Four Studies on How Past and Current Suicidality Relate Even When “Everything But the Kitchen Sink” Is Covaried Thomas E. Joiner, Jr. Florida State University Yeates Conwell University of Rochester Medical Center Kathleen Kara Fitzpatrick Ohio State University Tracy K. Witte and Norman B. Schmidt Florida State University Marcelo T. Berlim and Marcelo P. A. Fleck Federal University of Rio Grande do Sul and Hospital de Clı ´nicas de Porto Alegre M. David Rudd Baylor University T. E. Joiner’s (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior. Keywords: Joiner’s theory, past, future, suicidal behavior Past suicidal behavior is related to future suicidal behavior. But is the relation meaningful (i.e., nonspurious), perhaps even causal, or is it fully accounted for by a set of third variables, such as enduring predispositions or various clinical conditions (e.g., mood disorders)? A full understanding of suicidal behavior hinges on this question. Joiner (2004, in press) has theorized that the acquired ability to enact lethal self-injury is a key precondition for serious suicidal behavior. His framework not only asserts that few people want to die by suicide, but also, and perhaps more importantly, that few people can. Self-injury, especially when severe, has the potential to be painful and fear inducing. Who can tolerate such high levels of pain, fear, and the like? Joiner’s model suggests that those who, via past suicidal behavior, have habituated to these negative aspects of suicide, and additionally, who have acquired competence and even courage specifically regarding suicide, are at particular risk for serious suicidal behavior. In this framework, past suicidal behavior instantiates the ability to enact future lethal self-injury; that is, the relation of past to future suicidality is nonspurious, partly causal, and thus meaningful indeed. How does one habituate to and become competent and coura- geous regarding suicide? In a word, practice. People who have hurt themselves before (especially intentionally), who have investi- gated suicide methods, and who show resolve about following through with suicide, are viewed as practiced regarding, and thus at substantial risk for, suicide. To become good at something (cf. competence) and to lose fear about something (cf. courage), one must have experience with it—in general, the more experience, the more competence, and the more courage. According to Joiner’s (2004, in press) model, experience with self-harm facilitates future self-injury through two primary mech- anisms. First, with repeated exposure, one habituates—the taboo and prohibited quality of suicidal behavior diminishes, and so may the fear and pain associated with self-harm. Second, and relatedly, opponent-processes are implicated. Briefly, opponent process the- ory (Solomon, 1980) predicts that, with repetition, the effects of a provocative stimulus diminish, and the opposite effect, or oppo- nent process, becomes amplified and strengthened. For example, with repetition, the fear-inducing effects of skydiving (the “a” process) diminish, and the exhilarating effects of the opponent Thomas E. Joiner, Jr., Tracy K. Witte, and Norman B. Schmidt, De- partment of Psychology, Florida State University; Yeates Conwell, Depart- ment of Psychiatry, University of Rochester Medical Center; Kathleen Kara Fitzpatrick, Department of Psychology, Ohio State University; Mar- celo T. Berlim and Marcelo P. A. Fleck, Department of Psychiatry and Forensic Medicine, Federal University of Rio Grande do Sul and Mood Disorders Program, Hospital de Clı ´nicas de Porto Alegre, Porto Alegre, Brazil; M. David Rudd, Department of Psychology, Baylor University. Preparation of this article was supported in part by a fellowship from the John Simon Guggenheim Memorial Foundation and Grants R01 MH51201, K24 MH01759, and R29 MH48097 from the National Institute of Mental Health. Correspondence concerning this article should be addressed to Thomas E. Joiner, Jr., Department of Psychology, Florida State University, Talla- hassee, FL 32306-1270. E-mail: joiner@psy.fsu.edu Journal of Abnormal Psychology Copyright 2005 by the American Psychological Association 2005, Vol. 114, No. 2, 291–303 0021-843X/05/$12.00 DOI: 10.1037/0021-843X.114.2.291 291