An urge to jump affirms the urge to live: An empirical examination of the high place phenomenon

Journal of Affective Disorders 136 (2012) 1114–1120

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Journal of Affective Disorders

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Preliminary communication

An urge to jump affirms the urge to live: An empirical examination of thehigh place phenomenon

Jennifer L. Hames, Jessica D. Ribeiro, April R. Smith, Thomas E. Joiner Jr. ⁎Department of Psychology, Florida State University, United States

a r t i c l e i n f o

⁎ Corresponding author at: Florida State UnivePsychology, 1107 West Call Street, Tallahassee, FL 3230

E-mail address: [email protected] (T.E. Joiner).

0165-0327/$ – see front matter © 2011 Elsevier B.V. Adoi:10.1016/j.jad.2011.10.035

a b s t r a c t

Article history:Received 30 July 2011Accepted 25 October 2011Available online 25 November 2011

Background: The experience of a sudden urge to jump when in a high place has been speculat-ed to be associated with suicidal ideation; however, scant data has informed this speculation.We termed this experience the high place phenomenon (HPP) and proposed that it stems from amisinterpreted safety signal (i.e., survival instinct). The present study aimed to assess theprevalence of the HPP, to provide evidence that the phenomenon is not exclusive to suicideideators, and to explore the role of anxiety sensitivity in the phenomenon.Methods: 431 undergraduate college students completed online measures of lifetime frequen-cy of experiencing the HPP, suicidal ideation, anxiety sensitivity, depressive symptoms, andhistory of mood episodes.Results: The HPP was commonly reported in the general population, even among participantswith no history of suicidal ideation. There was a significant correlation between anxiety sensi-tivity and the HPP, and this relationship was moderated by level of current suicidal ideation.Particularly, the relationship between anxiety sensitivity and the HPP was potentiatedamong participants with low levels of suicidal ideation.Limitations: The cross-sectional design of the study limits the strength of the conclusions thatcan be drawn.Conclusions: The HPP is commonly experienced among suicide ideators and non-ideators alike.Thus, individuals who report experiencing the phenomenon are not necessarily suicidal; rath-er, the experience of HPP may reflect their sensitivity to internal cues and actually affirm theirwill to live.

© 2011 Elsevier B.V. All rights reserved.

Keywords:High place phenomenonUrge to jumpSuicidal ideationAnxiety sensitivity

1. Introduction

“You know that feeling you get when you're standing in ahigh place… sudden urge to jump?… I don't have it” (Cap-

In the United States alone, approximately 95 people perday die by suicide, making it the 11th leading cause ofdeath (American Association of Suicidology, 2007). Far

rsity, Department o6-4301, United States.

ll rights reserved.

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more common than deaths by suicide, though, are suicidalthoughts. In fact, the estimated lifetime prevalence of suicidalideation is 13.5%, meaning that close to 1 in 7 people willhave thoughts of suicide at least once in their life (Kessleret al., 1999).

A phenomenon that the lay public often speculates to beassociated with suicidal ideation is an experience we termedthe high place phenomenon, or the experience of a suddenurge to jump when in a high place (e.g., bridge, building). Asimple online search of the phrase “urge to jump” producesnumerous message board threads, blogs, and websites dedi-cated to individuals sharing their experiences of high placesuicidal impulses. Although the high place phenomenon hasbeen speculated about often, scant data have been collectedto inform this speculation. Therefore, the goal of the present

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study was threefold: first, to provide evidence that the highplace phenomenon exists; second, to provide evidence thatthe phenomenon occurs in the general population and isnot exclusive to individuals who experience suicidal idea-tion; and third, to explore the potential role of anxiety sensi-tivity in the experience of the high place phenomenon.

The experience of the high place phenomenon has beenused to defend at least two misconceptions of suicide andhuman nature. The first view is that suicide is often a trulyimpulsive act, with no premeditation, and the second viewis that deep down, everyone has a “death wish.”

Regarding “impulsive suicide,”when an individual is stand-ing in a high place and has a sudden, inexplicable urge to jump(i.e., suicidal impulse), the thought can seem to come out of theblue, particularly if the individual is neither suicidal nor de-pressed. It is thus not surprising then that the experience ofthis phenomenon might be used to defend the view that sui-cide is an impulsive act. If seemingly “suicidal” urges tend tocome to non-suicidal and non-depressed people in an “out ofthe blue” fashionwhen they are in high places, it is understand-able to assume that death by suicide occurs when an individualacts impulsively on “flash in the pan” suicidal urges.

Although several theories (Baumesiter, 1990; Mann et al.,1999) and empirical studies (e.g., Dougherty et al., 2004;Hull-Blanks et al., 2004; Maser et al., 2002) have suggestedthat there is a direct and proximal link between impulsive per-sonality traits and suicidal behavior, there is reason to believethat the relationship between impulsivity and suicidal behavioris more indirect and distal than has previously been proposed(Joiner, 2005, 2010; Van Orden et al., 2010; Witte et al.,2008). In particular, the interpersonal–psychological theory ofsuicide (Joiner, 2005; Van Orden et al., 2010) proposes thatthere is an indirect association between impulsivity and suicidein that impulsive individuals are more likely to engage in pain-ful and provocative behavior (e.g., physical fights, accidental in-jury), which, in turn, makes them less fearless of pain anddeath, and therefore more capable of suicide should the desirefor death emerge. The theory posits that in order to overcomethe powerful self-preservation instinct, an individual must de-velop a fearlessness of pain, injury, and death, which is ac-quired through repeated exposure to painful and provocativeexperiences. This process, far from being sudden or having a“flash in the pan” quality, requires time to develop; impulsivity,because it can facilitate painful and otherwise provocative ex-periences over time, is thus a distal and indirect precursor ofsuicidal behavior. In the moments before death by suicide, thestate of mind is characterized not by impulsivity, but ratherby intent, deliberation, and resolve. In fact, an empirical studyby Bender et al. (2011) provided evidence that the relationshipbetween impulsivity and suicidality is mediated by the experi-ence of painful and provocative events.

Regarding the notion of a “death wish,” the “out of theblue” nature of the high place phenomenon not only leadsone to believe that suicide is an impulsive act, but it alsocan be used to defend the psychoanalytic idea that everyoneharbors, at least to some degree, a “death wish” (i.e. a drive toreturn to an inanimate state of existence; Freud, 1922). Forinstance, when an individual walks across a high bridge, amessage such as “back up, you might fall” is rapidly firedand the individual might notice him or herself back away orgrasp the railing. After becoming aware that he or she is not

in danger of actually falling because there is a railing inplace and the structure is sturdy, some individuals may con-clude that they must have wanted to jump and thus musthave a death wish involving heights.

Instead of the high place phenomenon defending the viewthat everyone has a “death wish” or that “suicide is impul-sive,” we propose that at its core, the experience of the highplace phenomenon stems from the misinterpretation of asafety or survival signal (e.g., “back up, you might fall”). Iron-ically, on this view, the phenomenon, far from underscoringdeath strivings, instead illuminates the nature and strengthof humans' survival instinct. In particular, we propose thatfear plays a role in the misinterpretation of a safety signal.It follows that if a misinterpreted safety signal is at the coreof the high place phenomenon, individuals who tend to bemore sensitive to such safety signals will be more likely to re-port experiencing the phenomenon, as compared to individ-uals who are not as sensitive to safety signals.

One particular marker of this sensitivity to safety signals isan individual's level of anxiety sensitivity (i.e. trait tendencyto be fearful of anxiety-related symptoms and arousal sensa-tions; Schmidt et al., 2001). There is evidence that anxietysensitivity is associated with the tendency to misinterpret in-nocuous bodily sensations as threatening (Richards et al.,2001) and make negative interpretations of ambiguous stim-uli (McNally et al., 1999). There is also evidence that anxietysensitivity levels are elevated in most anxiety disorders (e.g.,panic disorder, posttraumatic stress disorder; Schmidt et al.,2006; Taylor et al., 1992). Importantly, the tendency to mis-interpret bodily and/or environmental signals is a commonlyassociated feature of such anxiety disorders. Taken together,the research on anxiety sensitivity suggests a clear associa-tion between anxiety sensitivity and the tendency to misin-terpret bodily and environmental cues. Given our view thatthe high place phenomenon stems from a misinterpretationof a safety signal, it seems logical to predict that individualswho report high anxiety sensitivity would be more likely toreport experiencing the phenomenon.

There is reason to believe, however, that the role anxietysensitivity plays in the experience of the high place phenome-non may depend on one's level of suicidal ideation. In particu-lar, anxiety sensitivity may play a larger role in the experienceof the phenomenon for individuals with low (compared tohigh) levels of current suicidal ideation, because of hownovel, alarming, and anxiety-provoking they consider suicidalthoughts. For individuals who do not report experiencing sui-cidal thoughts very frequently (or at all), a suicidal thoughtmay seem to come out of the blue and arouse concerns aboutacting on the thought. For this reason, if individuals with lowlevels of suicidal ideation also have a tendency to misinterpretsafety signals (i.e., report high anxiety sensitivity), they willlikely bemore prone tomisinterpret a safety signal as an alarm-ing suicidal urgewhen they are on a high place (i.e., experiencethe high place phenomenon) compared to individuals who re-port low anxiety sensitivity and those who report high anxietysensitivity coupled with high suicidal ideation. This is consis-tent with our view that the high place phenomenon stemsfrom a misinterpreted – and novel and thus alarming – safetysignal, as well as with the fact that high levels of anxiety sensi-tivity increase the chances that an individual will misinterpretcues.

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By contrast, for individuals with high levels of current sui-cidal ideation, anxiety sensitivity may not play as much of arole in the experience of the phenomenon. Therefore, insteadof a misinterpreted safety signal driving their experience ofthe phenomenon, their suicidal ideation may also be contrib-uting to their experience of high place suicidal urges. For in-dividuals with high levels of suicidal ideation, standing on ahigh place may elicit thoughts of suicide because they areplaces that are often associated with suicide attempts (e.g.,jumping from a bridge). Thus, regardless of their level of anx-iety sensitivity, those who report high levels of current sui-cidal ideation will likely report experiencing the high placephenomenon more frequently.

1.1. The present study

The goals of the present study were threefold. The firstgoal was to assess the prevalence of the high place phenom-enon. The second goal was to determine whether the highplace phenomenon occurs uniquely in individuals who havea lifetime history of suicidal ideation (i.e., lifetime ideators),or whether the phenomenon is also commonly experiencedby individuals who have no current or past suicidal ideation(i.e., lifetime non-ideators). Based on our assumption thatthe high place phenomenon stems from a misinterpretedsafety signal, we predicted that the phenomenon would bea common experience in the general population, evenamong lifetime non-ideators.

The third goal was to determine the extent to which anx-iety sensitivity and suicidal ideation contribute to the experi-ence of the high place phenomenon. Given our assumptionthat fear contributes to the misinterpretation of a safety sig-nal, we predicted that there may be a positive association be-tween anxiety sensitivity and the experience of thephenomenon. Next, given our view that suicidal ideationmay also increase the likelihood of experiencing high placesuicidal urges, we predicted that there would also be a posi-tive association between suicidal ideation and the experienceof the phenomenon. However, given that suicidal thoughtsare likely novel, alarming, and anxiety provoking for individ-uals who do not experience them often (or at all), we thenpredicted that the relationship between anxiety sensitivityand the experience of the high place phenomenon would de-pend on one's level of suicidal ideation. In particular, we pre-dicted that for participants reporting low (but not high)levels of suicidal ideation, as their level of anxiety sensitivityincreased, so too would their frequency of reporting the highplace phenomenon.

2. Methods

2.1. Participants

Participants were 431 undergraduate college students froma large public university in the southeast. The majority of thesample (65.4%) was female, and participants were 84.0%Caucasian, 12.3% African American, 2.8% Asian, .5% PacificIslander/Native Hawaiian, and .5% Native American/AlaskanNative. With regard to ethnicity, 16.0% of the sample reportedbeing Hispanic or Latino. Ages of participants ranged from 17to 45 (M=19.44, SD=2.59). All participants voluntarily

consented to participate and were compensated with credit to-ward course research requirements. The present study wasreviewed and approved by the Florida State University institu-tional review board.

2.2. Procedure

Participants completed the measures included in thisstudy in a single online questionnaire session. The surveywas administered to participants on Psychdata.com, a secureonline survey website that is frequently used for researchpurposes. Participants signed up for the study on an onlineexperiment sign-up page, and at this time, they were provid-ed with instructions on how to access and complete the on-line survey. The contact information of the principalinvestigator was made available to all participants in theevent that they had any questions or concerns.

2.3. Measures

2.3.1. High Place Phenomenon Index (HPPI)Three items were used to assess how frequently partici-

pants have experienced the high place phenomenon in theirlifetime, using a 6-point Likert type scale ranging from (1)never to (6) always. The first item assesses how frequentlyparticipants have experienced the urge to jump from a highplace (Item 1: When standing on the edge of a tall building orwalking on a bridge, have you ever had the urge to jump?How often has this happened in your lifetime?). The secondand third items assess how frequently participants haveimagined themselves jumping when they are in a highplace (Item 2: When you see a tall building or are walking ona bridge, have you ever thought about what it would be like tojump off of it? How often has this happened in your lifetime?;Item 3: When you are inside a tall building have you ever imag-ined jumping out a window? How often has this happened inyour lifetime?).

Confirmatory Factor Analysis (CFA) with maximum likeli-hood estimation (ML) was employed to examine the factorstructure of the scale, using Mplus 5.0 (Muthén andMuthén, 2004). As the scale consists of only three-items,only a one-factor solution was examined as the limited num-ber of indicators precludes examining a solution with a great-er number of factors. Further, since the one-factor solutionwill result in a just-identified model, standard goodness-of-fit indices are not applicable. Nonetheless, the model canstill be evaluated with respect to the strength and interpret-ability of parameter estimates. CFA also allows for signifi-cance testing of individual parameter estimates, whichcannot be conducted outside of a CFA framework. As antici-pated, all three items significantly loaded onto a single factor(Item 1=0.76; Item 2=0.84; Item 3=0.83, all pb .001). Ad-ditionally, the scale evidenced good internal consistency; co-efficient alpha for the total scale was .85. See Table 1 forparameter estimates, item means, standard deviations, andinter-item correlations.

2.3.2. Anxiety Sensitivity Index (ASI; Reiss et al., 1986)The ASI is a 16-item self-report inventory designed to

measure the degree to which individuals are concernedabout the potential negative effects of experiencing anxiety

Table 1Factor loadings and reliability for the High Place Phenomenon Index (HPPI).

Item Factorloadings

Item 1 Item 2 Item 3 M SD Skew Kurtosis

1 .76 – 1.55 .97 1.81 2.652 .84 .64 – 2.07 1.28 1.09 0.363 .83 .65 .70 – 1.64 1.04 1.67 2.07

Note. Item 1=When standing on the edge of a tall building or walking on abridge, have you ever had the urge to jump? How often has this happened inyour lifetime?; Item 2=When you see a tall building or are walking on abridge, have you ever thought about what it would be like to jump off ofit? How often has this happened in your lifetime?; Item 3=When you areinside a tall building have you ever imagined jumping out a window? Howoften has this happened in your lifetime?

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symptoms. Respondents are asked to indicate the degree towhich each item applies to them using a 5-point Likert typescale ranging from (0) very little to (4) very much. The scalehas been found to have strong internal consistency andtest-retest reliability and has demonstrated adequate con-struct and predictive validity (Antony, 2001; Zvolensky etal., 2001). In the present sample, the coefficient alpha forthe total scale was .85, indicating good internal consistency.

2.3.3. Depressive Symptoms Inventory–Suicide Subscale (DSI–SS;Metalsky and Joiner, 1997)

The DSI–SS consists of four self-report items focusing onfrequency and intensity of suicidal thoughts during the past2 weeks. Respondents are asked to indicate which of four

Table 2Frequency of responses to items on the High Place Phenomenon Index(HPPI).

Non-SI SI Total

Item 1Never 234 (82.7%) 60 (43.5%) 294 (69.8%)Very rarely 26 (9.2%) 32 (23.2%) 58 (13.8%)Rarely 18 (6.4%) 25 (18.1%) 45 (10.2%)Occasionally 4 (1.4%) 16 (11.6%) 20 (4.8%)Frequently 1 (0.4%) 4 (2.9%) 5 (1.2%)Very frequently 0 (0.0%) 1 (0.7%) 1 (0.2%)

Item 2Never 161 (56.9%) 36 (25.9%) 197 (46.7%)Very rarely 68 (24.0%) 31 (22.3%) 99 (23.5%)Rarely 22 (7.8%) 33 (23.7%) 55 (13.0%)Occasionally 27 (9.5%) 23 (16.5%) 50 (11.8%)Frequently 3 (1.1%) 10 (7.2%) 13 (3.1%)Very frequently 2 (.7%) 6 (4.3%) 8 (1.9%)

Item 3Never 216 (76.3%) 59 (42.8%) 275 (65.3%)Very Rarely 38 (13.4%) 32 (23.2%) 70 (16.6%)Rarely 12 (4.2%) 31 (22.5%) 43 (10.2%)Occasionally 13 (4.6%) 9 (6.5%) 22 (5.2%)Frequently 3 (1.1%) 7 (5.1%) 10 (2.4%)Very frequently 1 (0.4%) 0 (0.2%) 1 (0.2%)

Note. Item 1=When standing on the edge of a tall building or walking on abridge, have you ever had the urge to jump? How often has this happened inyour lifetime?; Item 2=When you see a tall building or are walking on abridge, have you ever thought about what it would be like to jump off ofit? How often has this happened in your lifetime?; Item 3=When you areinside a tall building have you ever imagined jumping out a window? Howoften has this happened in your lifetime?; Non-SI=participants with nolifetime history of suicidal ideation; SI=participants with lifetime historyof suicidal ideation.

options best describes their thoughts (e.g. “Sometimes Ihave thoughts of killing myself.”). Total scores can rangefrom 0 to 12, with higher scores representing increased se-verity of suicidal ideation. Prior studies have reported goodpsychometric properties for the measure (e.g., Joiner et al.,2002). Internal consistency of the DSI–SS in this sample wasadequate (alpha=.81).

2.3.4. History of suicidality and mood episodesSeveral items were used to assess participants' history of

suicidal and depressive symptoms. Particularly, participantswere asked to respond either “yes” or “no” to items relatedto their lifetime history of suicidal ideation (“Have you everhad thoughts about suicide in the past?”), lifetime history offormulating a suicide plan (“Have you ever formulated aplan for suicide?”), lifetime history of suicide attempts(“Have you ever attempted suicide?”), and their lifetime his-tory of major depressive episodes (“Have you ever experi-enced a Major Depressive Episode?”).

2.3.5. Beck Depression Inventory (BDI; Beck et al., 1979)The BDI is a 21-item self-report questionnaire that as-

sesses the presence and severity of cognitive, affective, moti-vational, and somatic symptoms of depression. Participantsare given instructions to read each group of statements care-fully and to mark the one statement in each group that de-scribes the way they have felt the past week. Each item israted on a scale of 0 to 3, and the participant's rating foreach item is then summed across the items to form a totalscore. Scores on the BDI range from 0 to 63, with higherscores indicating more depressive symptoms. Previous re-search has shown that the BDI is internally consistent (Coef-ficient alpha=.81) for nonpsychiatric samples (Beck et al.,1988). In the present sample, the coefficient alpha for thetotal scale was .86, indicating good internal consistency.

3. Results

3.1. Frequency of responses

In order to examine the prevalence of the phenomenon,we first examined the frequency of experiencing the urge tojump (item 1) and imagining what it would be like to jump(items 2 and 3). We then examined the frequency of theseoccurrences in both lifetime suicide ideators (individualswho reported any lifetime history of suicidal ideation) versuslifetime non-ideators (those who did not endorse any currentor past suicidal ideation). As anticipated, the phenomenonwas commonly reported in the general population, evenamong lifetime non-ideators. We present the item-leveldata below and in more detail in Table 2.

3.1.1. Item 1 — urge to jump from bridge or buildingMore than 30% of individuals reported experiencing the

urge to jump at least once in their lifetime. As anticipated,experiencing the urge to jump from a high place was not lim-ited to lifetime suicide ideators. When the sample was parsedinto lifetime suicide ideators and non-ideators, lifetime non-ideators continued to report the experience, with approxi-mately 17.3% of the sample reporting that they had the expe-rience at least once in their lifetime. Unsurprisingly, lifetime

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suicide ideators reported significantly higher rates ofexperiencing the urge to jump (χ2[5, N=421]=73.52,pb .001), with over half (56.50%) reporting having had theexperience at least once in their lives.

3.1.2. Item 2 — imagined jumping from bridge or buildingOver half of the sample (53.3%) endorsed imaginingwhat it

would be like to jump fromahigh building or bridgewhen con-fronted with the stimulus. As with the urge to jump, lifetimesuicide ideators endorsed imagining the experience of jumpingat higher rates than lifetime non-ideators (χ2[5, N=421]=59.18, pb .001), but non-ideators endorsed high rates too. Ap-proximately 74% of lifetime suicide ideators and 43% of lifetimenon-ideators reported having had the experience at least oncein their lives.

3.1.3. Item 3 — imagined jumping from building windowWhen asked about imagining jumping out a window

when inside a tall building, nearly half the sample (48.7%)endorsed having the experience at least once. Again the sam-ple was examined on the basis of lifetime history of suicidalideation. More than half of the lifetime suicide ideators(57%) endorsed having the experience at least once in theirlifetime. Although there was a significant difference betweenlifetime ideators and non-ideators (χ2[5, N=421]=58.92,pb .001), such that lifetime suicide ideators noted more fre-quent experiences of envisioning jumping out a window,the phenomenon was still rather common in lifetime non-ideators, among whom nearly 24% endorsed the occurrence.

3.2. Associations with suicidal ideation, suicidal behavior, andanxiety sensitivity

After examining the frequency of the aspects that we be-lieve to make up the phenomenon, we then turned to explor-ing associations with relevant variables. For ease ofinterpretation, we elected to use the HPPI total score.

3.2.1. Associations with relevant constructsPearson product moment correlations were used to ex-

amine associations of the HPPI with other measures designedto assess different psychological constructs. Of constructs in-cluded, and consistent with differences between ideators andnon-ideators already documented, current suicidal ideationas indexed by the DSI–SS demonstrated the strongest

Table 3Means, standard deviations, and correlations.

1 2 3 4 5

1. HPPI 1.02. BDI .38⁎⁎ 1.03. DSI–SS .41⁎⁎ .42⁎⁎ 1.04. Past attempts .22⁎⁎ .05 .32⁎⁎ 1.05. Past plans .27⁎⁎ .15⁎⁎ .39⁎⁎ .46⁎⁎ 1.06. Past ideation .39⁎⁎ .42⁎⁎ .47⁎⁎ .24⁎⁎ .36⁎⁎

7. Past MDE .24⁎⁎ .30⁎⁎ .22⁎⁎ .27⁎⁎ .33⁎⁎

10. ASI .24⁎⁎ .45⁎⁎ .26⁎⁎ .08 .10⁎

Note. HPPI = High Place Phenomenon Index; BDI = Beck Depression Inventory; DSLifetime history of suicide attempts; Past plans = Lifetime history of making a suiLifetime history of major depressive episodes; ASI = Anxiety Sensitivity Index.⁎ pb .05.⁎⁎ pb .001.

association (r=.41, pb .001), and lifetime history of suicidalideation demonstrated a similarly robust relationship(r=.39, pb .001). Indicators of suicidal behavior also demon-strated significant, though more modest, correlations withHPPI total scores. More specifically, history of past suicide at-tempts (r=.22, pb .001) and formulating a suicide plan(r=.27, pb .001) were moderately correlated with HPPIscores. Self-reported history of a major depressive episodeevidenced a small-to-moderate correlation with HPPI(r=.24, pb .001). Severity of current depressive symptomswas also significantly positively associated with HPPI totalscores (r=.38, pb .001). Lastly, HPPI scores demonstrated asignificant positive association with ASI total scores (r=.24,pb .001). This finding is consistent with our prediction thatanxiety sensitivity would be implicated in the phenomenon,but the regression analyses to follow will qualify this finding.Refer to Table 3 for correlations.

3.2.2. Suicidal ideation as a moderatorAlthough we expected (and found) a zero-order correla-

tion between anxiety sensitivity and the high place phenom-enon, we predicted that this association would beparticularly clear among non-ideators. Hierarchical multipleregression was used to examine whether suicidal ideation(indexed by DSI–SS scores) moderated the relationship be-tween anxiety sensitivity (ASI scores) and frequency of HPP(HPPI scores), after controlling for the influence of currentdepressive symptoms (BDI) and suicide attempt history. Pre-liminary analyses did not indicate any violations of the as-sumptions of normality, linearity, multicollinearity, andhomoscedasticity. Suicide attempt history and BDI totalscores were entered at Step 1, explaining 16.7% of the vari-ance in HPPI scores. At step 2, DSI–SS, ASI, and their interac-tion were entered. Results indicated that the total varianceexplained by the model was 21.4% (F[5, 364]=19.51,pb .001), which corresponds to an R squared change=.05,pb .05. In the final model, a main effect of ASI was notdetected, contrary to expectation. However, a main effect ofDSI–SS was found, such that individuals with higher levelsof suicidal ideation had significantly higher HPPI scores(β=.29, pb .001), which was as anticipated. Also in linewith our hypotheses, the interaction between DSI–SS andASI was significant (β=−.10, p=.05). At high levels of sui-cidal ideation (1 SD above the mean of DSI–SS scores),there was no significant effect of ASI on HPPI scores (β=

6 7 8 M SD Skew Kurtosis

5.25 2.91 1.41 1.327.22 6.46 1.38 2.15.36 .98 3.37 12.47.04 .20 4.74 20.59.07 .26 3.36 9.33

1.0 .33 .47 .73 −1.47.35⁎⁎ 1.0 .29 .29 .92 −1.17.25⁎⁎ .23⁎⁎ 1.0 18.93 9.54 .59 .16

I–SS = Depressive Symptoms Inventory–Suicide Subscale; Past attempts =cide plan; Past ideation = Lifetime history of suicidal ideation; Past MDE =

Table 4Anxiety sensitivity interacts with suicidal ideation to predict high place phe-nomenon, controlling for depressive symptoms and past attempts.

Predictors in the set β SE t p

Step 1(Constant) .21 19.02 b.001BDI .37 .02 7.58 b.001Past attempts .16 .74 3.27 b.001

Step 2(Constant) .23 18.92 b.001BDI .25 .03 4.48 b.001Past attempts .10 .75 2.12 .04DSI–SS .26 .19 4.45 b.001ASI .05 .02 .98 .33DSI–SS X ASI −.10 .02 −1.96 .05

Note. BDI = Beck Depression Inventory; Past attempts = Lifetime history ofsuicide attempts; DSI–SS = Depressive Symptoms Inventory–SuicideSubscale; ASI = Anxiety Sensitivity Index.

1119J.L. Hames et al. / Journal of Affective Disorders 136 (2012) 1114–1120

−.05, p=.51, n.s.); however, at low levels of suicidal ideation(1 SD below the mean of DSI–SS scores), as ASI scores in-crease, HPPI scores increase as well (β=.15, p=.037).Refer to Table 4 for a summary of results and Fig. 1 for agraph of the findings.

4. Discussion

The aim of the present study was to investigate the highplace phenomenon, an occurrence in which one experiencesor imagines the urge to jump when in high places, such as atall building or bridge. Specifically, we examined the frequen-cy of the high place phenomenon among a group of college-aged lifetime suicide ideators and non-ideators, assessedthe association of anxiety sensitivity and other psychologicalfactors with the phenomenon, and tested the moderatingrole of suicidal ideation in the relationship between anxietysensitivity and the experience of the high place phenomenon.

Our results suggest that the high place phenomenon wasexperienced by a considerable number of individuals. In fact,over 50% of lifetime non-ideators reported experiencing

0

1

2

3

4

5

6

Low ASI (-1 SD) High ASI (+1 SD)

High DSI-SS(+1 SD)

Low DSI-SS(-1SD)

HP

PI

Note: HPPI = High Place Phenomenon Index; DSI-SS = Depressive Symptoms Inventory - Suicide Subscale; ASI = Anxiety Sensitivity Index.

Fig. 1. Anxiety sensitivity interacts with suicidal ideation to predict highplace phenomenon, controlling for depressive symptoms and past attempts.Note. HPPI = High Place Phenomenon Index; DSI–SS = Depressive Symp-toms Inventory–Suicide Subscale; ASI = Anxiety Sensitivity Index.

aspects of the phenomenon at least once in their lives, andover three-quarters of lifetime suicide ideators reportedexperiencing the urge to jump from thewindow of a tall build-ing or off of a bridge or building. These percentages help dispela common myth about suicide – that if you imagine your owndeath you have a deathwish – as amajority of our participants,whohad never thought of suicide (i.e., never had a deathwish),had experienced the urge to jump from a high place.

In terms of associated factors and moderators, we foundthat the HPPI was most strongly associated with currentand lifetime suicidal ideation as well as severity of currentdepressive symptoms; additionally, the HPPI was moderate-ly, but significantly associated with both history of major de-pressive episodes, history of suicidal behavior, and currentanxiety sensitivity (although this latter main effect faded inregression analyses, and was qualified by a significant inter-action with suicidal ideation). Furthermore, our results sug-gest that, especially for lifetime non-ideators, anxietysensitivity seems to potentiate the experience of the highplace phenomenon.

Why is it that so many experience this seemingly self-destructive urge, and why might anxiety sensitivity be asso-ciated with more frequent experiences of the high place phe-nomenon among individuals who have no lifetime history ofsuicidal ideation? One explanation involves fear circuitry,subserved largely by the amygdala. Several systems of per-ception have evolved in humans — systems that are veryfast and not subject to conscious control and systems thatare slower and can be modulated. These different sets of sys-tems generally work well together; however, we proposethat the high place phenomenon represents an instancewhen they are discordant. Put simply, when an individualstands on a high place, his or her fear circuitry might reactto the potential danger in the situation by sending a rapid sig-nal such as, “Back up, you might fall.” This “safety signal” isintended to keep the person alive and out of danger, and itis fired so quickly that the person backs away from theedge, often without being fully aware of why he or she didthis. It is not until moments later, when the person tries tounderstand his or her behavior, that the individual's slowerperceptual system kicks in and potentially misattributes thesafety signal (“Getting too close, back up”) to a death wish in-volving heights (a misattribution encouraged by lay under-standings of psychoanalytic thought, and indeed bypsychoanalytic thought itself). Thus in our study, it may bethat among lifetime non-ideators, high anxiety sensitivitywas positively associated with the experience of the highplace phenomenon because individuals high in anxiety sensi-tivity are more sensitive to interoceptive cues in general (cf.,Domschke et al., 2010), and are therefore more likely to mis-attribute a safety signal (i.e., “back up”) as an “urge to jump.”

There are several important limitations to note in this pre-liminary investigation of the high place phenomenon. First,the cross-sectional nature of the study precludes conclusionsof causality and temporal precedence. Second, this sampleconsisted entirely of college students, most of whom wereCaucasian; thus, it is not clear whether these results will gen-eralize to other populations. Third, we did not account forsensation seeking in our analyses, which may be informativein future research on the high place phenomenon. Finally, ourmeasure of the high place phenomenon was newly

1120 J.L. Hames et al. / Journal of Affective Disorders 136 (2012) 1114–1120

developed; however, preliminary validity results on the HPPIare promising.

Despite these limitations, there are some notablestrengths of the current study, including our large samplesize. Further, to our knowledge this is the first empirical in-vestigation of the high place phenomenon, which appearsto be a commonly endorsed experience. Moreover, wefound preliminary evidence that anxiety sensitivity is relatedto the experience of the high place phenomenon especiallyamong lifetime non-ideators; however, future research isneeded to better understand the causal role of anxiety sensi-tivity in the experience of the phenomenon.

Although at first blush, the experience – and even thedescription – of the high place phenomenon calls to mindsuicidal desires, clearly the experience is commonly felt bymany non-suicidal individuals. In fact, experiencing thisphenomenon may have the counter-intuitive effect ofaffirming one's will to live, for as Harry Stack Sullivannoted in 1953: “The [suicidal] reverie studies danger,personal probabilities, with, as an unwitting goal, a goalthat is not noticed by the person who is entertaining thesuicidal fantasy, the prevention of this very act of self-destruction. The prevention of the hostile-destructive actis the unwitting goal, the unnoticed goal, of the reverie pro-cess” (p. 26).

Role of funding sourceNo funding was provided for the present study.

Conflict of interestAll authors declare that they have no conflicts of interest.

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