Clarifying the association of eating disorder features to suicide ideation and attempts.

OBJECTIVE: We examine the relationships of eight eating disorder (ED) features to histories of suicide ideation and suicide attempts. METHOD: Participants were 387 adults (62% female, mean age = 36 years) recruited via an online platform, and oversampled for the presence of ED features, who completed standardized self-report measures of study variables. RESULTS: Different ED features predicted suicide ideation versus attempts. Specifically, Restrictive Eating (d = 0.44), Purging (d = 0.30), and Body Dissatisfaction (d = 0.27) were higher among ideators compared to nonsuicidal participants. In contrast, Muscle Building (d = 0.31), Excessive Exercise (d = 0.26), Cognitive Restraint (d = 0.23), and Restrictive Eating (d = 0.20) were higher among attempters compared to ideators-however, we note that the p-values for these effects range between 0.02 and 0.04 and it is unclear if they would replicate. Independent replication is important. CONCLUSION: Findings have implications for the conceptualization of suicide risk in individuals with EDs.

The three-step theory of suicide: Description, evidence, and some useful points of clarification.

There has been considerable uptake of the Three-Step Theory (3ST) of suicide since its publication in 2015. The 3ST is a concise, evidence-based, and actionable theory that explains suicide in terms of four factors: pain, hopelessness, connection, and capability for suicide. The 3ST has not only been cited in hundreds of scientific papers, but incorporated into continuing education programs, gatekeeper training, and self-help resources. In this context, it is useful to clarify the theory's content and review its scientific support. Thus, the present article describes the 3ST, provides an updated evidence review for each of its premises, and offers several points of clarification so that the claims of the 3ST may be better understood, evaluated, and applied. To date, research (including research on correlates, risk factors, motivations, warning signs, and means-safety interventions) supports the 3ST. At the same time, there are aspects of the theory that are challenging to operationalize and that require further testing.

Exploring the scope and structure of suicide capability.

OBJECTIVE: Recent theories of suicide suggest that a construct called "capability for suicide" facilitates the progression from suicidal thoughts to attempts. Various measures of capability have been developed to assess different parts of the construct, but studies report inconsistent findings regarding reliability, validity, and structure. The present study pooled items from multiple measures to identify distinct, reliable, and valid domains of suicide capability. METHOD: We administered items from several suicide capability measures to an online sample of US adults (n = 387), and utilized exploratory factor analysis to identify distinct domains of capability. We then examined the internal consistencies of and intercorrelations among these domains, as well as their associations with suicide attempts. RESULTS: Findings identified three domains of suicide capability: fearlessness about death, practical capability, and pain tolerance. These domains were internally consistent (αs = 0.80-0.92), and relatively independent from one another (intercorrelations = 0.15-0.35). Finally, each of these domains was moderately elevated among attempters compared to ideators (although only fearlessness about death and practical capability offered unique information about attempter status). CONCLUSIONS: Findings suggest that fearlessness about death, practical capability, and pain tolerance can be measured reliably, and may be relevant for understanding which ideators make attempts.