accordance with the characteristic features discussed, a consensus set of warning signs identified by the American Association of Suicidology working group are presented, along with a discussion of relevant clinical and research applications.

Background Much of the suicidology literature focuses on establishing contextual risk factors for suicidal behavior. However, the study of the parameters of suicidal behavior (e.g., intensity, duration, and variability) has been somewhat neglected [Joiner, T., Rudd, M.D., 2000. Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. J. Consult. Clin. Psychol. 68, 909–916] . Having previously established a relationship between variability in suicidal ideation and a previous history of suicide attempts [ Witte, T.K., Fitzpatrick, K.K., Warren, K.L, Schatschneider, C., Schmidt, N.B., submitted for publication. Naturalistic Evaluation of Suicidal Ideation: Variability and Relation to Attempt Status ], we felt it important to assess the liability conferred by a variable pattern of ideation compared to the intensity and duration of suicidal thoughts. We also examined if there was an interaction between gender and the parameters of intensity, duration, and variability. Method One hundred eight participants (54 non-attempters, 35 single attempters, and 19 multiple attempters) completed the Suicide Probability Scale every day for 4 weeks, allowing us to measure the parameters of interest. These variables were entered into a regression model as predictors of previous suicide attempts. Results Consistent with prediction, high variability of ideation was the only significant predictor of previous attempt status. In addition, an interaction between gender and variability in suicidal ideation suggested that variability appeared more critical in predicting previous attempts for males. Limitations The limited number of multiple attempters in our sample and the use of college students limit the current study. Conclusions Variability appears to be the most potent predictor of attempt status among the parameters of suicidal ideation examined in the current study. This relationship appears to be particularly important in males, suggesting that fluctuating levels of suicidal ideation may confer future risk for suicide.

T. E. Joiner's (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.

The Interpersonal-Psychological Theory of Suicide (IPTS) proposes that suicide ideation is caused by the interaction of perceived burdensomeness and thwarted belongingness, in which each predictor amplifies the harm of the other. Though several studies support this synergy hypothesis, research has not considered potential quadratic effects of perceived burdensomeness and thwarted belongingness, which can distort the sign, size, and significance of interactions, if mistakenly neglected in a model. This investigation examined the synergy hypothesis in samples of university undergraduates and psychiatric inpatients, this time controlling for quadratic effects. Despite adequate power, results showed no interaction between perceived burdensomeness and thwarted belongingness in either sample, regardless of the presence of quadratic effects. Additionally, no quadratic effects were observed. The lower-order, linear perceived burdensomeness term was positively associated with suicide ideation in both samples, but the thwarted belongingness term was not associated with suicide ideation in either sample. The discussion considers implications of current findings for the IPTS, highlighting a need to formally test the impact of sample characteristics on the estimation of theory parameters. Recommendations for systematic evaluation of such sample and theory parameters are offered and their clinical implications are discussed.

Though some preliminary research within the framework of the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) has postulated that restrictive eating may contribute to increased risk for suicide through its effect on the acquired capability for suicide (ACS; i.e., increased fearlessness about death and heightened physical pain tolerance), existing studies have not conducted direct tests of this relationship. To enhance understanding of this relationship, we compared undergraduates who endorsed one form of restrictive eating, fasting, (n=99) to controls endorsing no forms of eating pathology over the lifetime (n=94). We hypothesized that the fasting group would have higher ACS and higher likelihood of suicide attempt history. Contrary to hypotheses, no differences emerged between groups on ACS, and frequency of fasting within the fasting group was not significantly associated with ACS. Consistent with hypotheses, the fasting group was more likely to have suicide attempt history. Though results were not entirely consistent with hypotheses, the current study represents the first attempt at isolating and examining one form of restrictive eating (i.e., fasting) within the context of the IPTS. RESULTS suggest that, in isolation, fasting may not be directly contributing to increases in ACS. Language: en

We examined the relationship between season of birth and depressive and suicidal symptoms among 859 elderly outpatients. Date and country of birth were recorded for each participant. Those in utero during the Northern or Southern Hemisphere flu peak were expected to show the highest depressive and suicidal symptoms. Hypotheses were partially supported.

This study examined the factor structure of the Cambridge Depersonalization Scale (CDS; M. Sierra & G. E. Berrios, 2000 ), a 29-item self-report measure of depersonalization. The CDS was based on a conceptualization of depersonalization as a multidimensional construct, a theoretical perspective that has received limited empirical attention. Exploratory and confirmatory factor analyses were conducted on CDS item scores in a sample of 534 trauma-exposed college students. Results failed to support factor structures of the CDS previously reported in the literature and instead supported a 2-factor solution, with 1 factor representing a sense of unreality and detachment and a 2nd factor representing emotional and physical numbing. Implications regarding the structural validity of the CDS are discussed. [Supplementary material is available for this article. Go to the publisher's online edition of Journal of Trauma & Dissociation for the following resource: Four tables with the following information: inter-correlations among CDS items from Samples 1 and 2; Sierra et al. (2005 ) four-factor model and Simeon et al. (2008 ) five-factor model estimated factor loadings, covariances, and R-square in Sample 1; Factor loadings for 3-7 factor EFA models in Sample 1; and estimated factor loadings for one-factor CFA model in Sample 2.].

The present study examines the psychometric properties and construct validity of scores derived from the Interpersonal Needs Questionnaire (INQ) using latent variable modeling with five independent samples varying in age and level of psychopathology. The INQ was derived from the Interpersonal Theory of Suicide and was developed to measure thwarted belongingness and perceived burdensomeness—both proximal causes of desire for suicide. Results support that thwarted belongingness and perceived burdensomeness are distinct, but related constructs and that they can be reliably measured. Further, multiple group analyses were consistent with invariance for younger vs. older adults and non-clinical versus clinical populations thereby supporting the relevance of these constructs to diverse populations. Finally, both constructs demonstrated convergent associations with related interpersonal constructs—including loneliness and social support for belongingness and social worth and death ideation for burdensomeness—as well as prospective associations with suicidal ideation.

Background. Oquendo and colleagues ( Oquendo, Baca-García, Mann, & Giner, 2008 ; Oquendo & Currier, 2009 ) recommend that DSM-V emphasize suicide risk assessment on a sixth axis, thereby increasing regularity of suicide risk assessments. Aims. We propose that evidence of nonredundancy with Axis V – Global Assessment of Functioning (GAF) is one piece of data that can serve as a starting point for a line of research establishing incremental predictive utility for a separate suicide risk assessment in the DSM framework. Methods. A standardized suicide risk assessment protocol, measures of depressive, anxious, and eating disordered symptomatology, as well as an index of comorbidity were administered to a sample of 412 adult outpatients. Results. Our data indicate that data from standardized suicide risk assessments are associated with indices of symptomatology severity as well as comorbidity, controlling for GAF. Conclusions. These results support the nonredundancy of the assessments and suggest the utility of longitudinal investigations of the predictive utility of a sixth DSM axis in the assessment of suicide risk.

The six-point dial of treatment described in this case report was developed to guide graduate student psychological trainees through treatment and includes the following components: assessment of dangerousness, diagnosis, diagnosis-based treatment, ongoing evaluation of treatment response, obstacles to treatment, and motivation. In this case report, we describe the dial of treatment and present a case study of a client with paranoid schizophrenia (John) who presented at a graduate student training clinic to illustrate how this framework can be successfully applied. John has exhibited marked improvement, based on both objective measures and clinician judgment of global functioning.

Relatively little research has been conducted on the relationship between alcohol misuse and suicidal behavior among the elderly. The current study's aim was to examine whether quantity and frequency of alcohol use and the interaction between these variables are related to current suicidal ideation, previous suicidal ideation/intent, and past suicide attempts in a community sample of 1,010 Australian adults over age 60. Results partially supported our hypotheses. The interaction between quantity and frequency of alcohol use was significant, suggesting that those who use alcohol less frequently but in greater quantities (i.e., binge drinking) are more likely to have a history of suicide attempts.

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.

Previous research and popular conceptualizations of suicide have posited that many suicides are the result of impulsive, "on a whim" decisions. However, recent research demonstrates that most suicides are not attempted impulsively, and in fact involve a plan. Legally, suicide has historically been considered to be a superseding intervening cause of death that exonerates other parties from liability, but currently there are two general exceptions to this view. Specifically, another party may be found responsible for a suicide if that party either caused the suicide or failed in its duty to prevent the suicide from occurring. Both of these exceptions assume that the resulting suicide was foreseeable. Given that recent research has indicated that most suicides are planned, and thereby foreseeable to a certain extent under many circumstances, this article discusses issues of foreseeability as they pertain to litigation involving third party liability for the suicide of university students, prison inmates, and mental health patients. The authors contend that the surest way for universities, prison staff, and mental health practitioners to avoid being held liable for a suicide is to appropriately assess for suicidal intent.