The pursuit of death versus escape from negative affect: An examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury.

Across three studies, we tested a model in which the relationship between emotion dysregulation and suicidal behavior is accounted for by non-suicidal self-injury (NSSI). Whereas some models posit that suicide attempts serve as an escape from acute aversive states, our model proposes that NSSI accounts for the relationship between emotion dysregulation and suicide attempts. To test our model, we recruited two large nonclinical samples of adults and a clinical sample of adults seeking inpatient treatment for substance use disorders. To increase generalizability, we used four different measures of emotion dysregulation across the three studies: broad emotion regulation, distress tolerance, negative urgency, and grit (i.e., the persistent, passionate pursuit of long-term goals). Results were largely supportive of our hypothesized model, revealing significant indirect effects of emotion dysregulation on suicide attempts through NSSI in all three samples. Specifically, NSSI fully mediated the relationship between emotion dysregulation and suicide attempts in three of six analyses, and partially mediated this relation in the other three. Overall, findings are supportive of an emotion regulation model of NSSI and suggest that the relation between certain aspects of emotion dysregulation and suicide attempts may be indirect through NSSI.