Impulsivity, problem-solving, and suicide: Assessment and treatment considerations in the context of scientific literature

Impulsivity is a predisposition toward rapid, unplanned actions to internal or externalstimuli without regard to the negative consequences of these for self and/or others (Moelleret al., 2001). Clinically, impulsivity is a personality characteristic that is commonlyobserved in suicidal individuals based on both self-report and laboratory measures (Gorlyn,2005; Horesh, 2001). Therefore, empirically driven risk assessment protocols often mentionimpulsivity as a risk indicator for suicide. Of course, impulsivity can serve as a symptomfor psychiatric conditions such as bipolar disorder, borderline personality disorder, andsubstance-related disorders - all of which have also been recognized as risk factors forsuicide. Given the strong empirical link between impulsivity and suicide, one may assumethat all suicidal acts are impulsive in nature, yet to date, there is evidence to the contrary.For example, Witte and colleagues (2008) have shown that only less than a quarter of thoseattempting suicide do so impulsively (i.e., without prior planning). Therefore, some haveargued that the link between impulsivity and suicide may be indirect (Bender et al., 2011).One possible explanation for such an indirect path may be related to problem-solving. Anindividual who is characteristically impulsive may consequently engage in impulsive andcareless problem-solving, particularly during stressful life circumstances. Such deficits inproblem-solving may have a biopsychosocial underpinning. For example, an individualmay have had the biological predisposition to an impulsive nature and subsequently learnedover time to make careless decisions to cope with life stressors. The relationship betweenimpulsive and careless problem-solving and suicide-related behaviors has also been shownin the scientific literature. Simply stated, an individual with an impulsive and carelessproblem-solving style moves quickly from facing a problem to taking action withoutconsidering the consequences of such actions and/or repeatedly engages in many carelessand unsuccessful attempts at solving the same problem. The objectives of the proposedchapter are threefold. First, a brief summary of the scientific literature on the relationshipbetween impulsivity, problem-solving, and suicide will be presented. Second, clinicaladvantages of assessment and treatment of impulsivity and problem-solving are explored,and a list of psychometrically sound psychological assessments for the measurement ofimpulsivity and problem-solving will be presented. Finally, a series of assessment andtreatment recommendations will be provided to address impulsivity and problem-solvingamong suicidal individuals.