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Principal Investigator: Alexandre Y. Dombrovski
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $773,606
Funding agency: National Institute of Mental Health
This competing continuation proposal extends and deepens a productive program of longitudinal research on
suicidal behavior in a cohort of 303 people with borderline personality disorder (BPD) with a prospectively
ascertained high risk for serious suicide attempts. Our studies in 2017-22 focused on the pathway from
interpersonal experiences to suicidal behavior, integrating three timescales: naturalistic prediction of suicidal
behavior over years; prediction of suicidal ideation over days; and experimental interrogation of decision
processes over minutes. Taken together, our findings show that the emergence of suicidal ideation from
interpersonal conflict is catalyzed by internalizing psychopathology, whereas the transition to suicidal behavior
is facilitated by externalizing psychopathology and neurobehavioral alterations in decision-making. Building on
this work, we propose to (1) examine interpersonal traits and specific facets that cause decompensation in
BPD and facilitate transitions in the suicidal process on a timescale of years, (2) improve individualized
prediction of emotion dysregulation and suicidal thoughts on a timescale of hours to days, and (3) advance a
neurocomputational account of the failed search for solutions in a crisis on a timescale of minutes. For
continuity, we retain the historic focus on BPD as a prototypical personality disorder, yet we also emphasize
dissociable contributions of multiple underlying internalizing and externalizing dimensions to the suicidal
process. Our team has complementary expertise in suicide research (Dombrovski, PI), borderline personality
and experience sampling (co-investigators Hallquist and Wright, and consultant Pilkonis), decision
neuroscience (Dombrovski and Hallquist), and quantitative methods including machine learning (Hallquist and
Wright, with consultant Jacobson joining now). We began leading the study in 2017, boosting recruitment, and
quadrupling the number of publications compared to 2012-17. Proposed innovations include a focus on
clinically salient facets of interpersonal traits, integration of intensive and extended EMA with passive sensing,
an investigation of dynamic decision-making under high cognitive load supported by an original computational
model, and a recently developed and validated multi-level approach to fMRI analysis. Clinically, understanding
the suicidogenic effects of interpersonal trait facets and elaboration of personalized models of suicide risk will
advance suicide prediction and development of just-in-time interventions. Expected results will advance the
field of suicide research by unifying conceptual models of the suicidal process with hierarchical dimensional
models of psychopathology, identifying general vs. person-specific suicidogenic processes, and elucidating
decision-making under cognitive demands representative of the suicidal crisis. In line with the NIMH’s
prioritized research agenda on suicide, this work will address mechanisms of suicide risk, while investigating
RDoC’s reinforcement learning and limited capacity constructs and thus bridging RDoC with hierarchical
dimensional models of psychopathology.
Terms: <Arousal><Behavioral><Borderline Personality Disorder><Chronic><Clinical><Cognitive><Computer Models><Computerized Models><Decision Making><Development><Diathesis><Dimensions><Disease susceptibility><Disinhibition><Distress><Dysfunction><Emotional><Entropy><Equilibrium><Face><Feeling suicidal><Functional MRI><Functional Magnetic Resonance Imaging><Functional disorder><Grain><Hour><Human><Impairment><Impulsivity><Intervention><Intervention Strategies><Investigation><Investigators><Learning><Life><Link><Machine Learning><Measures><Methods><Modeling><Modern Man><NIMH><National Institute of Mental Health><Neurocognitive><Neurosciences><Neuroses><Neurotic Disorders><Pathway interactions><Patient Self-Report><Patients><Personality><Personality Disorders><Persons><Physiopathology><Process><Productivity><Psychological reinforcement><Psychoneuroses><Psychopathology><Publications><RDoC><Reinforcement><Research><Research Domain Criteria><Research Personnel><Research Priority><Research Resources><Researchers><Resources><Risk><Risk Factors><Sampling><Scientific Publication><Self-Report><Social Environment><Suicidal thoughts><Suicide><Suicide attempt><Symptoms><Thinking><Time><Uncertainty><Withdrawal><Work><abnormal psychology><antagonism><antagonist><balance><balance function><biological basis of behavior><biopsychology><callous unemotional trait><callousness><cognitive burden><cognitive load><cohort><computational modeling><computational models><computer based models><computerized modeling><developmental><doubt><emotion dysregulation><emotional dysregulation><experience><fMRI><faces><facial><fatal attempt><fatal suicide><high risk><ideation><improved><individual heterogeneity><individual response><individual variability><individual variation><individualized predictions><individualized response><innovate><innovation><innovative><intent to die><interpersonal conflict><interventional strategy><liability to disease><machine based learning><negative affect><negative affectivity><neural mechanism><neurobehavioral><neuromechanism><neurotic><neuroticism><non fatal attempt><nonfatal attempt><pathophysiology><pathway><personalized predictions><programs><prospective><psychobiology><recruit><response><social climate><social context><socioenvironment><socioenvironmental><suicidal><suicidal attempt><suicidal behavior><suicidal ideation><suicidal individual><suicidal risk><suicidal thinking><suicidality><suicide behavior><suicide ideation><suicide model><suicide risk><suicides><thoughts><thoughts about suicide><trait>