So why are theories important? 1)Guides research 2)Guides clinical work 3)Creates new hypotheses

Joiner’s Interpersonal-Psychological Theory of Suicidal Behavior Van Orden, Witte, Gordon, Bender & Joiner, 2008 Those Who Desire to Die Thwarted Belongingness Perceived Burdensomeness Those who are capable of suicide May endorse suicidal ideation At greatest risk of suicide

The interpersonal-psychological theory of suicidal behavior argues that, in order to enact lethal self- harm, an individual must habituate to physical pain and the fear of death. This process of habituation occurs through repeated exposure to painful and provocative events. Examples of habituation?

 Emphasized collective social forces and dismissed most other factors  Disturbed regulation of the individual by society Two basic types of regulation: 1) Social integration - Low integration = “egoistic” - when people feel like they don’t belong, purposeless and become desperate * Similar to Joiner’s concept of belongingness - High integration = “altruistic” – Excessive integration leads people to lose themselves and to commit to a larger goal * Similar to Joiner’s concept of burdernsomeness 2) Moral regulation - Low regulation = “anomic” - Sudden changes in the social position of an individual due to abrupt changes in society lead to a lack of social direction - High regulation = “fatalistic” – Occurs among people who live overregulated, unrewarding lives.

 Why was he so influential? 1)Emphasized social disconnection as a major source for one’s desire to end his/her life 2)Introduced the concept of perceived burdensomeness as a risk factor to serious suicidal behavior 3)There were very few theorists during this time -Sullivan -Menninger

 Focused on the nature of psychological needs and the consequences of having those needs thwarted  “Suicide is caused by a certain kind of psychological pain called “psychache”. ◦ Psychache is defined as a general psychological and emotional pain that reaches intolerable intensity. ◦ Risk factors operate by increasing psychache which predisposes one to suicidality.

 Psychache is compatible with Joiner’s concepts of perceived burdensomeness and failed belongingnes.

 Emphasized the role of hopelessness ◦ In one study Beck and colleagues correctly identified 91% of those who later died by suicide. ◦ Those with high hopelessness were 11 times more likely to die by suicide than those with lower scores.  Joiner believes that hopelessness doesn’t tell the whole story and is not sufficient for suicidal behavior. ◦ Hopelessness about belongingness and burdensomeness is required, together with the acquired capability for serious self-harm

 Beck also argued that previous suicidal experience sensitizes suicide-related thoughts and behaviors so that they become more accessible and active. ◦ Allows for subsequent episodes to be more easily triggered and more severe ◦ Shares similarities with Joiner’s model which proposes an escalating course of suicidal behavior over time through habituation.

 Proposed an escaped theory of suicide  Described a series of steps leading up to serious suicidal behavior: 1) Individual experiences a negative and severe discrepancy between expectations and actual events 2) An aversive state of high self-awareness develops, which produces negative affect * Person may dwell on personal inadequacies leading to distress, sadness, and worry.

 3) Person attempts to escape from negative affect as well as from the aversive self- awareness by retreating into a numb state of cognitive deconstruction. * Person disregards meaningful thoughts about self and replaces them with lower-level more immediate goals and tasks. * Reduced inhibition results which leads to a lack of impulse control in general (particularly with respect to suicidal behavior).

 Fluid Vulnerability Model ◦ Suicidal episodes are time-limited. ◦ Risk factors that both trigger a suicidal episode and determine the duration and severity of an episode are fluid. ◦ Imminent risk cannot endure beyond periods of heightened arousal. ◦ Baseline risk varies from person to person.

Suicidal Mode Fluid Vulnerability Model Adapted from Rudd, 2006