Edward A. Selby

The Interpersonal Theory of Suicide.

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 article 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 article, the theorys hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theorys hypotheses.

Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior: Empirical Tests in Two Samples of Young Adults

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) makes 2 overarching predictions: (a) that perceptions of burdening others and of social alienation combine to instill the desire for death and (b) that individuals will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and thus habituation to painful and/or fearsome experiences and is posited by the theory to be necessary for overcoming powerful self-preservation pressures. Two studies tested these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling that one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the 3-way interaction among 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.

Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades

Recent research suggests that many dysregulated behaviors, such as binge-eating and non-suicidal self-injury, often occur during times of emotional distress. These behaviors also appear to decrease negative affect. Why is it, however, that individuals engage in these behaviors to reduce emotional distress rather than taking a shower or talking to a friend? This study proposes the role of emotional cascades, an emotional phenomenon that occurs when an individual intensely ruminates on negative affect, thus increasing the magnitude of that negative affect to the point that an individual engages in a dysregulated behavior in order to distract from that rumination. The purpose of these studies was to examine the relationship between rumination and dysregulated behaviors, and in doing so determine if there is some support for the emotional cascade model of behavioral dysregulation. Using two different studies we were able to demonstrate that rumination is associated with some dysregulated behaviors, both cross-sectionally using structural equation modeling, and temporally using a two time-point method.

Cascades of Emotion: The Emergence of Borderline Personality Disorder from Emotional and Behavioral Dysregulation

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), in which 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.

An exploration of the emotional cascade model in borderline personality disorder.

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 non-suicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in a sample enriched with participants 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.

Non-suicidal self-injury (NSSI) disorder: A preliminary study.

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.

Overcoming the fear of lethal injury: Evaluating suicidal behavior in the military through the lens of the Interpersonal-Psychological Theory of Suicide

Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.

A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology

Affective lability has been linked to several maladaptive behaviors (Anestis et al., 2009; Coccaro, 1991). Methodology for measuring affective lability varies and includes retrospective self-report and ecological momentary assessment (EMA). In this study, we sought to test these methodologies by examining which better predicted binge eating episodes and general eating disorder symptoms in a sample (n = 131) of women diagnosed with bulimia nervosa (BN). We hypothesized that, while the two forms of measurement would be correlated with one another and predict binge eating episodes, EMA affective lability would be the stronger predictor. Results supported several hypotheses. Specifically, both EMA affective lability and retrospective self-report affective lability significantly predicted global eating disorder symptoms, even when controlling for depression, age, body mass index, and level of education, EMA affective lability exhibited a significantly stronger correlation with binge eating episodes than did retrospective self-report affective lability, and EMA affective lability predicted number of binge eating episodes on any given day controlling for the same list of covariates. Limitations include the use of a clinical sample that may limit the generalizability of our findings. Findings highlight the importance of affect in such behavior.

The Pernicious Blend of Rumination and Fearlessness in Non-Suicidal Self-Injury

Recent theory suggests that people may engage in dysregulated behaviors, such as non-suicidal self-injury (NSSI), as a way to distract from rumination and emotional cascades (Selby et al. 2008); similarly, another theory suggests that people may not engage in self-injurious behavior without habituation to fear through repeated exposure to painful events (Joiner 2005). We hypothesized that both high rumination and habituation to the fear of pain may strongly influence NSSI because those who lack a fear of pain and ruminate intensely will not be afraid to inflict physical pain as a way to distract from negative affect. Participants were undergraduate students (Nxa0=xa094), a large portion of whom reported engaging in NSSI. These participants were given measures of past painful experiences, rumination, and frequency of recent self-injury. Using hierarchical linear regression, evidence was found to support the interaction effect of rumination and painful/provocative experiences on the frequency of NSSI, even after controlling for important variables such as age, gender, and sensation seeking. Although the interaction significantly predicted NSSI, it did not predict dysregulated eating behaviors or drinking to cope.

Emotional Cascades as Prospective Predictors of Dysregulated Behaviors in Borderline Personality Disorder

People with borderline personality disorder (BPD) frequently engage in behaviors that may result in negative consequences. These behaviors can include binge eating, using substances, fighting, yelling, self-injuring, verbal aggression, or impulsive shopping. These behaviors frequently occur in the context of negative emotion, and they may serve to reduce it. The emotional cascade model (Selby & Joiner, 2009) asserts that people engage in these behaviors because the resulting physical sensations short-circuit emotional cascades, intense cycles of rumination, and negative emotion that are extremely painful. The purpose of the present study was to examine the potential for emotional cascades to prospectively predict the occurrence of dysregulated behaviors in daily life. Forty-seven behaviorally dysregulated participants completed 3,118 recordings of real-time emotions, thoughts, and behaviors on hand-held computers over 2 weeks. Results indicated that a 3-way interaction between elevated rumination, elevated negative emotion, and elevated BPD symptoms prospectively predicted the occurrence of a dysregulated behavior within the next 2 to 3 hr. In contrast, for those with elevated BPD symptoms, negative emotion at low levels of rumination was not predictive of a dysregulated behavior occurring, and neither was rumination at low levels of negative emotion. These findings suggest that the emotional cascade model may have important clinical implications, and future research should examine the specific facets of rumination and negative emotion involved in dysregulated behaviors.