539007 research-article2014
APAXXX10.1177/0003065114539007Poster SummariesPoster Summaries
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Poster Summaries
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POSTER SUMMARIES FROM THE 2014 POSTER SESSION OF THE AMERICAN PSYCHOANALYTIC ASSOCIATION I mpact of O b j ect R elations an d I mpulsi v ity O n P ersistent S uici d al Behav ior
Katie C. Lewis (Department of Psychology, Long Island University; Department of Psychiatry, Albany Medical Center) Kevin B. Meehan (Department of Psychology, Long Island University) Jane G. Tillman (Erikson Institute, Austen Riggs Center) Nicole M. Cain and Philip C. Wong (Department of Psychology, Long Island University) A. Jill Clemence (Department of Psychiatry, Albany Medical Center; Erikson Institute, Austen Riggs Center) Jennifer Stevens (Erikson Institute, Austen Riggs Center) DOI: 10.1177/0003065114539007
Suicide has been identified consistently over the past decade as one of the leading causes of death in the United States. Between the years 2009– 2011, suicide was estimated to be one of the top five leading causes of death for people between the ages of five and forty-four (Murphy, Xu, Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
485
Poster Summaries
and Kochanek 2012). Clinical populations are at an especially elevated risk for suicide (Ortigo, Westen, and Bradley 2009), and those with a history of suicide attempts are more likely to make an attempt than those with no suicidal history (Joiner et al. 2005). Several studies have identified impulsivity as an important risk factor for suicide (e.g., Nock and Kessler 2006; Witte et al. 2008), although the exact role of impulsivity in the development of and capacity for suicidal behavior remains unclear. Hakansson et al. (2011) found that subjects who made multiple suicide attempts throughout their lifetime reported higher impulsivity-related traits, such as difficulty controlling anger and an inability to maintain concentration. However, Nakagawa et al. (2009) found that the level of planning for a recent suicide attempt was unrelated to trait levels of impulsivity—that is, individuals who attempted suicide with little forethought had similar levels of impulsivity compared to those who spent a significant amount of time planning their attempt. Research has also shown that poor quality of object relations, defined as an internal understanding of the world and others that is poorly differentiated, illogical, or polarized in affective tone, is associated with psychiatric disturbance in several domains, including suicidal behavior (Twomey, Kaslow, and Croft 2000). Kaslow et al. (1998), for example, found that subjects with a recent suicide attempt demonstrated lower complexity and more malevolent affective quality of internal representations in comparison to subjects with no history of suicidal behavior, as well as a lower emotional investment in interpersonal relationships. The capacity to manage impulsive urges may be related to underlying quality of object representations, in that both are associated with emotional regulation capacities. Several studies have shown that a specific type of impulsivity, in which impulsive behavior arises only in the context of overwhelming negative affect (“negative urgency”), is related to suicidal behavior (Bornavalova et al. 2011; Klonsky and May 2010). These findings support other research demonstrating the importance of loss of self-regulatory functions (indicated by loss of impulse control) in “hot,” emotionally-activating situations (Cain et al. 2013; Meehan et al. 2013; Mischel and Ayduk 2002) and confirm that such a response pattern can facilitate engagement in suicidal behavior. To date, no study has evaluated the impact of impulsivity and quality of object representations on the emergence and chronicity of suicidal behavior. The current study sought to explore this relationship within a sample of treatment-resistant patients. Specifically, the following 486
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
hypotheses were investigated: (1) Subjects with a history of suicide attempts demonstrate poorer quality of object relations in both cognitive and affective domains. (2) Subjects with a history of suicide attempts demonstrate higher levels of attentional, motor, and non-planning impulsivity. (3) Poorer quality of object-relational functioning is associated with heightened risk for chronic suicidal behavior in highly impulsive individuals, but not in those with lower levels of impulsivity. Method
Subjects currently in residential treatment were recruited as part of a larger study on near-lethal suicide attempts. Participation was voluntary, and informed consent was obtained. All patients had been in four-timesweekly psychodynamic psychotherapy at the hospital for at least six weeks before admission to the study. Exclusion criteria included a suicide attempt made during the current hospitalization, obvious organic impairment, or acute psychosis. Patients were administered a series of questionnaires as part of their participation in the larger study. The present study used self-reported demographic information obtained from the Suicide Attempt Questionnaire (Tillman, Clemence, and Stevens 2008) and data on impulsivity levels from the Barratt Impulsiveness Scale (BIS-11; Patton, Stanford, and Barratt 1995). The BIS-11 yields subscale ratings on three dimensions: attentional impulsiveness (capacity to maintain concentration and sustained focus); motor impulsiveness (tendency to engage in impulsive decision making or unplanned actions); and non-planning impulsiveness (ability to plan and prepare for future events and to consider cause and consequence). Object-relational functioning was assessed using the Social Cognition and Object Relations Scale–Global Method (SCORS-G; Stein et al. 2011), a coding system applied by trained raters to participant Thematic Apperception Test narratives. The SCORS integrates psychodynamic and cognitive theoretical approaches to assess quality of internalized object representations on eight cognitive and affective dimensions. Participant gender, borderline personality disorder diagnostic status, and mean scores from the Reasons for Living scale (RFL; Linehan et al.) were included as covariates in all statistical analyses. Results
The final subject pool for the current study consisted of 124 treatment- resistant individuals. Subjects were predominantly female (63%) and Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
487
Poster Summaries
Caucasian (89%). Of the 124 participants, 67 reported at least one past suicide attempt. Participants were on average 33.1 years old (SD = 12.63) and carried an average of approximately three DSM-IV-TR Axis I diagnoses. Of those who had a history of suicide attempts, the number of lifetime attempts ranged from 1 to 12; most patients in the suicidal group had attempted suicide more than once (n = 41). No differences in object-relational functioning in attempters versus nonattempters. A logistic regression was used to test the hypothesis that subjects with a history of suicide attempts would demonstrate greater impairments in object-relational functioning compared to subjects with no such history. In the current sample, contrary to expectations, object-relational functioning did not differentiate between suicide attempters and non-attempters. No differences in impulsivity in attempters versus non-attempters. A logistic regression was used to test the hypothesis that subjects with a history of suicide attempts would demonstrate higher levels of attentional, motor, and non-planning impulsivity compared to subjects with no such history. Similar to our object relations findings, in the current sample impulsivity levels did not differentiate between subjects with a history of suicide attempts and those without. Interaction of object-relational functioning and impulsivity relates to frequency of attempts. A series of regression analyses were conducted to explore the potential moderating impact of impulsivity on object-relational functioning and the frequency of past suicidal behavior. Interaction terms were calculated between the three BIS subscales and the eight SCORS subscales; post hoc probing of significant moderation effects was conducted as recommended by Holmbeck (1997, 2002). (See Table 1.) Participants with higher levels of non-planning impulsivity were more likely to have a higher number of past suicide attempts if they also demonstrated impairments in managing aggressive impulses (the aggression subscale of SCORS); this effect was not seen in participants with low levels of non-planning impulsivity (see Figure 1). No significant moderating effects were found for attentional or motor impulsivity, or for any of the other object relations subscales. Discussion
Our study found no global differences in either object-relational functioning or impulsivity between attempters and non-attempters. Our first hypothesis, that individuals with past suicidal behavior would demonstrate greater impairments in object-relational functioning, failed to
488
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
Table 1. Interaction of non-planning impulsivity and management of aggressive impulses on lifetime suicide attempts Variable Step 1 Constant RFL Step 2 Constant RFL AGG Step 3 Constant RFL AGG BIS-NP Step 4 Constant RFL AGG BIS-NP AGG*BIS-NP
B
SE B
1.41** -.69
.18 .20
1.42** -.63** -.56
.18 .21 .52
1.42** -.64** -.55 .01
.18 .21 .52 .03
1.39** -.60** .70 .01 -.20*
.17 .21 .52 .03 .08
β -.30 -.28 -.10 -.24 -.10 .02 -.26 .12 .03 -.21
N = 118. BIS-NP = Barratt Impulsiveness Scale–Non-planning subscale; RFL = Reasons for Living scale. AGG = Social Cognition and Object Relations Scale–Aggression subscale. R2 = .09 for Step 1, ΔR2 = .01 for Step 2 (n.s.), ΔR2 = .00 for Step 3 (n.s.), ΔR2 = .04 (p < .05) for Step 4. *p < .05, ** p < .01
yield significant results. Our second hypothesis, that there would be global differences in impulsivity levels in suicide attempters versus nonattempters, similarly failed to produce significant results. These findings are in contrast to research demonstrating a connection between both object-relational impairments (Kaslow et al. 1998) and impulsivity (Gvion and Apter 2011) and heightened suicide risk. Despite these unanticipated results, significant interactions did emerge between the SCORS aggression subscale and levels of non-planning impulsivity. Participants with higher levels of non-planning impulsivity were more likely to have a higher number of past suicide attempts if they also demonstrated a hostile or malevolent quality of internalized object representations; this effect was not seen in participants with low levels of non-planning impulsivity. No significant moderating effects
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
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Poster Summaries
Figure 1. Impact of high non-planning impulsivity and management of aggressive impulses on lifetime suicide attempts
AGG = Social Cognition and Object Relations Scale–Aggression subscale. NP = BIS nonplanning impulsivity. Higher scores on the SCORS variables represent healthier functioning. *p < .05, ** p < .01
were found for other measured forms of impulsivity, or for any of the other object relations variables. While most studies have investigated the relationship between aggression and impulsivity using self-report or behavioral measures, the current study is the first to compare unconscious aggressive quality of internalized representations assessed through projective techniques to self-reported levels of trait impulsivity in the prediction of suicidal behavior. Despite this methodological difference, our results remain consistent with what has been found in previous empirical studies. Giegling and colleagues (2009), for example, found that higher aggression turned inward related to impulsive suicide attempts in a sample of psychiatric inpatients. Within the paradigm of object relations theory, Maltsberger and colleagues (2011) have similarly suggested that impairments in affect regulation contribute to a difficulty in planning, leaving suicidal individuals without sufficient cognitive resources for navigating and surviving affective storms. Although much work undoubtedly remains to be done in better understanding the relationship between aggression and impulsivity in the prediction of suicidal behavior, these results provide early support for the idea that internalized hostility contributes to heightened risk for suicide in individuals who manifest trait levels of difficulty in considering cause and effect.
490
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
References
Bornavalova, M., Tull, M., Gratz, K., Levy, R., & Lejuez, C. (2011). Extending models of deliberate self-harm and suicide attempts to substance users: Exploring the roles of childhood abuse, posttraumatic stress, and difficulties controlling impulsive behavior when distressed. Psychological Trauma: Theory, Research, Practice, Policy 3:349–359. Cain, N.M., De Panfilis, C., Meehan, K.B., & Clarkin, J.F. (2013). Assessing interpersonal profiles associated with varying levels of effortful control. Journal of Personality Assessment 95:640–644. Giegling, I., Olgiati, P., Hartmann, A.M., Calati, R., Möller, H.J., Rujescu, D., & Serretti, A. (2009). Personality and attempted suicide: analysis of anger, aggression and impulsivity. Journal of Psychiatric Research 43:1262–1271. Gvion, Y., & Apter, A. (2011). Aggression, impulsivity, and suicide behavior: A review of the literature. Archives of Suicide Research 15:93–112. Hakansson, A., Brådvik, L., Schlyter, F., & Berglund, M. (2011). Variables associated with repeated suicide attempt in a criminal justice population. Suicide & Life-Threatening Behavior 41:517–531. Holmbeck, G. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the childclinical and pediatric psychology literatures. Journal of Consulting & Clinical Psychology 65:599–610. Holmbeck, G. (2002). Post-hoc probing of significant moderational and meditational effects in studies of pediatric populations. Journal of Pediatric Psychology 27:87–96. Joiner, T.E., Conwell, Y., Fitzpatrick, K.K., Witte, T.K., Schmidt, N.B., Berlim, M.T., Fleck, M.P., & Rudd, M.D. (2005). Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. Journal of Abnormal Psychology 114:291–303. Kaslow, N.J., Reviere, S.L., Chance, S.E., Rogers, J.H., Hatcher, C.A., Wasserman, F., Smith, L., Jessee, S., James, M.E., & Seelig, B. (1998). An empirical study of the psychodynamics of suicide. Journal of the American Psychoanalytic Association 46:777–797. Klonsky, E., & May, A. (2010). Rethinking impulsivity in suicide. Suicide & Life-Threatening Behavior 40:612–619. Linehan, M., Goodstein, J., Nielsen, S., & Chiles, J. (1983). Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory. Journal of Consulting & Clinical Psychology 51:276–286. Maltsberger, J.T., Goldblatt, M.J., Ronningstam, E., Weinberg, I., & Schechter, M. (2011). Traumatic subjective experiences invite suicide. Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry 39:671–694.
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
491
Poster Summaries
Meehan, K.B., De Panfilis, C., Cain, N.M., & Clarkin, J.F. (2013). Effortful control and externalizing problems in young adults. Personality & Individual Differences 55:553–558. Mischel, W., & Ayduk, O. (2002). Self-regulation in a Cognitive-Affective Personality System: Attentional control in the service of the self. Self & Identity 1:113–120. Murphy, S., Xu, J., & Kochanek, D. (2012). Deaths: Preliminary data for 2010. National Vital Statistics Report 60(4). Nakagawa, A., Grunebaum, M., Oquendo, M., Burke, A., Kashima, H., & Mann, J. (2009). Clinical correlates of planned, more lethal suicide attempts in major depressive disorder. Journal of Affective Disorders 112:237–242. Nock, M., & Kessler, R. (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. Journal of Abnormal Psychology 115:616–623. Ortigo, K., Westen, D., & Bradley, R. (2009). Personality subtypes of suicidal adults. Journal of Nervous & Mental Disease 197:687–694. Patton, J., Stanford, M., & Barratt, E. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51:768–774. Stein, M., Hilsenroth, M., Slavin-Mulford, J., & Pinsker, J. (2011). Social Cognition and Object Relations Scale: Global Rating Method (SCORS-G, 4th ed.). Unpublished manuscript, Massachusetts General Hospital and Harvard Medical School, Boston. Tillman, J., Clemence, A.J., & Stevens, J. (2008). Suicide Attempt Questionnaire. Unpublished manual, Austen Riggs Center, Stockbridge, MA. Twomey, H.B., Kaslow, N.J., & Croft, S. (2000). Childhood maltreatment, object relations, and suicidal behavior in women. Psychoanalytic Psychology 17:313–335. Witte, T.K., Merrill, K.A., Stellrecht, N.E., Bernert, R., Hollar, D., Schatschneider, C., & Joiner, T.E. (2008). “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal of Affective Disorders 107:107–116. This poster received the PPRS / Stuart T. Hauser Poster Award. Katie C. Lewis Albany Medical College Department of Psychiatry South Clinical Campus, MC 164 25 Hackett Boulevard Albany, NY 12208 E-mail: [email protected]
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APAXXX10.1177/0003065114539007Poster SummariesPoster Summaries
ja Pa
Poster Summaries
62/3
POSTER SUMMARIES FROM THE 2014 POSTER SESSION OF THE AMERICAN PSYCHOANALYTIC ASSOCIATION I mpact of O b j ect R elations an d I mpulsi v ity O n P ersistent S uici d al Behav ior
Katie C. Lewis (Department of Psychology, Long Island University; Department of Psychiatry, Albany Medical Center) Kevin B. Meehan (Department of Psychology, Long Island University) Jane G. Tillman (Erikson Institute, Austen Riggs Center) Nicole M. Cain and Philip C. Wong (Department of Psychology, Long Island University) A. Jill Clemence (Department of Psychiatry, Albany Medical Center; Erikson Institute, Austen Riggs Center) Jennifer Stevens (Erikson Institute, Austen Riggs Center) DOI: 10.1177/0003065114539007
Suicide has been identified consistently over the past decade as one of the leading causes of death in the United States. Between the years 2009– 2011, suicide was estimated to be one of the top five leading causes of death for people between the ages of five and forty-four (Murphy, Xu, Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
485
Poster Summaries
and Kochanek 2012). Clinical populations are at an especially elevated risk for suicide (Ortigo, Westen, and Bradley 2009), and those with a history of suicide attempts are more likely to make an attempt than those with no suicidal history (Joiner et al. 2005). Several studies have identified impulsivity as an important risk factor for suicide (e.g., Nock and Kessler 2006; Witte et al. 2008), although the exact role of impulsivity in the development of and capacity for suicidal behavior remains unclear. Hakansson et al. (2011) found that subjects who made multiple suicide attempts throughout their lifetime reported higher impulsivity-related traits, such as difficulty controlling anger and an inability to maintain concentration. However, Nakagawa et al. (2009) found that the level of planning for a recent suicide attempt was unrelated to trait levels of impulsivity—that is, individuals who attempted suicide with little forethought had similar levels of impulsivity compared to those who spent a significant amount of time planning their attempt. Research has also shown that poor quality of object relations, defined as an internal understanding of the world and others that is poorly differentiated, illogical, or polarized in affective tone, is associated with psychiatric disturbance in several domains, including suicidal behavior (Twomey, Kaslow, and Croft 2000). Kaslow et al. (1998), for example, found that subjects with a recent suicide attempt demonstrated lower complexity and more malevolent affective quality of internal representations in comparison to subjects with no history of suicidal behavior, as well as a lower emotional investment in interpersonal relationships. The capacity to manage impulsive urges may be related to underlying quality of object representations, in that both are associated with emotional regulation capacities. Several studies have shown that a specific type of impulsivity, in which impulsive behavior arises only in the context of overwhelming negative affect (“negative urgency”), is related to suicidal behavior (Bornavalova et al. 2011; Klonsky and May 2010). These findings support other research demonstrating the importance of loss of self-regulatory functions (indicated by loss of impulse control) in “hot,” emotionally-activating situations (Cain et al. 2013; Meehan et al. 2013; Mischel and Ayduk 2002) and confirm that such a response pattern can facilitate engagement in suicidal behavior. To date, no study has evaluated the impact of impulsivity and quality of object representations on the emergence and chronicity of suicidal behavior. The current study sought to explore this relationship within a sample of treatment-resistant patients. Specifically, the following 486
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
hypotheses were investigated: (1) Subjects with a history of suicide attempts demonstrate poorer quality of object relations in both cognitive and affective domains. (2) Subjects with a history of suicide attempts demonstrate higher levels of attentional, motor, and non-planning impulsivity. (3) Poorer quality of object-relational functioning is associated with heightened risk for chronic suicidal behavior in highly impulsive individuals, but not in those with lower levels of impulsivity. Method
Subjects currently in residential treatment were recruited as part of a larger study on near-lethal suicide attempts. Participation was voluntary, and informed consent was obtained. All patients had been in four-timesweekly psychodynamic psychotherapy at the hospital for at least six weeks before admission to the study. Exclusion criteria included a suicide attempt made during the current hospitalization, obvious organic impairment, or acute psychosis. Patients were administered a series of questionnaires as part of their participation in the larger study. The present study used self-reported demographic information obtained from the Suicide Attempt Questionnaire (Tillman, Clemence, and Stevens 2008) and data on impulsivity levels from the Barratt Impulsiveness Scale (BIS-11; Patton, Stanford, and Barratt 1995). The BIS-11 yields subscale ratings on three dimensions: attentional impulsiveness (capacity to maintain concentration and sustained focus); motor impulsiveness (tendency to engage in impulsive decision making or unplanned actions); and non-planning impulsiveness (ability to plan and prepare for future events and to consider cause and consequence). Object-relational functioning was assessed using the Social Cognition and Object Relations Scale–Global Method (SCORS-G; Stein et al. 2011), a coding system applied by trained raters to participant Thematic Apperception Test narratives. The SCORS integrates psychodynamic and cognitive theoretical approaches to assess quality of internalized object representations on eight cognitive and affective dimensions. Participant gender, borderline personality disorder diagnostic status, and mean scores from the Reasons for Living scale (RFL; Linehan et al.) were included as covariates in all statistical analyses. Results
The final subject pool for the current study consisted of 124 treatment- resistant individuals. Subjects were predominantly female (63%) and Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
487
Poster Summaries
Caucasian (89%). Of the 124 participants, 67 reported at least one past suicide attempt. Participants were on average 33.1 years old (SD = 12.63) and carried an average of approximately three DSM-IV-TR Axis I diagnoses. Of those who had a history of suicide attempts, the number of lifetime attempts ranged from 1 to 12; most patients in the suicidal group had attempted suicide more than once (n = 41). No differences in object-relational functioning in attempters versus nonattempters. A logistic regression was used to test the hypothesis that subjects with a history of suicide attempts would demonstrate greater impairments in object-relational functioning compared to subjects with no such history. In the current sample, contrary to expectations, object-relational functioning did not differentiate between suicide attempters and non-attempters. No differences in impulsivity in attempters versus non-attempters. A logistic regression was used to test the hypothesis that subjects with a history of suicide attempts would demonstrate higher levels of attentional, motor, and non-planning impulsivity compared to subjects with no such history. Similar to our object relations findings, in the current sample impulsivity levels did not differentiate between subjects with a history of suicide attempts and those without. Interaction of object-relational functioning and impulsivity relates to frequency of attempts. A series of regression analyses were conducted to explore the potential moderating impact of impulsivity on object-relational functioning and the frequency of past suicidal behavior. Interaction terms were calculated between the three BIS subscales and the eight SCORS subscales; post hoc probing of significant moderation effects was conducted as recommended by Holmbeck (1997, 2002). (See Table 1.) Participants with higher levels of non-planning impulsivity were more likely to have a higher number of past suicide attempts if they also demonstrated impairments in managing aggressive impulses (the aggression subscale of SCORS); this effect was not seen in participants with low levels of non-planning impulsivity (see Figure 1). No significant moderating effects were found for attentional or motor impulsivity, or for any of the other object relations subscales. Discussion
Our study found no global differences in either object-relational functioning or impulsivity between attempters and non-attempters. Our first hypothesis, that individuals with past suicidal behavior would demonstrate greater impairments in object-relational functioning, failed to
488
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
Table 1. Interaction of non-planning impulsivity and management of aggressive impulses on lifetime suicide attempts Variable Step 1 Constant RFL Step 2 Constant RFL AGG Step 3 Constant RFL AGG BIS-NP Step 4 Constant RFL AGG BIS-NP AGG*BIS-NP
B
SE B
1.41** -.69
.18 .20
1.42** -.63** -.56
.18 .21 .52
1.42** -.64** -.55 .01
.18 .21 .52 .03
1.39** -.60** .70 .01 -.20*
.17 .21 .52 .03 .08
β -.30 -.28 -.10 -.24 -.10 .02 -.26 .12 .03 -.21
N = 118. BIS-NP = Barratt Impulsiveness Scale–Non-planning subscale; RFL = Reasons for Living scale. AGG = Social Cognition and Object Relations Scale–Aggression subscale. R2 = .09 for Step 1, ΔR2 = .01 for Step 2 (n.s.), ΔR2 = .00 for Step 3 (n.s.), ΔR2 = .04 (p < .05) for Step 4. *p < .05, ** p < .01
yield significant results. Our second hypothesis, that there would be global differences in impulsivity levels in suicide attempters versus nonattempters, similarly failed to produce significant results. These findings are in contrast to research demonstrating a connection between both object-relational impairments (Kaslow et al. 1998) and impulsivity (Gvion and Apter 2011) and heightened suicide risk. Despite these unanticipated results, significant interactions did emerge between the SCORS aggression subscale and levels of non-planning impulsivity. Participants with higher levels of non-planning impulsivity were more likely to have a higher number of past suicide attempts if they also demonstrated a hostile or malevolent quality of internalized object representations; this effect was not seen in participants with low levels of non-planning impulsivity. No significant moderating effects
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
489
Poster Summaries
Figure 1. Impact of high non-planning impulsivity and management of aggressive impulses on lifetime suicide attempts
AGG = Social Cognition and Object Relations Scale–Aggression subscale. NP = BIS nonplanning impulsivity. Higher scores on the SCORS variables represent healthier functioning. *p < .05, ** p < .01
were found for other measured forms of impulsivity, or for any of the other object relations variables. While most studies have investigated the relationship between aggression and impulsivity using self-report or behavioral measures, the current study is the first to compare unconscious aggressive quality of internalized representations assessed through projective techniques to self-reported levels of trait impulsivity in the prediction of suicidal behavior. Despite this methodological difference, our results remain consistent with what has been found in previous empirical studies. Giegling and colleagues (2009), for example, found that higher aggression turned inward related to impulsive suicide attempts in a sample of psychiatric inpatients. Within the paradigm of object relations theory, Maltsberger and colleagues (2011) have similarly suggested that impairments in affect regulation contribute to a difficulty in planning, leaving suicidal individuals without sufficient cognitive resources for navigating and surviving affective storms. Although much work undoubtedly remains to be done in better understanding the relationship between aggression and impulsivity in the prediction of suicidal behavior, these results provide early support for the idea that internalized hostility contributes to heightened risk for suicide in individuals who manifest trait levels of difficulty in considering cause and effect.
490
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
Poster Summaries
References
Bornavalova, M., Tull, M., Gratz, K., Levy, R., & Lejuez, C. (2011). Extending models of deliberate self-harm and suicide attempts to substance users: Exploring the roles of childhood abuse, posttraumatic stress, and difficulties controlling impulsive behavior when distressed. Psychological Trauma: Theory, Research, Practice, Policy 3:349–359. Cain, N.M., De Panfilis, C., Meehan, K.B., & Clarkin, J.F. (2013). Assessing interpersonal profiles associated with varying levels of effortful control. Journal of Personality Assessment 95:640–644. Giegling, I., Olgiati, P., Hartmann, A.M., Calati, R., Möller, H.J., Rujescu, D., & Serretti, A. (2009). Personality and attempted suicide: analysis of anger, aggression and impulsivity. Journal of Psychiatric Research 43:1262–1271. Gvion, Y., & Apter, A. (2011). Aggression, impulsivity, and suicide behavior: A review of the literature. Archives of Suicide Research 15:93–112. Hakansson, A., Brådvik, L., Schlyter, F., & Berglund, M. (2011). Variables associated with repeated suicide attempt in a criminal justice population. Suicide & Life-Threatening Behavior 41:517–531. Holmbeck, G. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the childclinical and pediatric psychology literatures. Journal of Consulting & Clinical Psychology 65:599–610. Holmbeck, G. (2002). Post-hoc probing of significant moderational and meditational effects in studies of pediatric populations. Journal of Pediatric Psychology 27:87–96. Joiner, T.E., Conwell, Y., Fitzpatrick, K.K., Witte, T.K., Schmidt, N.B., Berlim, M.T., Fleck, M.P., & Rudd, M.D. (2005). Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. Journal of Abnormal Psychology 114:291–303. Kaslow, N.J., Reviere, S.L., Chance, S.E., Rogers, J.H., Hatcher, C.A., Wasserman, F., Smith, L., Jessee, S., James, M.E., & Seelig, B. (1998). An empirical study of the psychodynamics of suicide. Journal of the American Psychoanalytic Association 46:777–797. Klonsky, E., & May, A. (2010). Rethinking impulsivity in suicide. Suicide & Life-Threatening Behavior 40:612–619. Linehan, M., Goodstein, J., Nielsen, S., & Chiles, J. (1983). Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory. Journal of Consulting & Clinical Psychology 51:276–286. Maltsberger, J.T., Goldblatt, M.J., Ronningstam, E., Weinberg, I., & Schechter, M. (2011). Traumatic subjective experiences invite suicide. Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry 39:671–694.
Downloaded from apa.sagepub.com at UNIV OF MONTANA on April 5, 2015
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Poster Summaries
Meehan, K.B., De Panfilis, C., Cain, N.M., & Clarkin, J.F. (2013). Effortful control and externalizing problems in young adults. Personality & Individual Differences 55:553–558. Mischel, W., & Ayduk, O. (2002). Self-regulation in a Cognitive-Affective Personality System: Attentional control in the service of the self. Self & Identity 1:113–120. Murphy, S., Xu, J., & Kochanek, D. (2012). Deaths: Preliminary data for 2010. National Vital Statistics Report 60(4). Nakagawa, A., Grunebaum, M., Oquendo, M., Burke, A., Kashima, H., & Mann, J. (2009). Clinical correlates of planned, more lethal suicide attempts in major depressive disorder. Journal of Affective Disorders 112:237–242. Nock, M., & Kessler, R. (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. Journal of Abnormal Psychology 115:616–623. Ortigo, K., Westen, D., & Bradley, R. (2009). Personality subtypes of suicidal adults. Journal of Nervous & Mental Disease 197:687–694. Patton, J., Stanford, M., & Barratt, E. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51:768–774. Stein, M., Hilsenroth, M., Slavin-Mulford, J., & Pinsker, J. (2011). Social Cognition and Object Relations Scale: Global Rating Method (SCORS-G, 4th ed.). Unpublished manuscript, Massachusetts General Hospital and Harvard Medical School, Boston. Tillman, J., Clemence, A.J., & Stevens, J. (2008). Suicide Attempt Questionnaire. Unpublished manual, Austen Riggs Center, Stockbridge, MA. Twomey, H.B., Kaslow, N.J., & Croft, S. (2000). Childhood maltreatment, object relations, and suicidal behavior in women. Psychoanalytic Psychology 17:313–335. Witte, T.K., Merrill, K.A., Stellrecht, N.E., Bernert, R., Hollar, D., Schatschneider, C., & Joiner, T.E. (2008). “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal of Affective Disorders 107:107–116. This poster received the PPRS / Stuart T. Hauser Poster Award. Katie C. Lewis Albany Medical College Department of Psychiatry South Clinical Campus, MC 164 25 Hackett Boulevard Albany, NY 12208 E-mail: [email protected]
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