Integrating Dimensional Personality and Autistic Traits to Predict Suicidal Ideation, Suicide Attempts, and Nonsuicidal Self-Injury in Autistic Adults

Autistic adults experience significantly elevated rates of suicidal ideation, suicide attempts, and nonsuicidal self-injury. Although these outcomes often co-occur, they are clinically distinct. Nonsuicidal self-injury involves intentional self-injury without intent to die, and the factors that give rise to suicidal ideation are not necessarily those that drive the transition from ideation to a suicide attempt. While their high prevalence is now well documented, less is known about the individual differences that distinguish autistic adults who engage in nonsuicidal self-injury, who contemplate suicide, and who attempt it.
 

Personality traits describe the enduring ways people tend to think, feel, and behave, and they offer a useful lens in autism, where chronic stressors can deplete coping resources. When pressures such as sensory overload, social isolation, or exclusion intersect with a tendency toward strong emotional reactivity, crisis risk may escalate. Pitt Psychiatry investigators Aliona Tsypes, PhD (Assistant Professor of Psychiatry), Timothy Allen, PhD (Assistant Professor of Psychiatry), Ligia Antezana, PhD (Assistant Professor of Psychiatry), Kelly Beck, PhD (Assistant Professor of Psychiatry), Caitlin Conner, PhD (Research Associate Professor of Psychiatry), Lori Scott, PhD (Associate Professor of Psychiatry), and Carla Mazefsky, PhD (Nancy J. Minshew, MD Chair in Autism Research and Professor of Psychiatry, Clinical and Translational Science, and Psychology), examined how autistic traits and broader dimensional personality traits were jointly associated with these outcomes in 102 clinician-diagnosed autistic adults, who completed structured clinical interviews assessing lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury.
 

"We wanted to know whether autism-informed and broader personality measures capture different aspects of risk, or whether they are partly measuring the same thing," said Dr. Tsypes, the study's corresponding author.
 

The findings, recently published in Autism Research, converged on three patterns. Anhedonia, or reduced interest and enjoyment in routine activities, was associated with more severe suicidal ideation, with higher odds of a lifetime suicide attempt, and, among those who had experienced suicidal ideation, with having gone on to make an attempt. Emotional lability, or rapid and unpredictable shifts in emotion, was strongly related to nonsuicidal self-injury and to ideation severity. Autistic traits added complementary information: greater social strain was linked to elevated risk across outcomes, and repetitive behaviors used to relieve stress, such as rocking or fiddling, were related to NSSI. Exploratory modeling further showed that what anhedonia and social strain share—reduced reward and social disengagement—was the most consistent correlate of risk. 
 

"The answer was both, and that is the argument for using these measures together rather than choosing between them. Because suicide risk is dynamic, an important next step is to examine how these traits influence suicidal thinking in daily life," added Dr. Tsypes.
 

Integrating Dimensional Personality and Autistic Traits to Predict Suicidal Ideation, Suicide Attempts, and Nonsuicidal Self-Injury in Autistic Adults
Tsypes A, Allen TA, Antezana L, Beck KB, Conner CM, Scott LN, Mazefsky CA.
Autism Research 19, no. 4: e70202. https://doi.org/10.1002/aur.70202.