Interpersonal-psychological theory of suicidal behaviour

Ameya Naik

TW: Suicide  

Across the globe, it has been noted that approximately one in every 100 deaths is caused because of suicide (Suicide, 2021). Given that suicidal behaviour can be prevented, it is essential to know what causes an individual to attempt suicide. A possible explanation of why an individual would engage in suicidal behaviour is explained by the interpersonal-psychological theory of suicidal behaviour (Joiner, 2005). The theory posits that in order for an individual to die by committing suicide, an individual should experience a desire for committing suicide and should be capable to fulfil the desire. The desire for committing suicide stems from two interpersonal psychological states, namely, perceived burdensomeness and thwarted belongingness. However, this desire needs to be coupled with an individual's acquired ability to cause self-injury and overcome their self-preservation instinct. Therefore, this blog post aims to examine the interpersonal-psychological theory of suicidal behaviour through the two interpersonal psychological states, one’s capability of suicide, and interaction between the states. 

 

The first interpersonal psychological state that leads to the desire of death is known as perceived burdensomeness. This state claims that an individual views their existence as a burden on their family and their community and that this view stems from a misperception that one’s death is more worthy than their life to others (Joiner, 2009). This sense of burdensomeness felt by individuals towards their family was tested in two studies analysing suicide notes by Joiner et al. (2002). Results demonstrated that perceived burdensomeness was significantly correlated with individuals who committed suicide and did so in more lethal ways. Namely, higher levels of burdensomeness were observed in individuals who committed suicide as compared to individuals who attempted suicide and also in individuals who died through more violent ways as compared to individuals who died through less violent ways. Additionally, studies have also suggested that perceived burdensomeness significantly predicts and explains the variation in suicidal ideation even when other predictors like hopelessness, depression, and functional impairments are controlled for (Cukrowicz et al., 2011; Van Orden, Lynam, Hollar, and Joiner (2006)). Hence, an individual’s perception of being a burden to others and being someone that can be expendable can lead to suicidal ideation and more lethal ways of dying. 

 

The second interpersonal psychological state that affects an individual’s desire to die is thwarted belongingness. This state is based on humans having a fundamental need to belong, hence thwarted belongingness or lack of belongingness is characterised by the feeling of loneliness and alienation. Given that suicide risk had increased due to social isolation and lockdown during the COVID-19 pandemic, a study by Gratz et al. (2020) examined the relationship between the COVID-19 consequences of either stay-at-home orders or experiencing a job loss with the risk of suicide through thwarted belongingness. Results showed that there was a significant indirect relationship between suicide risk and thwarted belongingness in participants who were ordered to stay-at-home. Another study examining the difference between suicide attempts and unintentional overdose in methadone-dependent individuals found that lack of belongingness distinguished individuals who attempted suicide versus those who unintentionally overdosed; additionally, thwarted belongingness also predicted a lifetime history of attempts to commit suicide (Conner et al., 2007). Lastly, it has also been observed that suicidal ideation increased in college students during the summer semester since the campus was more empty and less active (Orden et al., 2008). This suggests how the lack of belongings in the summer semester was significantly associated with suicide ideation by students. Therefore, the feeling of not belonging to a group or community along with being isolated or lonely can be significantly detrimental to an individual because it can create a desire for committing suicide.  

 

Even though the two interpersonal psychological states can instill a desire for committing suicide, the theory claims that the states are not enough for an individual to translate their desire into actions. According to the theory, a third element known as the acquired ability to cause self-injury is very essential for an individual to attempt suicide (Joiner, 2005). This ability is acquired and not innate since individuals have to outrightly fight their natural self-preservative motives. So if an individual repeatedly engages in fighting their self-preservation motives and does so in different domains, then the individual will be more able to adopt lethal ways of self-injury (Joiner, 2009). This ability is primarily based on the principles of opponent-process theory which postulates that recurrent exposure to an affective stimulus can change the reaction an individual has to the stimulus— an individual's original response to the stimulus is lost and the opposite response is reinforced (Solomon, 1980). In terms of suicidal attempts, the application of this theory suggests that repeated exposure to self-harming and painful stimuli causes an individual to gradually acquire the capability of committing suicide. Results from different studies delineate how past suicidal behaviour is a strong predictor of future suicidal behaviour since individuals get accustomed to the pain and fear caused by self-harm (Joiner et al., 2005; Brown et al., 2000). However, non-suicidal forms of self-injury like starvation, physical abuse, and more can also increase individuals' tolerance towards self-injury and habituate them to the pain (Nock et al., 2006). Therefore, the acquired capability of suicide plays a crucial role in the conversion of the desire to the action of committing suicide. 

 

Therefore, the overall interpersonal-psychological theory of suicidal behaviour tries to explain the potential causes of suicide through the interaction between perceived burdensomeness, thwarted belongingness, and the ability to cause self-injury. An individual who experiences high burdensomeness, low belongingness, and has repeatedly inflicted self-harm is most likely to die by suicide. Since the impact of the three elements on suicide has been validated through several studies, the theory could be used as a basis for the prevention of suicide. Clinicians could be more cognisant of their patients’ level of burdensomeness, belongingness, and acquired the ability to harm during counselling and assessment of suicide risk. Lastly, understanding the significant causes of suicidal behaviour could help decrease the global prevalence of suicide.

 

 

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