Impulsivity has long been thought to be an important risk factor for suicide. But recent research, described in this article, suggests that the reality is counterintuitive.
Answer C: Impulsivity is similarly elevated in people who have made suicide attempts (attempters) and those who have suicidal thoughts but have never attempted (ideators only).
A new theory of suicide positioned within the ideation-to-action framework is the 3-step theory (3ST). The 3ST makes 3 central claims (summarized below), all of which are consistent with existing evidence that is supported by recent findings.1
1. the combination of pain and hopelessness is what brings about suicidal ideation.1 If the experience of pain is accompanied by hopelessness (over the idea that the pain will never improve), suicidal thinking begins.
2. connectedness prevents suicidal ideation from escalating in those at risk (ie, those experiencing both pain and hopelessness). In other words, if connectedness to life—to loved ones, to a valued role, or to any sense of meaning or purpose—exceeds the pain, suicidal ideation will remain at modest levels. If pain exceeds connectedness, suicidal ideation becomes strong and active. Recent findings support this notion: connectedness was found to be a significant buffer against suicidal ideation only in those with pain and hopelessness; in everyone else, connectedness is negligibly related to suicidal ideation.1
3. strong suicidal ideation leads to a suicide attempt if, and only if, one has the capacity to make an attempt. Three categories of variables contribute to suicide capacity: dispositional, acquired, and practical. Recent research has found that each of these 3 variables predicts suicide attempt history, even when controlling for past and current suicidal ideation.
1. Klonsky ED, May AM. The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther. 2015(8):114-129.
For detailed information, please see “Impulsivity and Suicide Risk: Review and Clinical Implications,” by E. David Klonsky, PhD and Alexis M. May, MA, on which this quiz was based.