Affective and Behavioral Dysregulation

Suicide claims the lives of approximately 32,000 Americans each year. The interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) was developed in an effort to clarify the nature of suicidality as well as to enhance risk assessment and prevention approaches. The IPTS differentiates between the desire for death by suicide and the capability for suicide, which is said to be acquired through repeated exposure to painful and provocative life events. Thus far, the relationship between painful and provocative events and the acquired capability for suicide has been repeatedly supported in independent samples (e.g., Van Orden et al.,2008; Bryan et al., 2010). To date, however, no research has investigated whether the path from pain and provocation to the acquired capability is uniform across populations. I sought to test whether individuals' experiences with negative affect might moderate this relationship, with individuals exhibiting greater difficulty managing emotional distress who report greater levels of lifetime pain and provocation demonstrating the highest levels of the acquired capability. Specifically, I examined negative urgency and distress tolerance as moderators. Results utilizing structural equation modeling indicated that the proposed models were not an adequate fit for the data; however, a post hoc series of hierarchical linear regressions revealed a number of significant interactions between emotion-based individual difference variables (negative urgency, distress tolerance) and pain and provocation in the prediction of the acquired capability for suicide. These significant interactions were not in the hypothesized direction, as greater levels of negative urgency and lower levels of distress tolerance dampened the relationship between painful and provocative events and the acquired capability for suicide. These results might indicate that, although emotionally dysregulated individuals exhibit a higher rate of death by suicide (e.g., Linehan, 1993), this is true despite their emotion dysregulation, not because of it. Experiencing discomfort as highly aversive may actually serve as a buffer against suicide and require that such individuals experience greater exposure to pain and provocation in order to habituate sufficiently to such stimuli.