Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T23:00:38.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Interoceptive deficits, non-suicidal self-injury, and suicide risk: a multi-sample study of indirect effects

Published online by Cambridge University Press:  03 January 2019

Christopher R. Hagan Open the ORCID record for Christopher R. Hagan [Opens in a new window] ,
Megan L. Rogers ,
Amy M. Brausch ,
Jennifer J. Muehlenkamp  and
Thomas E. Joiner Jr
Christopher R. Hagan*
Affiliation:
University of Wisconsin Eau Claire
Megan L. Rogers
Affiliation:
Florida State University
Amy M. Brausch
Affiliation:
Western Kentucky University
Jennifer J. Muehlenkamp
Affiliation:
University of Wisconsin Eau Claire
Thomas E. Joiner Jr
Affiliation:
Florida State University
*
Author for correspondence: Christopher Hagan, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Interoceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior.

Methods

This study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews.

Results

Contrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance.

Conclusions

We found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.

Keywords

Interoceptive deficitsnon-suicidal self-injurypain tolerancesuicide
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 16 , December 2019 , pp. 2789 - 2800
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anestis, MD, Bagge, CL, Tull, MT and Joiner, TE (2011) Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research 45, 603–611.Google Scholar
Barlow, DH, Allen, LB and Choate, ML (2016) Toward a unified treatment for emotional disorders – republished article. Behavior Therapy 47, 838–853.Google Scholar
Beck, AT, Steer, RA and Ranieri, WF (1988) Scale for suicide ideation: psychometric properties of a self-report version. Journal of Clinical Psychology 44, 499–505.Google Scholar
Beck, AT, Steer, RA and Brown, GK (1996) Manual for the BDI-II. San Antonio, TX: Psychological Corporation.Google Scholar
Blakey, SM and Abramowitz, JS (2018) Interoceptive exposure: an overlooked modality in the cognitive-behavioral treatment of OCD. Cognitive and Behavioral Practice 25, 145–155.Google Scholar
Blascovich, J and Mendes, WB (2010) Social psychophysiology and embodiment. In Fiske, ST, Gilbert, DT and Lindzey, G (eds), Handbook of Social Psychology, 5th Edn. Hoboken, NJ: John Wiley & Sons, Inc, pp. 194–227.Google Scholar
Buhrmester, M, Kwang, T and Gosling, SD (2011) Amazon's Mechanical Turk: a new source of inexpensive, yet high-quality data? Perspectives on Psychological Science 6, 3–5.Google Scholar
Carlson, KD and Wu, J (2012) The illusion of statistical control: control variable practice in management research. Organizational Research Methods 15, 413–435.Google Scholar
Carruthers, G (2008) Types of body representation and the sense of embodiment. Consciousness and Cognition 17, 1302–1316.Google Scholar
Chu, C, Klein, KM, Buchman-Schmitt, J, Hom, MA, Hagan, CR and Joiner, TE (2015) Routinized assessment of suicide risk in clinical practice: an empirically-informed update. Journal of Clinical Psychology 71, 1186–1200.Google Scholar
Claes, L, Jiménez-Murcia, S, Agüera, Z, Castro, R, Sánchez, I, Menchón, JM and Fernández-Aranda, F (2012) Male eating disorder patients with and without non-suicidal self-injury: a comparison of psychopathological and personality features. European Eating Disorders Review 20, 335–338.Google Scholar
Craig, AD (2002) How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience 3, 655–666.Google Scholar
Dodd, DR, Smith, AR, Forrest, LN, Witte, TK, Bodell, L, Bartlett, M, Siegfried, N and Goodwin, N (2018) Interoceptive deficits, nonsuicidal self-injury, and suicide attempts among women with eating disorders. Suicide & Life Threatening Behavior 48, 438–448.Google Scholar
Ernst, J, Northoff, G, Böker, H, Seifritz, E and Grimm, S (2013) Interoceptive awareness enhances neural activity during empathy. Human Brain Mapping 34, 1615–1624.Google Scholar
Favaro, A and Santonastaso, P (1998) Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates. The Journal of Nervous and Mental Disease 186, 157–165.Google Scholar
Forcano, L, Fernández-Aranda, F, Álvarez-Moya, E, Bulik, C, Granero, R, Gratacòs, M, Jiménez-Murcia, S, Krug, I, Mercader, JM, Riesco, N, Saus, E, Santamaría, JJ and Estivill, X (2009) Suicide attempts in bulimia nervosa: personality and psychopathological correlates. European Psychiatry 24, 91–97.Google Scholar
Forrest, LN, Smith, AR, White, RD and Joiner, TE (2015) (Dis)connected: an examination of interoception in individuals with suicidality. Journal of Abnormal Psychology 124, 754–764.Google Scholar
Franklin, JC, Hessel, ET and Prinstein, MJ (2011) Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research 189, 362–367.Google Scholar
Franklin, JC, Ribeiro, JD, Fox, KR, Bentley, KH, Kleiman, EM, Huang, X, Musacchio, KM, Jaroszewski, AC, Chang, BP and Nock, MK (2017) Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychological Bulletin 143, 187–232.Google Scholar
Franko, DL, Keel, PK, Dorer, DJ, Blais, MA, Delinsky, SS, Eddy, KT, Charat, V, Renn, R and Herzog, DB (2004) What predicts suicide attempts in women with eating disorders? Psychological Medicine 34, 843–853.Google Scholar
Fukushima, H, Terasawa, Y and Umeda, S (2011) Association between interoception and empathy: evidence from heartbeat-evoked brain potential. International Journal of Psychophysiology 79, 259–265.Google Scholar
Füstös, J, Gramann, K, Herbert, BM and Pollatos, O (2013) On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Social Cognitive and Affective Neuroscience 8, 911–917.Google Scholar
Garfinkel, SN, Seth, AK, Barrett, AB, Suzuki, K and Critchley, HD (2015) Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology 104, 65–74.Google Scholar
Garner, DM (2004) EDI 3: Eating Disorder Inventory-3: Professional Manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Garner, DM, Olmstead, MP and Polivy, J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders 2,, 15–34.Google Scholar
Gratz, KL (2001) Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment 23, 253–263.Google Scholar
Guan, K, Fox, KR and Prinstein, MJ (2012) Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal of Consulting and Clinical Psychology 80, 842–849.Google Scholar
Gutierrez, PM, Osman, A, Barrios, FX and Kopper, BA (2001) Development and initial validation of the Self-Harm Behavior Questionnaire. Journal of Personality Assessment 77, 475–490.Google Scholar
Henry, JD and Crawford, JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology 44, 227–239.Google Scholar
Hölzel, BK, Lazar, SW, Gard, T, Schuman-Olivier, Z, Vago, DR and Ott, U (2011) How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 6, 537–559.Google Scholar
Hooley, JM and St Germain, SA (2014) Should we expand the conceptualization of self-injurious behavior? Rationale, review, and recommendations. In Nock, MK (ed.), The Oxford Handbook of Suicide and Self-Injury. Oxford, UK: Oxford University Press, pp. 47–60.Google Scholar
Hooley, JM, Ho, DT, Slater, J and Lockshin, A (2010) Pain perception and nonsuicidal self-injury: a laboratory investigation. Personality Disorders: Theory, Research, and Treatment 1, 170–179.Google Scholar
Hoyert, DL and Xu, J (2012) Deaths: preliminary data for 2011. National Vital Statistics Reports 61, 1–64.Google Scholar
Khalsa, SS, Adolphs, R, Cameron, OG, Critchley, HD, Davenport, PW, Feinstein, JS, Feusner, JD, Garfinkel, SN, Lane, RD, Mehling, WE, Meuret, AE, Nemeroff, CB, Oppenheimer, S, Petzschner, FH, Pollatos, O, Rhudy, JL, Schramm, LP, Simmons, WK, Stein, MB, Stephan, KE, Van den Bergh, O, Van Diest, I, von Leupoldt, A and Paulus, MP, Interoception Summit 2016 participants (2018) Interoception and mental health: a roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 3, 501–513.Google Scholar
Klonsky, ED and Glenn, CR (2009) Assessing the functions of non-suicidal self-injury: psychometric properties of the inventory of statements about self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment 31, 215–219.Google Scholar
Klonsky, ED and May, AM (2015) The three-step theory (3ST): a new theory of suicide rooted in the ‘ideation-to-action’ framework. International Journal of Cognitive Therapy 8, 114–129.Google Scholar
Klonsky, ED, May, AM and Glenn, CR (2013) The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. Journal of Abnormal Psychology 122, 231–237.Google Scholar
Lewinsohn, PM, Seeley, JR, Roberts, RE, Allen, NB (1997) Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging 12, 277–287.Google Scholar
Linehan, MM (1993) Cognitive Behavioral Therapy of Borderline Personality Disorder. New York: Guilford Press.Google Scholar
MacCormack, JK and Lindquist, KA (2017) Bodily contributions to emotion: Schachter's legacy for a psychological constructionist view on emotion. Emotion Review 9, 36–45.Google Scholar
Mason, W and Suri, S (2012) Conducting behavioral research on Amazon's Mechanical Turk. Behavior Research 44, 1–23.Google Scholar
May, AM and Klonsky, ED (2016) What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology: Science and Practice 23, 5–20.Google Scholar
Mehling, WE, Price, C, Daubenmier, JJ, Acree, M, Bartmess, E and Stewart, A (2012) The multidimensional assessment of interoceptive awareness (MAIA). PLoS ONE 7, e48230.Google Scholar
Muehlenkamp, JJ and Gutierrez, PM (2007) Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research 11, 69–82.Google Scholar
Muehlenkamp, JJ, Swanson, JD and Brausch, AM (2005) Self-objectification, risk taking, and self-harm in college women. Psychology of Women Quarterly 29, 24–32.Google Scholar
Muehlenkamp, JJ, Peat, CM, Claes, L and Smits, D (2012) Self-injury and disordered eating: expressing emotion dysregulation through the body. Suicide and Life-Threatening Behavior 42, 416–425.Google Scholar
Muehlenkamp, JJ, Bagge, CL, Tull, MT and Gratz, KL (2013) Body regard as a moderator of the relation between emotion dysregulation and nonsuicidal self-injury. Suicide and Life-Threatening Behavior 43, 479–493.Google Scholar
Nock, MK, Joiner, TE, Gordon, KH, Lloyd-Richardson, E and Prinstein, MJ (2006) Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research 144, 65–72.Google Scholar
Nock, MK, Holmberg, EB, Photos, VI and Michel, BD (2007) Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychological Assessment 19, 309–317.Google Scholar
Noma, S, ‘ichi, UT, Ono, M, Miyagi, T and Murai, T (2015) Differences between nonsuicidal self-injury and suicidal behavior in patients with eating disorders. Journal of Psychiatric Practice 21, 198–207.Google Scholar
O'Connor, RC, Cleare, S, Eschle, S, Wetherall, K and Kirtley, OJ (2016) The integrated motivational-volitional model of suicidal behaviour: an update. In O'Connor, RC and Pirkis, J (eds), The International Handbook of Suicide Prevention, 2nd Edn. Chichester: Wiley-Blackwell, pp. 220–240.Google Scholar
Peat, CM and Muehlenkamp, JJ (2011) Self-objectification, disordered eating, and depression: a test of mediational pathways. Psychology of Women Quarterly 35, 441–450.Google Scholar
Pollatos, O, Füstös, J and Critchley, HD (2012) On the generalised embodiment of pain: how interoceptive sensitivity modulates cutaneous pain perception. Pain 153, 1680–1686.Google Scholar
Radloff, LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.Google Scholar
Reynolds, WM (1988) SIQ, Suicidal Ideation Questionnaire: Professional Manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Reynolds, WM (2002) RADS-2: Reynolds Adolescent Depression Scale. Lutz, FL: Psychological Assessment Resources.Google Scholar
Rogers, ML, Hagan, CR and Joiner, TE (2018) Examination of interoception along the suicidality continuum. Journal of Clinical Psychology 74, 1004–1016.Google Scholar
Ross, S, Heath, NL and Toste, JR (2009) Non-suicidal self-injury and eating pathology in high school students. American Journal of Orthopsychiatry 79, 83–92.Google Scholar
Sim, L and Zeman, J (2004) Emotion awareness and identification skills in adolescent girls with bulimia nervosa. Journal of Clinical Child and Adolescent Psychology 33, 760–771.Google Scholar
Smith, A, Forrest, L and Velkoff, E (2018) Out of touch: interoceptive deficits are elevated in suicide attempters with eating disorders. Eating Disorders 26, 52–65.Google Scholar
Turner, BJ, Layden, BK, Butler, SM and Chapman, AL (2013) How often, or how many ways: clarifying the relationship between non-suicidal self-injury and suicidality. Archives of Suicide Research 17, 397–415.Google Scholar
Van Orden, KA, Witte, TK, Cukrowicz, KC, Braithwaite, SR, Selby, EA and Joiner, TE Jr (2010) The interpersonal theory of suicide. Psychological Review 117, 575–600.Google Scholar
Venta, A, Mellick, W, Schatte, D and Sharp, D (2014) Preliminary evidence that thoughts of thwarted belongingness mediate the relations between level of attachment insecurity and depression and suicide-related thoughts in inpatient adolescents. Journal of Social and Clinical Psychology 33, 428–447.Google Scholar
Victor, SE and Klonsky, ED (2014) Correlates of suicide attempts among self-injurers: a meta-analysis. Clinical Psychology Review 34, 282–297.Google Scholar
Weiss, S, Sack, M, Henningsen, P and Pollatos, O (2014) On the interaction of self-regulation, interoception and pain perception. Psychopathology 47, 377–382.Google Scholar
World Health Organization – Preventing suicide: A global imperative. Available at http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/) (Accessed 8 September 2014).Google Scholar
Supplementary material: File

Hagan et al. supplementary material

Tables S1-S5

Download Hagan et al. supplementary material(File)
File 37.2 KB