Studying the Connection between Suicidality and Being in Touch with Your Body
Principal Investigator: 

April Smith

Miami University

Some people are more in touch with their bodies than others. These people are more likely to notice when their hearts start beating rapidly, for instance, they are more aware of feelings of hunger or discomfort, and they are more attuned to their own emotional states. The scientific term for this sensitivity to the internal states of the body is interoception, and it has far greater implications for an individual’s health than one might guess. In particular, research has found that people who score low on measures of interoception are more likely to try to injure themselves or attempt suicide.

With this in mind, April Smith of Miami University is leading a research effort to study the relationship between interoception and self-injuring and suicidal behaviors specifically in a military population. If the results of the study are as Smith expects, the research could lead not only to new ways of identifying service members and Veterans who are at a higher risk of harming themselves but also to new types of treatments for reducing those risks.

Smith became interested in the connection between interoception and suicidality, she says, because of previous research she had done on interoception and eating disorders. Scientists who study anorexia, bulimia, and other eating disorders have long been interested in the role that interoception might play. If you can’t tell if you’re hungry or full, Smith explains, that could lead to eating too little or eating too much, and, indeed, poor scores on measures of interoception have been linked to an increased risk for eating disorders.

There is also a well known connection between eating disorders and the risk of suicide. People with anorexia, for instance, are much more likely to die by suicide than members of the general population, and Smith thought that interoception might play a role here as well. Dying by suicide requires overcoming your natural aversion to hurting yourself, and Smith suggested that people who are out of touch with their bodies might find it easier to injure themselves.

So over the past couple of years she and her students have carried out a series of studies to test that supposition, and the results have been clear: People who score lower on an interoception measure (which is based on the answers to a series of questions such as how attuned they are to emotions and how sensitive they are to feelings of hunger) are more likely to have harmed themselves, had suicidal thoughts, and attempted suicide than those who score higher on interoception.

But those studies were carried out in the general population. Smith is now going to examine whether the same correlation will hold true in a military population. She is also interested to learn whether Veterans and active-duty members of the armed services might score lower on average than people in the general population on measures of interoception. Since members of the military are trained to ignore pain, fear, and other warning signs in order to complete their missions, Smith says, it seems possible that they are less in touch with their bodies than those who have never served.

To do her study, Smith will rely on data accumulated by other researchers funded by the MSRC. The various MSRC-funded studies all collect a set of common data—referred to as Common Data Elements—on their subjects, including not only demographic details and information on suicidal thoughts and self-injury, but also things like tolerance to physical pain, emotional numbness, and reacting to stressful memories with a pounding heart or difficulty breathing. The use of these Common Data Elements allows the data from all the MSRC-funded studies to be combined to create a large dataset with information on thousands of Veterans, active-duty personnel, and civilians which researchers can analyze, looking for various patterns and correlations.

Smith and her colleagues will analyze this dataset to examine the correlation between interoception and suicidal behavior in past and present members of the military. They have begun by developing a measure of interoception derived from various of the Common Data Elements (e.g., having physical responses to stressful memories, feelings of emotional numbness, pain tolerance, etc.), and they have shown that this new measure correlates well with more traditional measures of interoception. Thus they have assurance that they can get a good measure of interoception among the thousands of members of the military from whom Common Data Elements have been collected.

The next step is to use their new measure of interoception to look for correlations between low levels of interoception and increased risk of self-injury and suicidal thoughts and behavior among the Veterans and active duty members represented in the Common Data Elements. In studies on the general population, a clear pattern has emerged, Smith said. Those who have attempted suicide generally score lower on measures of interoception than those who have thought about suicide but not attempted it, and those who have thought about it score lower than those who have never thought about it. The lowest interoception scores are found in those who have attempted suicide multiple times, she said, summing up the findings in this way: “The more disconnected you are from your body, the more able you are to harm it.”

The purpose of the study that she will be conducting for the MSRC is to see whether this pattern holds for a military population and to look for any differences from the general population. She said that she expects that the general pattern will probably be the same—that multiple attempters of suicide will have, on average, lower interoception scores than single attempters, who will have lower scores than those who have thought about suicide but not attempted it, who will have lower scores than those who have never thought about it—but there may be important details that appear. For example, is it interoception in general that is important in prediction suicide risk, or just particular pieces of it? Is being unaware of pain a particularly important predictor, for instance? Or being out of touch with your emotion? The study may also reveal that interoception scores are lower in the military population than among civilians, Smith said.

Once the study is done, Smith’s sees the logical next step as determining whether helping people improve their interoception could reduce suicide risk. There are a number of well studied approaches that have been shown to improve interoception, at least temporarily, and these could be more acceptable to a military population than interventions that are explicitly targeted at suicide prevention. Instead, the interventions could be presented as a way for individuals to become more connected with their bodies and be able to perform their duties better, which might make it easier to get Veterans and active duty service members to buy in to the intervention.

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