خودکشی و رفتار خشونت آمیز: نقش خشم، اختلال در نظم احساسات و تکانشگری

Suicidality and violence are serious public health problems. A rich literature supports the relationship between suicidality and violence, including common associations with trait anger. However, less is known about how trait anger may facilitate these behaviors. Two potential mechanisms in this relationship are emotion dysregulation and impulsivity, both of which are linked to increased anger, suicidality, and violence. We investigated anger as a common underlying factor for both suicidal and violent behavior, and emotion dysregulation and impulsivity (i.e., negative and positive urgency) as potential mediators in this relationship. Results demonstrate that trait anger was associated with both suicidal and violent behavior. Further, emotion dysregulation mediated the anger and suicidal behavior relationship whereas both negative and positive urgency mediated the anger and violent behavior relationship. Although trait anger may be a common underlying factor for both suicidal and violent behavior, the nature of these relationships seems to vary significantly.

Intentional harm towards the self and others is a major public health concern. At the extremes, suicide and homicide are leading causes of mortality, second only to accidental death, among young people (CDC, 2012 and CDC, 2013). Less severe acts of harm towards self and others are even more ubiquitous. Between 1.9% and 8.7% of individuals attempt suicide in their lifetime (Nock et al., 2008), while 12% of adolescents report physical violence in romantic relationships (Halpern, Oslak, Young, Martin, & Kupper, 2001). These acts of non-fatal harm are of great concern, not only for their direct adverse consequences (Clarke and Whittaker, 1998 and Krug et al., 2002), but also because of the increased likelihood of engaging in other forms of harm. The relationship between suicidal and violent behavior has been long recognized with many psychoanalysts claiming that suicide is aggression turned inward (Plutchik & van Praag, 1986). More recently, empirical evidence has shown that individuals with a history of violence are more likely to engage in self-harm (Greening et al., 2010 and Zhang et al., 2012). Likewise, individuals with past suicide attempts are more likely to have a history of violence (Keilp et al., 2006). One trait that may predispose individuals to suicidal and violent behavior is anger. A rich literature shows a relationship between elevated anger and violence. Anger is the primary motivator for violent behavior and is the most common emotion experienced when engaging in aggression (Averill, 1983). Furthermore, increased anger is repeatedly associated with violence across clinical and non-clinical samples (Deffenbacher et al., 2003, McCloskey et al., 2006 and Ramírez and Andreu, 2006). Although less extensively studied, anger is also linked with suicidal behavior in both community and psychiatric populations (Giegling et al., 2009, Horesh et al., 1997 and Lehnert et al., 1994). The mechanism(s) through which anger may facilitate suicidal or violent behavior is less clear. Several intrapersonal variables, most notably emotion dysregulation and impulsivity, have been linked to suicidal and violent behavior, as well as anger (Giegling et al., 2009, Rajappa et al., 2012 and Ramírez and Andreu, 2006). Emotion dysregulation is associated with aggressive responding on laboratory tasks (Cohen, Zeichner, & Seibert, 2008) and discriminates between those who have and have not engaged in intimate partner violence (Gratz & Roemer, 2004). Likewise, emotion dysregulation is predictive of suicidal behavior (Rajappa et al., 2012). Emotion dysregulation is also strongly correlated with heightened trait anger (McCloskey et al., 2009). Although emotion dysregulation has been associated with both suicidal and violent behaviors, a more direct examination of how this trait may influence the pathway from anger to such behaviors is needed. Although impulsivity was once conceptualized as a facet of emotion dysregulation (Eysenck & Eysenck, 1969) it has since been recognized as an independent construct, where emotion dysregulation is central to coping with emotional experiences ( Gratz, 2007) and impulsivity is related to a general propensity to act rashly ( Whiteside, Lynam, Miller, & Reynolds, 2005). Both suicidal and violent behavior have been associated with impulsivity ( Anestis et al., 2007, Mann et al., 2009 and Shorey et al., 2011); however, specific facets of impulsivity may be more relevant to emotion dysregulation. Negative and positive urgency refer to rash behavior in response to negative and positive emotional experiences, respectively ( Cyders et al., 2007 and Whiteside and Lynam, 2001), and may facilitate risk behavior in different ways. For example, when experiencing distress one may act rashly to reduce negative affect whereas rash behavior may also be used to enhance an existing positive mood ( Cyders & Smith, 2008). Some research has suggested the importance of negative urgency in suicidal ( Anestis & Joiner, 2011) and violent ( Settles et al., 2012) behavior, but research has been limited. The tendency to act rashly in response to both negative and positive emotions may be an influential factor, but these relationships need to be explored. The aim of the current study was to assess potential pathways leading to suicidal and violent behavior by examining the role of trait anger, in addition to emotion dysregulation and impulsivity. We aimed to first replicate previous findings suggesting that trait anger may be a common underlying factor for both suicidal and violent behavior and then examined emotion dysregulation and impulsivity as mediators in this relationship. Given the support for the relationships between emotion dysregulation and suicidal and violent behavior, and anger, it is expected that emotion dysregulation will mediate the relationship between anger and both suicidal and violent behavior. Similarly, relationships established with negative urgency suggest that it may facilitate the progression from anger to suicidal and violent behavior. The role of positive urgency is less clear. Direct evidence has not examined the relationship between positive urgency and suicidal and violent behaviors, but it has been suggested that anger may serve as a positive, versus negative, emotion (see Litvak, Lerner, Tiedens, & Shonk, 2010 for review). As such, it was also expected that positive urgency would serve as a mediator.