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Psychological Pain and Suicidal Behavior: Clinical Implications
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Psychological Pain and Suicidal Behavior: Clinical Implications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: 25 June 2026 | Viewed by 2687

Special Issue Editor

Dr. Adrián Alacreu-Crespo

E-Mail Website
Guest Editor
Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, University of Zaragoza, Teruel, Spain
Interests: psychological pain; suicide; depressive disorder; psychophysiology; stress

Special Issue Information

Dear Colleagues,

This Special Issue seeks to explore the complex relationship between psychological pain and suicidal behavior, aiming to deepen our understanding of its clinical implications. Psychological pain intensity, psychological pain tolerance, and social pain are central variables in suicide and also transdiagnostic variables in some mental health problems. In this sense, in this Special Issue, we are also interested in other disorders close to suicide that interplay with psychological pain, such as mood and anxiety disorders, eating disorders, borderline personality disorders, schizophrenia, and non-suicidal self-injury in all kinds of populations. We welcome original research articles and reviews addressing, but not limited to, suicide prevention strategies, pharmacological impacts on psychological pain and/or suicidal behavior outcomes, and psychotherapeutic interventions and their efficacy in psychological pain and/or suicide. We also are very welcome to articles that investigate the interplay of psychological pain with other variables such as impulsivity, executive function, memory bias, social cognition, interoception, physical pain, and stress in suicide risk assessment. Moreover, we are also interested in papers validating instruments evaluating psychological pain intensity or psychological pain tolerance.

Therefore, the issue seeks to advance clinical understanding and provide evidence-based approaches for assessment and intervention. Submissions should focus on innovative therapeutic approaches, intervention strategies, and evidence-based practices that can improve clinical outcomes for individuals.

We look forward to your contributions.

Dr. Adrián Alacreu-Crespo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • suicidal behavior
  • psychological pain
  • pain tolerance
  • therapeutic interventions
  • clinical outcomes

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Published Papers (4 papers)

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Research

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15 pages, 473 KB  
Article
From Trauma to Suicidal Ideation in a Spanish Chronic Pain Population: Cognitive Mediation in the Genesis of Psychological Suffering
by Juan José Mora-Ascó, Carmen Moret-Tatay, María José Beneyto-Arrojo and Miguel Pedro León-Padilla
J. Clin. Med. 2026, 15(2), 715; https://doi.org/10.3390/jcm15020715 - 15 Jan 2026
Viewed by 545
Abstract
Background: Chronic pain is consistently associated with increased vulnerability to suicidal ideation, particularly among individuals with a history of early adverse experiences. However, the cognitive mechanisms linking childhood trauma to suicidal thoughts in this population remain insufficiently understood. Methods: A cross-sectional study was [...] Read more.
Background: Chronic pain is consistently associated with increased vulnerability to suicidal ideation, particularly among individuals with a history of early adverse experiences. However, the cognitive mechanisms linking childhood trauma to suicidal thoughts in this population remain insufficiently understood. Methods: A cross-sectional study was conducted with 251 adults living with chronic pain. Participants completed validated measures assessing childhood trauma, perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Correlational analyses were conducted to examine associations among variables, followed by a multiple mediation model to test the mediating role of cognitive processes. Data were analyzed using Pearson correlations and robust-estimation mediation procedures implemented in JASP. Results: Childhood trauma showed positive and significant associations with perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Mediation analyses showed that perceived burdensomeness, hopelessness, and pain catastrophizing significantly mediated the relationship between childhood trauma and suicidal ideation, with small-to-moderate indirect effects. These findings suggest that maladaptive cognitive patterns may partially explain how early adverse experiences are associated with suicidal thoughts in individuals with chronic pain. Conclusions: The results highlight the relevance of considering early adverse experiences and pain-related cognitive processes in the clinical assessment of suicidal ideation among individuals with chronic pain. Further research using longitudinal and multimethod designs is needed to refine explanatory models and guide psychological interventions aimed at reducing vulnerability to suicidal ideation in this population. This study expands existing knowledge by simultaneously examining perceived burdensomeness, hopelessness, and pain catastrophizing as mediators between childhood trauma and suicidal ideation in individuals with chronic pain. These findings contribute to refining trauma-informed clinical approaches and identifying specific intervention targets. Full article
(This article belongs to the Special Issue Psychological Pain and Suicidal Behavior: Clinical Implications)
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13 pages, 1983 KB  
Article
Psychological Pain Measurement in the Context of Suicidal Behavior: Rasch Analysis of the Spanish Psychache Scale Version
by Jorge L. Ordóñez-Carrasco, Claudia Suárez-Yera, María Sánchez-Castelló and Antonio J. Rojas-Tejada
J. Clin. Med. 2025, 14(24), 8847; https://doi.org/10.3390/jcm14248847 - 14 Dec 2025
Viewed by 616
Abstract
Background: The Psychache Scale (PS) is the most widely used scale to measure psychological pain due to its ease of application, favorable evidence of predictive validity, and adequate psychometric properties from the CTT (Classical Test Theory) approach. This paper aims to contribute [...] Read more.
Background: The Psychache Scale (PS) is the most widely used scale to measure psychological pain due to its ease of application, favorable evidence of predictive validity, and adequate psychometric properties from the CTT (Classical Test Theory) approach. This paper aims to contribute to the improvement of the Spanish version of the PS by analyzing its psychometric properties using a Rasch model. Methods: Using quota sampling, 905 young adults completed an online questionnaire with the PS. Results: The items and response categories showed an acceptable fit to the model and good performance. The separation index indicated three strata for persons. The item-person map showed that persons were placed lower on the psychological pain continuum than item, and some item pairs presented small difference in their severity. The study of men-women DIF (differential item functioning) showed a slight differential functioning only for item 6. Conclusions: This study provides new evidence that supports the use of the PS to measure psychological pain. Full article
(This article belongs to the Special Issue Psychological Pain and Suicidal Behavior: Clinical Implications)
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13 pages, 241 KB  
Article
Emotion Dysregulation, Impulsivity, and Implicit Cognition in Adolescent with Self-Injurious Thoughts and Behaviors: A Six-Month Prospective Study
by Inmaculada Peñuelas-Calvo, María Taracena-Cuerda, Manon Moreno, Sandra Cabrera-Redondo, Vera Álvarez-González, Rodrigo Puente-García, Blanca Quintana-Saiz, Ana Jiménez-Bidón and Alejandro Porras-Segovia
J. Clin. Med. 2025, 14(24), 8705; https://doi.org/10.3390/jcm14248705 - 9 Dec 2025
Cited by 1 | Viewed by 663
Abstract
Background/Objectives: Suicide is a leading cause of death among adolescents. Emotion dysregulation, impulsivity, and childhood trauma are key factors underlying Self-Injurious Thoughts and Behaviors (SITB), yet reliable short-term predictors are limited, especially in at-risk clinical populations. This study prospectively examined the association between [...] Read more.
Background/Objectives: Suicide is a leading cause of death among adolescents. Emotion dysregulation, impulsivity, and childhood trauma are key factors underlying Self-Injurious Thoughts and Behaviors (SITB), yet reliable short-term predictors are limited, especially in at-risk clinical populations. This study prospectively examined the association between SITB and clinical (psychological pain, impulsivity, childhood trauma) and cognitive measures (Implicit Association Tests, IATs). Methods: A prospective, observational study was conducted in adolescents (12–17) admitted to a university hospital psychiatry unit following recent SITB. Participants completed the Death/Suicide IAT (D/S-IAT), Self-Injury IAT (SI-IAT), and standardized instruments including the Columbia Suicide Severity Rating Scale (C-SSRS), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), and Childhood Trauma Questionnaire (CTQ-SF). SITB recurrence was assessed at six months. Results: Within six months, 28.9% of 38 participants reported suicidal thoughts, 15.8% engaged in self-injury, and 2.6% attempted suicide. The SI-IAT showed a small but significant correlation with C-SSRS, whereas D/S-IAT showed none. Neither IAT predicted SITB recurrence. Higher levels of emotion dysregulation and impulsivity were significantly associated with SITB. Specific DERS dimensions—emotional rejection, interference, and confusion—predicted future SITB, highlighting emotional dysregulation as a vulnerability factor. Conclusions: In high-risk adolescents, psychological pain and impulsivity predicted SITB more reliably than IATs. Unlike adult populations, explicit measures outperform implicit ones in suicide risk prediction. These findings emphasize emotion dysregulation as a key clinical construct that may intensify psychological pain and contribute to suicidal vulnerability. Full article
(This article belongs to the Special Issue Psychological Pain and Suicidal Behavior: Clinical Implications)

Review

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22 pages, 413 KB  
Review
Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol
by Laura Comendador, Diego J. Palao, Antoni Sanz, Jorge Andreo-Jover, Enrique Baca-García, Maria Luisa Barrigón, María Teresa Bobes-Bascarán, María Ángeles Botí, Marina Diaz-Marsá, Matilde Elices, Ariel Gaona-Casas, Ana González-Pinto, Iria Grande, Luis Jiménez-Treviño, Ángela Palao-Tarrero, Anna Pedrola-Pons, Natalia Roberto, Pilar Alejandra Saiz, Elizabeth Suarez-Soto, Alejandro de la Torre-Luque, The SURVIVE Consortium, Adrián Alacreu-Crespo, Ana Isabel Cebrià and Victor Perez-Solaadd Show full author list remove Hide full author list
J. Clin. Med. 2026, 15(8), 3124; https://doi.org/10.3390/jcm15083124 - 20 Apr 2026
Viewed by 267
Abstract
Background/Objectives: Psychological pain—also termed psychache or mental pain—has been suggested to constitute a relevant factor in the emergence of suicidal behaviour. Despite conceptual advances, empirical research on interventions specifically designed to alleviate psychological pain in individuals who have attempted suicide remains scarce. [...] Read more.
Background/Objectives: Psychological pain—also termed psychache or mental pain—has been suggested to constitute a relevant factor in the emergence of suicidal behaviour. Despite conceptual advances, empirical research on interventions specifically designed to alleviate psychological pain in individuals who have attempted suicide remains scarce. The present scoping review maps existing psychological and pharmacological interventions targeting psychological pain, identifies their core components, delineates gaps for future research, and proposes a therapeutic intervention protocol. Methods: Literature was searched through PubMed, PsycInfo, and ClinicalTrials.gov (until October 2025) using combinations of the terms suicide, psychache, psychological pain, intervention, treatment, therapy, pharmacological treatment, and psychotherapy. Both randomised controlled trials, non-randomised controlled trials, and literature reviews were included. Results: Evidence indicates that few interventions explicitly target psychological pain. Most suicide-specific therapies indirectly address components of psychological pain—such as unbearable affect, loss of meaning, and social disconnection. Narrative-based, emotion regulation, and acceptance-based therapies appear promising. Emerging pharmacological approaches may relieve psychological pain; however, further evidence is required. Conclusions: Integrating psychological pain as a therapeutic focus—through narrative, tolerance-building, and relational strategies—may enhance post-attempt interventions. Future trials should systematically measure psychological pain and test its role as a mediator of suicidal outcomes. Full article
(This article belongs to the Special Issue Psychological Pain and Suicidal Behavior: Clinical Implications)
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