Category: Suicide and Self-Injury
Introduction: A dissociative subtype of posstraumatic stress disorder (PTSD) has recently been added to the DSM-5 (American Psychiatric Association, 2013). The distinguishing feature of this subtype is experiencing derealization (i.e., the experience that ‘things are not real’) and depersonalization (i.e., an ‘out of body’ experience). These symptoms are highly distressing, and fear of these symptoms (i.e., anxiety sensitivity cognitive concerns; ASCC) has been associated with suicide risk in the past (Capron et al., 2012). Unsurprisingly, individuals who meet symptom criteria for this dissociative subtype evidence greater suicide risk than those with PTSD alone (Stein et al., 2013). However, gathering information on this subtype and its association with suicide risk has largely been confined to self-report measurements. The current study uses controlled experimental psychopathology paradigms (e.g., head-mounted display perceptual illusion challenges) to elicit fear reactivity to feelings of cognitive dyscontrol. We hypothesize that fear reactivity to head-mounted display perceptual illusion challenges will be significantly associated with suicidality. Methods: Participants (N = 55) with Anxiety Sensitivity Index-3 (Taylor et al., 2007) cognitive scores at least 1.5 SD above or below the mean completed cognitive dyscontrol challenges utilizing head-mounted display technology. Suicidality and depression were assessed by the Inventory of Depression and Anxiety Symptoms II (IDAS-II; Watson, O’Hara, Simms, & Kotov, 2007). Fear derived from the challenges was measured by SUDS (Wolpe & Lang, 1964) on a scale of 0-100. Results: A significant linear regression model revealed that baseline ASI-3 cognitive scores were a significant predictor of suicidality [B=.34, t(53)=2.66, p =.01]. Another linear regression model was used to understand whether SUDS scores from the challenges (i.e., a behavioral correlate of fear associated with derealization and depersonalization) would also predict suicidality. Suicidality was regressed on SUDS scores from the cognitive dyscontrol challenges. The model was significant with SUDS scores being a significant predictor of suicidality [B=.49, t(53)=4.10, p < .001]. Baseline SUDS scores, depression, and ASI-3 cognitive scores were then added into this model due to their relationships with suicidality. The model was significant with SUDS scores from the challenges [B=.31, t(50)=2.08, p =.04] and depression [B=.42, t(50)=2.94, p=.01] both being significant predictors; however, baseline SUDS scores and ASI-3 cognitive scores were not significant predictors. Conclusion: Our results are in line with past research citing ASCC as a contributing factor to suicide risk. These results also indicate that using head-mounted display perceptual illusion challenges to induce fear may be a more realistic measure of ASCC. Lastly, these findings call for further investigation into the viability of using such challenges to decrease fear. These procedures could be especially valuable in populations with high suicide risk and ASCC, such as those with dissociative subtype PTSD.