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).