Interpersonal-Psychological Theory of Suicide
Individuals who struggle with maladaptive eating behaviors often
experience impaired interpersonal functioning. Interpersonal dysfunction
is theorized to impact suicide risk (Joiner, 2005; Van Orden et al.,
2010). The interpersonal-psychological theory of suicide (IPTS; Van
Orden, 2010) is one of the more prominent theoretical frameworks of
suicide risk. There are three constructs central to this theory that are
necessary and sufficient for suicidal behavior: thwarted belongingness,
perceived burdensomeness, and capability for suicide (Van Orden, 2010).
According to the IPTS, thwarted belongingness is a feeling of social
isolation, like one does not belong to a group or belong with other
people and includes feelings of loneliness and the absence of
reciprocally caring relationships. Perceived burdensomeness is a feeling
that one is a burden on their family, friends, and/or society and that
these individuals would be better off without them, accompanying
feelings include liability and self-hate. Capability for suicide is
characterized by the loss of fear associated with death as well as the
ability to attempt to kill oneself. Both thwarted belongingness and
perceived burdensomeness are cognitive affective states that are likely
to vary over time, whereas capability is associated with habituation,
physical means, and underlying traits.
Suicide risk is thus determined by two progressive stages. The first
stage of the IPTS is associated with the desire for suicide, or suicidal
ideation, which develops from the simultaneous presence of both thwarted
belongingness and perceived burdensomeness and are both viewed as being
unamenable to change via the feeling of hopelessness. As such, the
desire for suicide will develop and will be manifested behaviorally as
active suicidal ideation (Joiner, 2005; Van Orden, 2010). The second
stage of the IPTS is associated with the capability to engage in
suicidal behavior. For a lethal, or near-lethal, attempt to occur, one
must have the desire for death (i.e., stage one) in addition to the
capability to engage in suicidal behavior. The capability to engage in
suicidal behavior is enhanced by habituation to situations that normally
produce feelings of fear, anxiety, and avoidance. In contrast to
thwarted belongingness and perceived burdensomeness, capability is a
construct that is stable and less amenable to therapeutic change, except
for physical means (e.g., removing weapons from a person’s environment).
It is based on both genetic components in addition to exposure to life
events that increase fearlessness about death (via habituation) and
increased pain tolerance (e.g., previous suicide attempts, non-suicidal
self- injury). It is theorized that habituation to pain and fear may
also occur via painful maladaptive eating behaviors (e.g., compulsive
exercise, self-induced vomiting, self-starvation; Smith et al., 2018).