An aspect of the capability for suicide—fearlessness of the pain involved in dying—amplifies the association between suicide ideation and attempts.
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The interpersonal theory of suicide posits that individuals who experience suicide ideation will only develop suicidal intent, and subsequently engage in suicidal behavior when they have concomitant fearlessness about death and tolerance for physical pain (i.e., the capability for suicide). The current studies examined the hypothesis that one aspect of the capability for suicide-fearlessness of the pain involved in dying-would amplify the positive association between current suicide ideation and a previous suicide attempt in two samples at high risk for experiencing suicide ideation and suicide attempts. Study 1 examined this relation using self-report methods in a sample of adults entering treatment in a mental health outpatient clinic. Study 2 utilized similar methods in a sample of adults admitted to inpatient psychiatry. Both studies indicated that those individuals who reported suicide ideation were more likely than non-ideators to report having attempted suicide only if they also reported greater fearlessness of the pain involved in dying. The current findings support the theorized role of the capability for suicide in the transition from ideation to attempt and also support assessing the capability for suicide in risk assessment.
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Ideators and attempters differ in psychological processes underlying their experiences leading up to and during suicidal crises; attempters demonstrate increased focus on suicide-related stimuli and reduced fear of death relative to ideators.
“In addition, there is evidence that ideators and attempters differ in terms of the psychological processes underlying their experiences leading up to and during suicidal crises. For example, attempters demonstrate an increased focus on suicide-related stimuli (Cha et al., 2010) and reduced fear of death (Smith et al., 2016), relative to ideators.”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Smith et al., 2016
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Experimental — accuracy not yet measuredIn some cases, fearlessness about death observed in attempters may also be due to limited awareness, since if individuals have limited awareness of goals which would be negatively affected by suicide, this may reduce their fear of death.
“In some cases, fearlessness about death observed in attempters (Smith et al., 2016) may also be due to limited awareness, since if individuals have limited awareness of goals which would be negatively affected by suicide, this may reduce their fear of death.”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Smith et al., 2016
The Abstract (page unavailable) reports that, among people with suicidal ideation, greater fearlessness of the pain involved in dying was associated with a history of suicide attempt. Study 1 Methods (page unavailable) specifies that this was measured with the item “The pain involved in dying frightens me,” not a measure of fearlessness about death generally. The limited-awareness explanation follows the citation and is the citing authors’ conjecture, not a finding attributed to Smith et al. (LLM, conf=0.85)
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- Authors
- Smith, P. N., Stanley, I. H., Joiner, T. E., Sachs-Ericsson, N. J., & Van Orden, K. A.
- Affiliations
- University of South Alabama (US)
- Florida State University (US)
- Corresponding author
- Smith, Phillip N.
- Venue
- Archives of Suicide Research
- Publisher
- Informa UK Limited
- Published
- 2016-03-16
- Volume
- 20
- Issue
- 4
- Pages
- 650-662
- ISSN
- 1381-1118 (ISSN-L)
- 1543-6136
- PMC
- PMC5025334
- OpenAlex
- W2312187039
- Cited by
- 35
- References
- 50
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 4
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Suicide Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5t32mh020061-25)
- Medical Center, University of Rochester
- National Institute of Mental Health (K23MH096936, T32-MH020061)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Keywords
- suicidal ideation, suicide attempts, interpersonal theory of suicide, suicide risk assessment, psychiatric inpatients
- MeSH terms
- Suicide Prevention, Adult, Attitude to Death, Dangerous Behavior, Female, Humans, Inpatients, Male, Middle Aged, Outpatients, Psychological Techniques, Suicide, Suicide, Attempted, Pain Threshold, Risk Assessment, Self Report, Pain Perception, Suicidal Ideation
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