Elsevier

Psychiatry Research

Volume 215, Issue 1, 30 January 2014, Pages 217-222
Psychiatry Research

Influence of violent video gaming on determinants of the acquired capability for suicide

https://doi.org/10.1016/j.psychres.2013.10.021Get rights and content

Abstract

The interpersonal theory of suicidal behavior proposes that fearlessness of death and physical pain insensitivity is a necessary requisite for self-inflicted lethal self-harm. Repeated experiences with painful and provocative events are supposed to cause an incremental increase in acquired capability. The present study examined whether playing a first-person shooter-game in contrast to a first-person racing game increases pain tolerance, a dimension of the acquired capability construct, and risk-taking behavior, a risk factor for developing acquired capability. N=81 male participants were randomly assigned to either play an action-shooter or a racing game before engaging in a game on risk-taking behavior and performing a cold pressor task (CPT). Participants exhibited higher pain tolerance after playing an action shooter game than after playing a racing game. Furthermore, playing an action shooter was generally associated with heightened risk-taking behavior. Group-differences were not attributable to the effects of the different types of games on self-reported mood and arousal. Overall these results indicate that action-shooter gaming alters pain tolerance and risk-taking behavior. Therefore, it may well be that long-term consumption of violent video games increases a person's capability to enact lethal self-harm.

Introduction

Suicide is a significant public health concern, with more than one million people worldwide dying from suicide every year (World Health Organization, 2013). Suicide is among the three leading causes of death among those aged 15–24 years and is the tenth leading cause of death for all ages in the United States (American Association of Suicidology, 2013). Males complete suicide at a rate 3–7 times that of females (Nock et al., 2008). In about 3.8% of the cases, suicidal persons impact other individuals (Large et al., 2009), sometimes in the form of spree killings, usually ending in the suicide of the perpetrator (Scheithauer and Bondü, 2011). A regularly discussed hypothesis concerning the possible causes of spree killings and school shootings is an increased engagement of the contraveners in violent video games, in which virtual enemies must be killed by different means (Anderson, 2004). Anderson (2004) assumes that action-shooter games reinforce killing and aggressive behaviors, which in turn might lead to a transfer of these behaviors into the real world. Yet, it is unclear if action-shooter games can be considered a risk factor for attempting or completing suicide and if so, which mechanisms link the frequent use of action-shooter games to increased suicide risk.

According to the Interpersonal Psychological Theory of Suicidal Behaviour (Joiner, 2005) three proximal, causal and interactive risk factors must be present in order for someone to both desire and be capable of suicide: The most dangerous form of suicidal desire is said to be caused by the simultaneous presence of thwarted belonginess – the experience that one is alienated from others, not an integral part of a valued group – and perceived burdensomeness – the view that one's existence burdens family, friends, and/or society. Yet, Joiner (2005) claims that desire to die by suicide is not sufficient to lead to lethal suicidal behavior – rather individuals have to have developed a fearlessness of pain, injury and death to be capable to act on the desire for suicide. According to this theory, the so-called acquired capability for suicide arises from repeated exposure to painful and/or fear inducing experiences. Van Orden et al. (2010) distinguish two dimensions of acquired capability: lowered fear of death and increased tolerance for pain.

Joiner (2005) proposes that the most direct route to acquiring the capability for suicide is by engaging in suicidal behavior, either through suicide attempts, or practicing and preparing for suicidal behavior. In line with this assumption, past suicide attempts are one of the strongest predictors of future suicide attempts – even after controlling for hopelessness and various psychopathological syndromes (e.g. Joiner et al., 2005). However, Joiner (2005) points to the fact that one can also become less fearful of pain, injury and death by experiences other than suicide attempts, e.g. childhood abuse, combat exposure, painful and provocative events like physical fights, promiscuous sex, playing contact sports etc. All of these experiences are supposed to increase the risk for lethal suicidal behavior because they are physically painful and/or sufficiently frightening to engage habituation and opponent processes (Solomon, 1980).

Evidence for the credibility of the suicidal theory is accruing, with a growing number of studies demonstrating profound associations between the theory's key variables and different markers of suicidality: Thus it has been shown that individuals with a history of suicidal behavior exhibited higher levels of the acquired capability than individuals with no history of suicidal behavior and that acquired capability is predictive of suicidal behavior (Van Orden et al., 2008, Anestis and Joiner, 2011). In general, men exhibit higher levels of acquired capability than women and soldier-samples exhibit higher levels than student-samples (Bryan et al., 2010, Witte et al., 2012). In accordance with the theoretical assumptions, higher levels of painful and provocative experiences significantly predicted higher levels of acquired capability and combat experiences characterized by violence and high levels of injury and death are strongly associated with the acquired capability (Van Orden et al., 2008, Bryan and Cukrowicz, 2011). With regard to the pain-tolerance dimension of acquired capability, several studies found that individuals with recent suicidal behavior demonstrate elevated physical pain tolerance (as measured by electric shock and thermal pain), compared with non-suicidal psychiatric patients and individuals in the community (Orbach et al., 1996a, Orbach et al., 1997) and compared with individuals admitted to the emergency room due to accident injuries (Orbach et al., 1996b). The latter finding indicates that elevated pain tolerance is likely specific to suicidal behavior rather than physical injury (cf. Van Orden et al., 2010). Bender et al. (2011) found self-reported experiences of painful and provocative events as well as acquired capability to be significantly associated with pain tolerance in a pressure algometer task and Franklin et al. (2011) could show that pain tolerance – assessed with a cold pressor task (CPT) – partially mediated the association between self-reported experiences of painful and provocative events and acquired capability. Finally, it has been found, that experiences with painful and provocative events mediated the relationship between impulsivity and suicidality: This means that impulsive individuals tend to have higher levels of acquired capability for suicidal behavior because they have experienced more painful and provocative events in their lives (Bender et al., 2011).

To date, no study has examined the role of violent video games in the development of acquired capability for suicide. There are studies showing that playing violent video games is associated with an increase in aggressive thoughts, feelings and behaviors, leading to desensitization to violence and also to decreases in pro-social behaviors and empathy (Anderson and Warburton, 2012). For example, Carnagey et al. (2007) found that participants who had previously played a violent video game for 20 min exhibited reduced physiological arousal while watching films of real violence thereafter, demonstrating a physiological desensitization to violence. Furthermore, video games that glorify risk-taking behavior have been shown to be associated with more risk-taking behaviors, cognitions, attitudes and risk-positive emotions (Fischer et al., 2011). Yet, it is unknown, whether dimensions and indicators of the acquired capability of suicide are also influenced by playing first-person shooter games. The current study addresses this issue. Thus, the study examined whether playing action-shooter games in contrast to engaging in an action-packed non-violent racing game was associated with elevated levels of pain tolerance – as one of the key dimensions of acquired capability – in a sample of healthy young males. Additionally, – building on the notion that impulsivity or risk taking behavior contribute to the acquisition of capability for suicide – we examined whether playing an action-shooter game led to an increase of risk-taking behavior and whether this increase was greater than the change after playing a racing game.

Section snippets

Participants

The study included 81 men, aged from 18 to 39 (M=26.2, S.D.=5.2 years). All participants were Caucasian. To take part in the study, participants had to be between 18 and 50 years old. Due to their influence on pain tolerance and risk-taking behavior, exclusion criteria were female gender, diagnosis of a psychiatric disorder, substance dependency or abuse, cardiovascular diseases and intake of psychoactive drugs, beta-blockers, analgesics as well as current suicidal ideation. In addition,

Participant characteristics

Participants in the four groups did not significantly differ in age [F(3, 77)=0.2, p=0.896], marital status [χ2=11.83, d.f.=9, p=0.223], education level [χ2=9.91, d.f.=12, p=0.623], gaming experience [χ2=17.22, d.f.=24, p=0.829] and self-reported levels of acquired capability for suicide, [F(3, 77)=0.36, p=0.786]. Across groups, ACSS-scores were significantly correlated with pain tolerance scores (r=0.27, p=0.015). Risk-taking behavior assessed via the Game of dice task was not correlated with

Discussion

The interpersonal theory of suicidal behavior proposes that fearlessness of death and physical pain insensitivity is a necessary requisite for self-inflicted lethal self-harm: In order to die by suicide one must face the fearsome prospect of death as well as the physical discomfort necessary to withstand the act of lethal self-injury. According to Joiner (2005) people can acquire such a capability for suicide by repeated experiences with painful and provocative events. The present study

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