Stoicism and sensation seeking: Male vulnerabilities for the acquired capability for suicide
Highlights
► Men die by suicide more than women do. ► Acquired capability for suicide (ACS) may explain gender differences in suicide. ► Stoicism and sensation seeking mediate the relationship between gender and ACS.
Introduction
In nearly every nation worldwide, men die by suicide more frequently than women (World Health Organization, 2011), and they represent approximately 80% of the people who die by suicide in the United States each year (National Center for Injury Prevention and Control, 2007). To date, much of the research investigating risk factors for suicide has focused on those that do not offer plausible explanations for gender differences in suicide mortality. For example, major depressive disorder is one of the most widely studied risk factors for suicidal behavior, yet it is substantially less likely to affect men than women (e.g., Nolen-Hoeksema, Grayson, & Larson, 1999). Further, many theoretical accounts of suicide (e.g., Beck et al., 1990, Shneidman, 1998) propose identical causal processes for non-fatal and fatal suicidal behavior. This is problematic in that men are far less likely to engage in non-fatal suicidal behavior than women (Nock et al., 2008), which suggests that there may be different causal pathways for lethal versus non-lethal suicidal behavior. There is a clear need to integrate risk factors that are differentially present in men with a comprehensive theory that accounts for the fact that there is a preponderance of women among suicide ideators and attempters and a preponderance of men among suicide decedents. The overarching goal of the current study is to investigate two personality traits that are part of the traditional male gender role (i.e., stoicism and sensation seeking) in the context of a recent theoretical conceptualization of suicidal behavior that proposes different causal processes for lethal versus non-lethal suicidal behavior (i.e., the interpersonal theory of suicide; Joiner, 2005, Van Orden et al., 2010).
The interpersonal theory of suicide introduces a novel construct known as the acquired capability for suicide, which is comprised of two facets: fearlessness about death and physical pain insensitivity. In order to die by suicide, one must face the fearsome prospect of death as well as the physical discomfort necessary to withstand the act of lethal self-injury. Without this requisite degree of fearlessness about death and pain insensitivity, a person will not be capable of inflicting lethal self-harm even if he or she strongly desires to die, according to the interpersonal theory (Joiner, 2005, Van Orden et al., 2010). The acquired capability for suicide is posited to develop relatively independently of desire for suicide. Thus, an individual could have a high level of acquired capability for suicide even if he/she has never experienced suicidal ideation (Smith, Cukrowicz, Poindexter, Hobson, & Cohen, 2010).
Viewed through the lens of the interpersonal theory, gender differences in lethal suicidal behavior may be explained by gender differences in acquired capability. Lower acquired capability for suicide among women may serve to prevent lethal self-harm in many cases, whereas higher acquired capability for suicide among men make it possible for them to enact lethal self-harm in the presence of suicidal desire. Consistent with the notion that gender differences in acquired capability may explain gender differences in suicidal behavior, men score higher than women do on a self-report measure of fearlessness about death (Ribeiro, Witte, & Van OrdPlease update reference ‘Ribeiro et al., submitted for publication), and there is a large body of literature demonstrating that men have higher physical pain insensitivity than women (e.g., Berkley, 1997).
Despite this initial evidence that men have higher acquired capability for suicide than women, there has not been an empirical examination of personality traits that may explain this gender difference. The capability for fatal self-harm is posited to be acquired over time through repeated exposure and habituation to experiences that are painful and fear inducing (e.g., impulsive behaviors, past suicide attempts). Although exposure to these experiences is considered crucial in order to fully acquire the capability for suicide, the interpersonal theory allows for the possibility that certain personality traits may directly be associated with higher baseline fearlessness about death and/or pain insensitivity (Smith and Cukrowicz, 2010, Van Orden et al., 2010). If particular personality traits are more common in one gender versus another, this would lead to differential risk for developing the acquired capability for suicide and ultimately, differential risk for death by suicide.
Both stoicism and sensation seeking are personality traits that are associated with the traditional male gender role (e.g., Cheng, 1999, David and Brannon, 1976, Roberti, 2004, Zuckerman et al., 1978) and share similar features with the acquired capability for suicide. Sensation seeking has been defined as the propensity toward engaging in behaviors that involve risk, including risk of death (e.g., Whiteside and Lynam, 2001, Zuckerman, 1979). Stoicism has been defined as the “denial, suppression, and control of emotion” (Wagstaff & Rowledge, 1995, p. 181). This diminished display of emotions may make an individual more capable of withstanding the emotional and physical pain involved in enacting self-harm.
An emerging literature demonstrates a link between sensation seeking and acquired capability for suicide. Anestis, Bagge, Tull, and Joiner (2011) found that sensation seeking was a significant predictor of self-reported acquired capability for suicide and physical pain insensitivity. Additionally, Bender, Gordon, Bresin, and Joiner (2011) found evidence for both indirect and direct effects of sensation seeking on acquired capability, as measured by self-report. A key limitation of the Bender et al. (2011) study, however, is that they did not examine the influence of gender in their analyses, which is notable given its known association with both sensation seeking and acquired capability for suicide. Further, the self-report measure of acquired capability utilized by both studies conflates fearlessness about death with pain insensitivity; therefore, they were unable to examine specific relationships between the two facets of acquired capability for suicide and sensation seeking.
Although stoicism has not previously been examined in relation to suicidal behavior, there are several studies indicating that there is a link between stoicism and pain insensitivity (Robinson et al., 2001, Wise et al., 2002, Yong, 2006). Witte (2009) found that the related construct of affective intensity (another trait that is associated with male gender; Thompson, Dizen, & Berenbaum, 2009) was negatively associated with acquired capability among men, as measured by both self-report and physical pain insensitivity. The distinction between stoicism and affective intensity is that stoicism is defined as the resolve to not display one’s emotional state, whereas affective intensity is the trait-like level of emotional arousal one typically experiences. We propose that stoicism is a more pertinent trait for explaining gender differences in suicide rates than affective intensity because engaging in lethal suicidal behavior would likely result in intense emotional arousal even in individuals with generally low affective intensity. Thus, it is the ability to endure this inevitable distress and fear that makes lethal self-harm possible, not necessarily one’s general tendency for lower emotional arousal.
The major objective of the current study was to test our hypothesis that emotional stoicism and sensation seeking account for the relationship between gender and the acquired capability for suicide. To accomplish this objective, we utilized structural equation modeling to test our hypothesis in two independent samples.
Section snippets
Sample 1 characteristics
Sample 1 was comprised of 185 undergraduates (62% male) enrolled at a large university in the Southeastern United States. We oversampled for males starting approximately halfway through the data collection process in order to ensure adequate representation of males in our sample, given that the participant pool is predominantly female. Eighty-nine percent of the participants were non-Hispanic/Latino. The racial breakdown of the sample was as follows: 78% Caucasian, 17% African-American/Black,
Data analytic strategy
Descriptive statistics for all observed variables in both samples can be found in Table 1. The majority of our variables approximated a normal distribution. Although there were a few exceptions to this general rule, we opted to use the maximum likelihood estimator in our analyses, as the non-normality seen in our variables was not extreme and was limited to the measurement of pain threshold. We utilized Mplus Version 6 (Muthen & Muthen, 1998–2010) for our main analyses.
To determine the pattern
Preliminary analyses
See Tables S1 and S2 in the online Supplemental materials for bivariate correlations between all observed indicators in our models. First, we opted to conduct a CFA of the two latent variables in our model (i.e., fearlessness about death and pain insensitivity). All indicators were congeneric, and we did not estimate covariance between any of the residuals. In Sample 1, our model fit was generally adequate (χ2 = 120.22, df = 53, p < .001; RMSEA = .08 CFI = .96, TLI = .95; SRMR = .05). In contrast, in Sample
Acknowledgments
This research was supported, in part, by Grant F31 MH077386 from the National Institute of Mental Health to Tracy K. Witte and Thomas E. Joiner, Jr., a Grant EPS-081442 from the North Dakota Experimental Program to Stimulate Competitive Research to Kathryn H. Gordon, and Grant T32 MH20061 from the National Institute of Mental Health to Yeates Conwell.
References (59)
- et al.
Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample
Journal of Psychiatric Research
(2011) - et al.
Impulsivity and suicidality: The mediating role of painful and provocative experiences
Journal of Affective Disorders
(2011) - et al.
Testosterone exposure, domapminergic reward, and sensation-seeking in young men
Physiology and Behavior
(2010) - et al.
The effects of experimenter characteristics on pain reports in women and men
Pain
(2004) - et al.
Big boys don’t cry: An investigation of stoicism and its mental health outcomes
Personality and Individual Differences
(2008) - et al.
Pressure pain thresholds as asymmetry in left- and right-handers: Associations with behavioural measures of cerebral laterality
European Journal of Pain
(1999) - et al.
The effects of cigarette smoking on pain and anxiety
Addictive Behaviors
(1984) A review of behavioral and biological correlates of sensation seeking
Journal of Research in Personality
(2004)- et al.
Gender role expectations of pain: Relationship to sex differences in pain
The Journal of Pain
(2001) A social neuroscience perspective on adolescent risk-taking
Developmental Review
(2008)
The unique relations between emotional awareness and facets of affective instability
Journal of Research in Personality
The five factor model and impulsivity: Using a structural model of personality to understand impulsivity
Personality and Individual Differences
Gender role expectations of pain: Relationship to experimental pain perception
Pain
Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance, and functional interference in chronic pain patients?
European Journal of Pain
Methods of suicide: International suicide patterns derived from the WHO mortality database
Bulletin of the World Health Organization
The moderator–mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations
Journal of Personality and Social Psychology
Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients
American Journal of Psychiatry
Beck scale for suicide ideation
Comparative fit indices in structural models
Psychological Bulletin
Sex differences in pain
Behavioral and Brain Sciences
Marginalized masculinities and hegemonic masculinity: An introduction
Journal of Men’s Studies
Applied missing data analysis
The relative performance of full information maximum likelihood estimation for missing data in structural equation models
Structural Equation Modeling: A Multidisciplinary Journal
Die lateral asymmetrie der menschilchen Schmerzempfindlichkeit
Der Schmerz
Identifying causal relationships in clinical assessment: Treatment implications of psychological assessment
Psychological Assessment
Principles of Medical Statistics
Cited by (88)
Establishing the psychometric properties and construct validity of the Painful and Provocative Events Scale-Revised
2019, Journal of Affective DisordersCitation Excerpt :Sensation seeking is closely associated with the stereotypical male gender role, and men often display greater sensation seeking than women (e.g., Zuckerman et al., 1978). Sensation seeking is positively associated with capability for suicide (Anestis et al., 2011; Bender et al., 2011; Witte et al., 2012), and meditational studies indicate that sensation seeking mediates the association between male gender and fearlessness about death (Witte et al., 2012). Several items that loaded onto the Actual or Potential Injuries factor (e.g., seeing someone die or someone close to you dying by suicide) are not directly related to sensation-seeking behavior.
The androgen model of suicide completion
2019, Progress in NeurobiologyCitation Excerpt :It is assumed that the male behavioral trait of sensation seeking as a facet of impulsivity contributes to the gender dimorphism in suicide completion via the psychological construct of acquired suicide capability. This model includes fearlessness of death and, indirectly, suicidal intent (Witte et al., 2012). In accordance with the assumption of prenatal hyperandrogenization in suicide completion, the extent of sensation seeking correlates negatively with the 2D:4D ratio (Hampson et al., 2008).
Non-monotonic temporal variation in fearlessness about death: A latent class growth analysis
2018, Psychiatry ResearchBorderline personality disorder and emotion dysregulation
2019, Development and Psychopathology