Elisha Klonsky

The present study used the Three Step Theory of Suicide (3ST) to explain the association between BPD traits and suicide desire. The 3ST states that pain and hopelessness cause suicide desire, and that the extent to which pain exceeds connectedness determines the intensity of suicide desire. The ability of these premises to explain elevated suicide desire in BPD was examined in 852 participants, including 456 with histories of suicide ideation or attempts. BPD traits, current suicide desire, pain, hopelessness, and connectedness were measured using validated self-report questionnaires. Consistent with step 1 of the 3ST, pain and hopelessness explained most of the association between BPD traits and suicide desire. Consistent with step 2, the association between BPD and intensity of suicide desire was fully accounted for by a pain-connectedness difference score. In a simpler model, pain, hopelessness, and connectedness reduced the correlation between BPD and suicide desire from r=.41 to r?=.08. This research improves our understanding of why people with BPD traits experience suicide desire and informs the development of treatment and prevention strategies.

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Suicide is a leading cause of death worldwide. Despite decades of research, knowledge is lacking regarding which individuals who think about suicide will go on to attempt suicide. This distinction is important, as most people who think about suicide will never attempt. Identifying factors associated with increased risk of attempting suicide among those with suicide ideation is critical for improving suicide prevention. Dissociation (e.g., feeling detached from one’s body and/or surroundings) is proposed to facilitate engaging in lethal self-harm and may play a role in decreasing the fear and perception of pain involved in attempting suicide. However, previous research is unable to discern whether dissociation is a correlate of suicide ideation, suicide attempts, or both. Thus, this study examines whether dissociation exhibits a relationship to suicide attempts over and above a relationship to suicide ideation.Undergraduates oversampled for histories of suicide ideation and attempts were recruited from the University of British Columbia (n=754). The sample was divided into three groups: no history of ideation or attempts (nonsuicidal; n=356), ideation and no attempts (ideators; n=276), and ideation and attempts (attempters; n=122). All participants completed a battery of self-report questionnaires assessing key study variables.Results show that dissociation was elevated not only among ideators compared to nonsuicidal participants (d=0.19, p=.021), but also among attempters compared to ideators (d=0.28, p=.009). Dissociation maintained its unique association to suicide attempt history when controlling for suicide capability, but not when controlling for current suicidal desire, emotion dysregulation, symptoms of Borderline Personality Disorder (BPD), symptoms of Posttraumatic Stress Disorder (PTSD), or nonsuicidal self-injury (NSSI). Similarly, dissociation no longer related to suicide ideation history controlling for low belongingness, emotion dysregulation, symptoms of BPD, or PTSD. Main findings suggest that dissociation is associated with suicide attempt history over and above suicide ideation, however, this relationship does not persist when controlling for covariates. Among these, symptoms of BPD and NSSI emerged as relatively stronger predictors of suicide attempt history. Findings highlight the unique contribution of dissociation to suicide attempts and the relative importance of different clinical variables in understanding the presentation of undergraduates with a history of suicide attempts.

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Individuals with eating disorders (EDs) have an elevated risk for suicide compared to the general population. To date, research on EDs and suicide has mainly used ED diagnostic categories as the unit of analysis, for example, comparing Anorexia Nervosa and Bulimia Nervosa with regard to the frequency and lethality of suicide attempts. However, an increasing number of studies suggest that specific features of EDs (i.e., restrictive eating, fasting, binge-eating, and purging) may be most helpful in predicting suicide risk rather than the diagnostic categories, which can share similar features. Therefore, the present study examined a wide variety of specific ED features in relation to histories of suicidal ideation and attempts. In addition, the present study explored the role of capability in relation to ED features and suicide.Participants were 387 adults recruited via an online platform (MTurk) who completed questionnaires assessing eating disorder features, history of suicide ideation and attempts, suicide capability, and other relevant variables. A total of 70 participants with a lifetime history of suicide attempts, 114 participants with a lifetime history of suicide ideation but no history of attempts, and 203 participants with no history of either suicide ideation or attempts were obtained.Results revealed small to moderate differences on almost all ED features between ideators and nonsuicidal participants (d range = -.44 to .07, median = -.29), where ideators were more likely to endorse ED features than nonsuicidal participants. Smaller differences were observed between ideators and attempters for fewer ED features (d range = -.31 to .00, median = -.14), where attempters were more likely to endorse ED features than ideators. Specifically, cognitive restraint, restricting behaviours, excessive exercise, and muscle building were more associated with attempts than with ideation. Practical capability mediated the relationships of cognitive restraint and restricting behaviours to suicide attempts. Findings suggest that some ED features may be uniquely associated with suicidal ideation whereas others may be uniquely, albeit modestly, associated with suicide attempts among those with ideation. Future research, assessment, and treatment of individuals with certain ED features should consider the potential risk factor for suicidal thoughts and behaviours.

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Suicide is a leading cause of global mortality. However, despite decades of scientific and policy efforts, rates of suicide attempts have remained largely unchanged. A key reason for this is that most identified risk factors predict suicidal thoughts, but not acts. Understanding how people decide to die may help elucidate why some individuals act on their suicidal thoughts whereas others do not. The current project examined decision making styles in relations to suicidal thoughts and suicidal acts.Results showed rational decision making style differentiated attempters from ideators, with attempters exhibiting lower rational decision making style. Avoidant and dependent styles also distinguished attempters from ideators, with dependent decision makers less likely to be attempters, while the reverse was true for avoidant decision makers. As such, decision making styles may help to distinguish active suicide attempters vs. passive suicidal ideators, thus potentially contributing not only to suicide risk assessment but also intervention.

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Background: There has long been a proposed clinical link between sexuality and eating disorders; however, little empirical evidence exists regarding this relationship. The limited body of research on sexuality in eating disorders supports the occurrence of considerable sexual concerns. The aim of the present study was to expand on the dearth of empirical literature exploring altered sexuality in relation to disordered eating. Study 1 examines disordered eating in relation to sexual function and sexual insecurities. Study 2 examines the association between eating disorder symptoms in relation to genital pain and sexual distress. Study 3 examines the mediational role of personality and mood on the relation between eating pathology and genital pain. Methods: Undergraduate female UBC students completed a series of online questionnaires assessing eating habits, sexual functioning, sexual insecurities, personality, and mood. Two rounds of data collection were conducted, the first occurring from December of 2013 to April of 2014 (n = 321), the second between May of 2014 and April of 2015 (n = 854). Results: Several domains of sexual dysfunction were associated with disordered eating symptom severity, particularly genital pain and sexual distress. Mean differences in eating disorder symptoms emerged in women with clinically significant genital pain compared to those without pain, such that women in the genital pain group reported more eating pathology. Mean differences in genital pain, sexual distress, and sexual insecurities emerged among women categorized as being at elevated, typical, or low eating disorder risk, with those at greater risk reporting greater sexual difficulties. Sexual insecurity variables, as well as personality and characteristics common to individuals with eating disorder pathology, mediated the association between disordered eating and genital pain. Discussion: Sexuality is rarely considered in the context of eating disorder treatment unless a history of sexual abuse is present. The results of this study suggest that sexual functioning difficulties should be addressed during eating disorder care. Findings also indicate that women with eating disorders would benefit from treatments targeting sexual insecurities and personality gestures associated with eating pathology in addition to sexual function.

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Introduction: Suicide has a devastating impact on individuals and communities worldwide yet few risk few factors reliably predict future suicide attempts. A growing body of research suggesting that that risk factors commonly associated with suicide (such as depression) are more predictive of suicidal thoughts, not suicidal acts – an important distinction since most people who think about suicide do not act on their thoughts. Executive functioning abilities mediate the relationship between thoughts and behaviours and therefore might be uniquely implicated in the progression from suicidal thoughts to suicidal acts. Our study examined whether two multidimensional measures of executive functioning differentiated those with a history of suicidal ideation from those with a history of suicide attempts using an online platform.Participants and Methods: Five-hundred and seventy seven participants (Mean age=34.6, SD=11.6) participated in study. Participants were divided into five groups based on lifetime, greater than past-12 month, and past-12 month histories of suicide ideation and suicide attempts: nonsuicidal (n=180), non-recent ideation (n=136), recent ideation (n=61), non-recent attempts (n=103), recent attempts (n=21). Executive functioning (EF) was measured using the Behavioural Rating Inventory of Executive Functions – Adult Version (BRIEF-A) and the Frontal Systems Behaviour Scale (FrSBe). Several covariates including impulsivity and other known suicide risk factors and potential confounds were also assessed.Results: Moderate to large differences (d range=.53-1.08) in executive functioning were obtained comparing recent attempters to recent ideators. Attempters and ideators differed most on the FrSBe disinhibition scale (d=1.08), BRIEF Behaviour Regulation Index (d=1.02), and BRIEF-A Global Executive Composite (d=1.01), with attempters reporting worse executive functioning. Interestingly, comparing lifetime attempters to ideators as well as non-recent attempters to ideators revealed only weak to small differences (d range=.11-.38 and .03 – .3, respectively). This pattern remained robust when controlling for covariates.Discussion: Lifetime attempters and ideators did not meaningfully differ on self-reported executive functioning. Executive functioning did, however, clearly differentiate recent attempters from recent ideators suggesting that impaired executive functioning might represent an important state risk factor for suicide attempts. However, findings may also represent a reporting bias, and it will be important for future studies to utilize prospective designs.

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Many theoretical models addressing the role of the parasympathetic branch of theautonomic nervous system in psychopathology predict decreased respiratory sinusarrhythmia (RSA) in disorders such as depression and anxiety. However, decreased RSAin depression is not consistently observed across studies. Research on the relationshipbetween anxiety and RSA has also been mixed, but the results may be more robust thanthat of depression. Before the theoretical models can be re-examined based on thesefindings, researchers must clarify the nature of these relationships. Specifically, threethings should be determined: a) is there a relationship between RSA and depression; b) isthere a relationship between anxiety and RSA; and c) could comorbid anxiety indepression be playing a role in the mixed findings to date.This study was specifically designed to address those three questions. Based onthe empirical literature, we hypothesized that: 1) depression would have a small butsignificant relationship to RSA; 2) anxiety would have a significant relationship to RSAthat would be stronger than that of depression to RSA; 3) the anxiety-RSA relationshipwould persist when controlling for depression, whereas the depression-RSA relationshipwould not persist when controlling for anxiety. Additionally, the Cardiac SympatheticIndex (CSI) was used to explore the potential relationships that depression and anxietymay have with sympathetic-related heart rate variability and sympathovagal balance.One-hundred and twenty-eight physically healthy undergraduate studentscompleted a questionnaire measure assessing depression and anxiety symptoms. Participants’ ECG recordings were taken both at rest and during a stressful arithmetic taskto obtain measures of RSA and CSI. Regression analysis revealed a significant inverserelationship between anxiety and RSA, and a marginally significant inverse relationshipbetween depression and RSA, during the stressful arithmetic task. No significantrelationships were observed at rest, or with CSI. Importantly, the relationship betweenanxiety and RSA persisted when controlling for depression, whereas the opposite was nottrue: the relationship between depression and RSA is almost eliminated when controllingfor anxiety. These results suggest that some of the positive findings in the depression-RSA literature may be due to uncontrolled, co-occurring anxiety symptoms.

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Non-suicidal self-injury (NSSI) is the intentional, direct injury to one’s body that results in tissue damage, is not socially sanctioned, and is not suicidal in nature. Individuals who engage in NSSI experience elevated levels of emotion dysregulation (Gratz & Tull, 2010) and negative emotional experiences (Andover & Gibb, 2010; Ross & Heath, 2002); these difficulties help explain the consistent finding that individuals typically engage in NSSI as a way to regulate emotional experiences (Klonsky, 2007).Research on emotional experiences in this population has focused primarily on broad measures of positive versus negative emotion. Little research has been done on specific emotional experiences – including the particular emotions and dimensions of emotional reactivity -- that characterize the daily lives of individuals who engage in NSSI compared to those who do not. Additionally, research is lacking regarding the specific emotional states related to prospective risk of NSSI.This study investigated specific emotions and three dimensions of emotional reactivity – frequency, intensity, and duration -- in a sample of primarily university undergraduates with either no history of NSSI or a recent history of NSSI. Participants completed baseline measures of specific emotional experiences and NSSI behaviors, as well as potentially relevant confounds such as personality disorder symptoms. Participants then completed daily diary measures of specific emotional experiences and NSSI behaviors over fourteen days.Results indicated that individuals with a history of NSSI experience significantly greater levels of several negative emotional states, and significantly lower levels of several positive emotional states, than individuals with no NSSI history. The emotion that best differentiated current self-injurers was high self-dissatisfaction. Prospectively, baseline report of duration of negative emotional experiences best predicted performance of NSSI during the subsequent diary period. These results suggest that self-dissatisfaction may be a specific emotional experience associated with the decision to engage in NSSI, while the duration of negative emotional experiences may be related to continuing NSSI behaviors in individuals with a history of NSSI.

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Suicidal ideations and attempts are a major public health problem. Most known risk factors predict suicidality overall, rather than attempt or ideation specifically. Limited research has investigated risk factors that distinguish individuals who attempt suicide from individuals who only think about suicide. Existing demographic, psychological, personality, and sociodemographic risk factors were investigated in 3 samples using validated questionnaires and structured interviews. Cross-sectional data was gathered from 1,348 college students and 2,011 military recruits. Ten-year longitudinal data was gathered from 49 clinically depressed adults. Results from the cross-sectional samples (college students and military recruits) suggest that most risk factors for suicidality do not differentiate attempters from ideators. Risk factors that did appear associated with attempts over ideation were female gender, non-suicidal self-injury, amphetamine use, and a domain of impulsivity - lack of premeditation. Among women, the personality trait of manipulativeness was associated with ideation over attempts. Results from the longitudinal sample (depressed adults) suggest that co-morbid personality disorders, co-morbid anxiety disorders, co-morbid substance use disorders, social adjustment difficulties, and a poor maternal relationship predict suicide attempts in the next 10 years among suicide ideators. Co-morbid personality disorder, especially in Cluster B, appear to be the strongest predictors of attempts in the depressed ideating sample. Further research is needed to replicate these findings and identify further unique predictors of suicide attempts among ideators. This will aid in suicide risk assessment and the development of a comprehensive theory of suicidality.

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