Externalizing the threat from within: A new direction for researching associations between suicide and psychotic experiences

Jamie Murphy, M Shevlin, Louise Arsenault, Richard Bentall, Avshalom Caspi, Andrea Danese, Philip Hyland, Terri Moffitt, Helen Fisher

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
83 Downloads (Pure)


A recent suicidal drive hypothesis posits that psychotic experiences (PEs) may serve to externalize internally generated and self-directed threat (i.e., self-injurious/suicidal behavior [SIB]) in order to optimize survival; however, it must first be demonstrated that such internal threat can both precede and inform PEs. The current study conducted the first known bidirectional analysis of SIB and PEs to test whether SIB could be considered as a plausible antecedent for PEs. Prospective data were utilized from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins, that captured SIB (any self-harm or suicidal attempt) and PEs at ages 12 and 18 years. Cross-lagged panel models demonstrated that the association between SIB at age 12 and PEs at age 18 was as strong as the association between PEs at age 12 and SIB at age 18. Indeed, the best representation of the data was a model where these paths were constrained to be equal (OR = 2.48, 95% CI = 1.63-3.79). Clinical interview case notes for those who reported both SIB and PEs at age 18, revealed that PEs were explicitly characterized by SIB/threat/death-related content for 39% of cases. These findings justify further investigation of the suicidal drive hypothesis.

Original languageEnglish
Pages (from-to)1034-1044
Number of pages11
JournalDevelopment and Psychopathology
Issue number3
Early online date6 Jan 2021
Publication statusPublished (in print/issue) - 31 Aug 2022

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2020. Published by Cambridge University Press.

Copyright 2020 Elsevier B.V., All rights reserved.


  • birth-cohort
  • cross-lagged panel analysis
  • psychosis
  • self-harm
  • self-injurious behavior


Dive into the research topics of 'Externalizing the threat from within: A new direction for researching associations between suicide and psychotic experiences'. Together they form a unique fingerprint.

Cite this